Neonates with fever aged 28 days or younger may have few clues on history and physical examination to guide therapy. Therefore, a high index of suspicion is necessary to detect the febrile neonate with a serious bacterial infection. Obtaining the pertinent medical history from the mother regarding the pregnancy, delivery, and early neonatal life of the febrile neonate is essential. Typically, infections in the 1st week of life are secondary to vertical transmission, and those infections after the 1st week are usually community acquired or hospital acquired. Bacterial meningitis is more common in the 1st month of life than at any other time. An estimated 5%–10% of neonates with early onset group B streptococcal (GBS) sepsis have concurrent meningitis. Therefore, febrile infants (temperature >38°C) younger than 28 days should receive a full sepsis workup. CBC, chest X-ray (A), urinalysis (B), and blood cultures (C) are a partial workup for neonatal fever.
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