REVIEW   

Minerva Pediatrics 2022 April;74(2):195-201

DOI: 10.23736/S2724-5276.22.06666-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Management of fever in infants and children in the emergency setting and during home discharge: recommendations from an Italian panel

Davide SILVAGNI ¹ ✉, Emanuele CASTAGNO ², Fabio CARDINALE ³, Sara CHIAPPA ⁴, Antonio CHIARETTI ⁵, Ilaria CORSINI ⁶, Elena FERRARI ⁷, Stefano MASI ⁸, Mariaclaudia MELI ⁹, Lucia G. PECCARISI ¹⁰, Emanuela PICCOTTI ¹¹, Vincenzo TIPO ¹², Antonio VITALE ¹³, Stefania ZAMPOGNA ¹⁴, Tiziana ZANGARDI ¹⁵

¹ Department of Pediatric Emergency, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy; ² Unit of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, Turin, Italy; ³ Unit of Pediatrics and Pediatric Emergency, Consorziale-Policlinico University Hospital, Giovanni XXIII Childern’s Hospital, University of Bari, Bari, Italy; ⁴ ASST Spedali Civili of Brescia, Brescia, Italy; ⁵ Unit of Pediatric Emergency, Department of Woman, Child and Public Health Science, Child Health Area, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ⁶ Unit of Pediatric Emergency, S. Orsola-Malpighi IRCCS Polyclinic Hospital, IRCCS, Bologna, Italy; ⁷ Private Practitioner, Reggio Emilia, Italy; ⁸ Meyer University Hospital, Florence, Italy; ⁹ Gaspare Rodolico Polyclinic University Hospital, San Marco, Catania, Italy; ¹⁰ Private Practitioner, Corato, Bari, Italy; ¹¹ G. Gaslini IRCCS Hospital, Genoa, Italy; ¹² Santobono Pausilipon University Hospital, Naples, Italy; ¹³ S. G. Moscati University Hospital, Avellino, Italy; ¹⁴ Pugliese Hospital, Ciacco, Catanzaro, Italy; ¹⁵ University Hospital of Padua, Padua, Italy

In infants and children, fever is very common in the emergency setting. The overall aim of the present publication was to overview guidance and provide an algorithm for use in the emergency setting as well as recommendations to inform parents for home care. To obtain consensus, a core steering committee drafted a management algorithm and general consensus was obtained by remote voting among experts. A number of common messages are found in current guidelines: management of fever depends on age, antipyretics are indicated only for discomfort; paracetamol or ibuprofen can be recommended; physical methods for lowering temperature are discouraged. A consensus algorithm is presented in which infants <28 days are considered separately, while those >28 days and <90 days are divided into those ill or well appearing. All infants <28 days with fever ≥37.5 °C should undergo complete work-up for sepsis, strongly considered to receive empirical antibiotics ± acyclovir, and be hospitalized. All infants (between 28 and 90 days) ill appearing should undergo diagnostic work-up for sepsis, receive empirical antibiotics, and be hospitalized. In well appearing infants, diagnostic work-up should be carried out to decide admission to hospital and administration of antibiotics. Specific recommendations are also given for home discharge that can be used to inform parents about the actions to take during home care in the attempt to reinforce existing guidelines. At present, physical examination and laboratory tests, along with best clinical judgement and postdischarge guidance following a defined algorithm, are the foundation of management of febrile children.

KEY WORDS: Fever; Infant; Child; Pediatric emergency medicine; Patient discharge; Disease management