Pediatrics
The 21-Day-Old With a Fever
Presentation
A 21-day-old, full-term, previously healthy boy is brought in by his parents for a rectal temperature of 38.6 C (101.5 F) at home. He has been feeding less over the past 6 hours, is more sleepy than usual, and had one episode of back-arching that worried his mother. There is no cough, rhinorrhea, or sick contacts, and the pregnancy and delivery were uncomplicated.
T 38.7 C (rectal) | HR 178 | RR 52 | BP 74/44 | SpO2 98% RA | weight 3.9 kg
↻ LP is performed; CSF is faintly cloudy. You now select empiric antibiotics while awaiting results.
This 21-day-old neonate now has a documented rectal fever of 38.7 C along with poor feeding, lethargy, and a possible seizure. What is the most appropriate initial evaluation?