FEVER MANAGEMENT IN THE FIRST 60 DAYS OF LIFE: DOING LESS, BUT SAFELY

Fever in neonates and infants younger than 60 days represents one of the most frequent cause of admission to the Pediatric Emergency Department and represents a significant clinical challenge. Although the majority of infections in this age group are viral, a non-negligible risk of invasive bacterial infections (IBIs), including bacteremia and bacterial meningitis, persists. The clinical presentation is often nonspecific and physical examination alone has low sensitivity for identifying serious bacterial disease. This paper provides a summary of the most recent evidence on the management of febrile newborns and infants (<60 days), with particular reference to the guidelines of the American Academy of Pediatrics, comparing them with European and British approaches. AAP recommendations propose an age-stratified decision-making model (8–21, 22–28, and 29–60 days) integrating clinical assessment with inflammatory biomarkers, particularly procalcitonin, C-reactive protein, and absolute neutrophil count. This strategy allows clinicians to tailor the indication for invasive testing, hospitalization, and empiric antibiotic therapy according to the neonate/infant’s risk profile, thereby reducing unnecessary interventions in low-risk infants without compromising patient safety. Available evidence demonstrates that the combined use of inflammatory biomarkers, especially procalcitonin, has a high negative predictive value for IBIs and supports a more selective approach to lumbar puncture and hospitalization. In conclusion, the management of febrile neonates and infants younger than 60 days should be based on a structured and cautious approach, balancing the need for early identification of serious bacterial infections with the goal of limiting unnecessary diagnostic and therapeutic interventions.