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Febrile infant ≤28 days — MCCQE Part 1 MCQ

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HardChild with FeverFebrile infant ≤28 daysMCCQE Part 1

18-day-old term neonate presents with fever at home. Rectal temperature is 38.2°C; the infant appears well but is feeding less. Which of the following is the most appropriate next step?

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Correct answer: A — Perform full sepsis evaluation, give empiric IV antibiotics and admit

Perform full sepsis evaluation, give empiric IV antibiotics and admit is best because neonates with fever require aggressive evaluation even when well appearing. Provide only reassurance without clear follow-up or safety-netting is suboptimal because children can deteriorate quickly and follow-up must be explicit; Use adult dosing or adult pathways without paediatric adjustment is suboptimal because children require age- and weight-appropriate care; Delay assessment until the next routine visit is suboptimal because developmental, infectious and neonatal red flags require timely assessment; Give antibiotics, steroids or investigations routinely despite no indication is suboptimal because over-treatment can cause harm when supportive or targeted care is indicated. Young infants can have invasive bacterial infection with few signs.

Reference: Canadian Paediatric Society febrile infant statement