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Should We LP Febrile 29-60 Day Infants?

March 21, 2019

Written by Clay Smith

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This QI protocol to reduce LP, antibiotic use, and hospitalization in febrile infants 29-60 days was very effective and did not miss any serious bacterial infections (SBI) post-implementation.

Why does this matter?
More institutions are moving toward risk stratification prior to LP in febrile infants 29-60 days. But is this safe?

More infant fever goodness
In this single center in Connecticut, they developed an evidence-based QI protocol, based on modified Rochester criteria, to manage febrile infants 29-60 days old, with a goal of reducing invasive testing (i.e. LP), unnecessary antibiotic use, and unnecessary hospitalization. There were 220 patients before the QI protocol and 130 after. They found that the rate of LP dropped from 32% to 0%, antibiotic use from 30% to 1%, and hospitalization from 17% to 2%. There were no missed SBIs post-implementation. This is encouraging. Bear in mind, this is a small, single center study. But it shows this pilot was safe and effective in its objectives. What is this magical protocol? See below. Imagine if the statistically derived PECARN rule we covered yesterday was used.

Figure 2 from cited article

Figure 2 from cited article

Reducing Invasive Care for Low-risk Febrile Infants Through Implementation of a Clinical Pathway. Pediatrics. 2019 Feb 6. pii: e20181610. doi: 10.1542/peds.2018-1610. [Epub ahead of print]

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What are your thoughts?