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Rochester criteria for febrile infants

Low-risk criteria for serious bacterial infection in febrile infants <=60 days.

Rochester criteria for febrile infants
Ill-appearing
History of prematurity, perinatal antibiotics, unexplained hyperbilirubinemia requiring treatment, prior hospitalization, or chronic/underlying illness
Evidence of skin, soft-tissue, ear, bone, or joint infection
White blood cell count
/mm³
Absolute band count
/mm³
Urine WBC
/hpf
Stool WBC (only if diarrhea present)
/hpf
Complete the fields above to see the result.

When to use

  • Identifying febrile infants <=60 days old at low risk for serious bacterial infection who may be candidates for outpatient management without empiric antibiotics.

Formula

Low risk requires ALL of: well-appearing, previously healthy, no focal bacterial infection, WBC 5,000-15,000/mm³, band count <=1,500/mm³, urine WBC <=10/hpf, and (if diarrhea present) stool WBC <=5/hpf.

Pearls and pitfalls

  • Developed before procalcitonin was in routine use; more recent rules (e.g., PECARN, Step-by-Step) that add procalcitonin have higher sensitivity.

References

  1. Jaskiewicz JA, McCarthy CA, Richardson AC, et al. Pediatrics. 1994;94(3):390-396.