Moving the Field Forward to Safely Do Less With Febrile Neonates

Newborns with suspected infections are a common source of anxiety for pediatricians. As the adage goes, “never trust a newborn,” and for good reason. Young infants are immunologically vulnerable and at risk for rapid progression of bacterial infections during their postnatal transition. Most pediatricians can vividly describe neonates who rapidly declined despite appropriate therapy, and these experiences inform an understandable bias toward clinical conservatism that prioritizes interventions aimed at minimizing risk. At the same time, there is undeniable evidence of the iatrogenic harm from invasive testing, early antimicrobial exposure, and hospitalization for newborns. How best to balance the common—a young febrile infant who recovers uneventfully—with the catastrophic—the rare case of an infant with invasive bacterial infection—remains the heart of this clinical conundrum. On initial presentation, these infants are often clinically indistinguishable. Emerging evidence allows pediatricians to perennially recalibrate as we strive to determine what neonates can safely receive fewer interventions.