What question did this study set out to answer?

To assess the management practices for well-appearing febrile infants aged 29–90 days in pediatric emergency departments across Italy.

August 2, 2026Open Access

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

EVElisabetta VenturiniMeyer Children's Hospital GMGregorio P. MilaniUniversity of Milan ACAnna ComottiFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

Key Points

To assess the management practices for well-appearing febrile infants aged 29–90 days in pediatric emergency departments across Italy.
Conducted a multicenter cross-sectional survey among pediatricians in 20 Italian PEDs with a 22-item questionnaire.
Analyzed responses using descriptive statistics and Chi-square tests for geographic area and physician seniority variations.
Collected data on clinical assessment, protocols, antibiotic prescribing, and physicians' confidence levels.
273 pediatricians participated, with a response rate of 84%.
56% used standardized protocols, with significant variability in the definition of ‘well appearing’.
67% discharged patients with normal inflammatory markers with follow-up, and 83.5% initiated antibiotics conditionally.

Abstract

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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