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Background <p>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.</p> Methods <p>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.</p> Results <p>A total of 273 (response rate 84%) participated in the study. Half of them worked in Northern Italy, and 47% had &lt; 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.</p> Conclusions <p>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.</p>

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Management of well-appearing febrile infants aged 29–90 days: a multicenter survey on current practices and guideline adherence

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  • 发表日期：

    2026年7月31日

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  • Elisabetta Venturini,
  • Gregorio Paolo Milani,
  • Anna Comotti,
  • Niccolò Parri,
  • Agnese Tamborino,
  • Elena Chiappini,
  • Luisa Galli,
  • Elena Altieri,
  • Lorenza Baroni,
  • Roberta Caiazzo,
  • Crescenzo Coppola,
  • Giulia Dal Canto Dal Canto,
  • Margherita Del Bene,
  • Giada Di Pietro,
  • Federica Forlanini,
  • Chiara Gabrielli Gabrielli,
  • Luisa Giannone,
  • Ilaria Liguoro,
  • Giulia Lorenzetti,
  • Caterina Marabotto,
  • Carmela Mercogliano,
  • Sara Monaco,
  • Cristina Moracas,
  • Marco Antonio Motisi,
  • Paola Musso,
  • Francesco Nunziata,
  • Victoria Rinaldi,
  • Alessia Sallemi,
  • Marco Sarno,
  • Agnese Tamborino,
  • Marco Zaramella

摘要

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.