Management of well-appearing febrile infants aged 29-90 days: a multicenter survey on current practices and guideline adherence.
6 affiliations
- 1Paediatric Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- 2Pediatric Unit, Annunziata Hospital, Via Felice Migliori 1, 87100, Cosenza, Italy. [email protected].
- 3Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy. [email protected].
- 4Occupational Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- 5Department of Emergency Medicine and Trauma Center, Meyer Children's Hospital IRCCS, Florence, Italy.
- 6Department of Health Sciences, University of Florence, Florence, Italy.
Abstract
Background
Fever without a source in well appearing young infants remains a challenge in pediatric emergency departments (PEDs). Although evidence-based decision rules exist, limited data are available on how these patients are managed in daily clinical practice.Methods
We conducted a multicenter cross-sectional survey among pediatricians working in 20 Italian PEDs. The 22-item questionnaire explored the definition of "well appearing", clinical assessment, diagnostic workup, use of standardized protocols, antibiotic prescribing, and self-reported competence in managing well-appearing febrile young infants aged 29-90 days. Descriptive statistics and Chi-square tests were used to compare responses by geographic area and physician seniority.Results
A total of 273 (response rate 84%) participated in the study. Half of them worked in Northern Italy, and 47% had < 5 years of experience. Standardized protocols were used by 56%, most commonly the Step-by-Step approach (28%) or local institutional guidelines (32%). Criteria used to define "well appearing" were highly heterogeneous. Urine dipstick testing was routinely performed by 80%, with culture obtained based on dipstick positivity in 66%. Inflammatory markers were routinely tested by 58%, and lumbar puncture was reserved for neurologic signs or clinical deterioration (63%). When inflammatory markers were within normal ranges, 67% discharged patients with close follow-up, while 83.5% reported using a conditional approach to antibiotic initiation guided by diagnostic findings (inflammatory markers and/or viral testing), mainly amoxicillin-clavulanate. Regional and seniority-related variability was significant.Conclusions
Italian PED physicians show moderate adherence to standardized protocols for managing well-appearing febrile young infants, but there is no shared definition of "well appearing". These findings underscore the need for harmonized national guidelines and shared definitions to promote evidence-based care.
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BibTeX
@article{venturini2026management,
title = {{Management of well-appearing febrile infants aged 29-90 days: a multicenter survey on current practices and guideline adherence.}},
author = {Elisabetta Venturini and Gregorio Paolo Milani and Anna Comotti and Niccolò Parri and Agnese Tamborino and Elena Chiappini and Luisa Galli and FEBRIOUT Study Group},
journal = {Italian journal of pediatrics},
year = {2026},
month = jul,
doi = {10.1186/s13052-026-02304-8},
url = {https://europepmc.org/article/MED/42972373},
note = {CC BY},
}
RIS
TY - JOUR
TI - Management of well-appearing febrile infants aged 29-90 days: a multicenter survey on current practices and guideline adherence.
AU - Elisabetta Venturini
AU - Gregorio Paolo Milani
AU - Anna Comotti
AU - Niccolò Parri
AU - Agnese Tamborino
AU - Elena Chiappini
AU - Luisa Galli
AU - FEBRIOUT Study Group
PY - 2026
DA - 2026/07/31
JO - Italian journal of pediatrics
DO - 10.1186/s13052-026-02304-8
UR - https://europepmc.org/article/MED/42972373
AB - Background Fever without a source in well appearing young infants remains a challenge in pediatric emergency departments (PEDs). Although evidence-based decision rules exist, limited data are available on how these patients are managed in daily clinical practice.Methods We conducted a multicenter cross-sectional survey among pediatricians working in 20 Italian PEDs. The 22-item questionnaire explored the definition of "well appearing", clinical assessment, diagnostic workup, use of standardized protocols, antibiotic prescribing, and self-reported competence in managing well-appearing febrile young infants aged 29-90 days. Descriptive statistics and Chi-square tests were used to compare responses by geographic area and physician seniority.Results A total of 273 (response rate 84%) participated in the study. Half of them worked in Northern Italy, and 47% had < 5 years of experience. Standardized protocols were used by 56%, most commonly the Step-by-Step approach (28%) or local institutional guidelines (32%). Criteria used to define "well appearing" were highly heterogeneous. Urine dipstick testing was routinely performed by 80%, with culture obtained based on dipstick positivity in 66%. Inflammatory markers were routinely tested by 58%, and lumbar puncture was reserved for neurologic signs or clinical deterioration (63%). When inflammatory markers were within normal ranges, 67% discharged patients with close follow-up, while 83.5% reported using a conditional approach to antibiotic initiation guided by diagnostic findings (inflammatory markers and/or viral testing), mainly amoxicillin-clavulanate. Regional and seniority-related variability was significant.Conclusions Italian PED physicians show moderate adherence to standardized protocols for managing well-appearing febrile young infants, but there is no shared definition of "well appearing". These findings underscore the need for harmonized national guidelines and shared definitions to promote evidence-based care.
SN - 1824-7288
ER -