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Fever and Sepsis Evaluation in the Neonate (0-28 days)

Pathway Background and Objective(s)

Neonates presenting with fever are at high risk of having and/or developing a serious bacterial infection. The management of febrile neonates is widely accepted and standardized, particularly if the neonate is 21 days or younger. This work up includes blood, urine, and cerebrospinal fluid (CSF) testing with Herpes Simplex virus (HSV) studies; management includes empiric antibiotics and acyclovir. For neonates 22-28 days old, HSV testing and empiric acyclovir is only recommended if there are risk factors present.

The objectives of this pathway are to:

  • Decrease unnecessary variation in patient care based on current evidence
  • Standardize the initial workup for febrile neonates
  • Provide guidelines for when to include HSV testing
  • Help guide appropriate antimicrobial therapy
  • Provide guidelines for a safe discharge home


Download Fever and Sepsis Evaluation in the Neonate Pathway Algorithm Updated June 18, 2020

Quality Metrics

  • Percentage of eligible patients treated per pathway
  • Percentage of patients with order set usage
  • Percentage of patients with HSV testing performed per pathway
  • Percentage of patients with Acyclovir administration within 4 hours of HSV lab test collection
  • Percentage of patients with antibiotics administered per pathway recommendation (correct medication and dosage)
  • Percentage of patients with antibiotics administered within 2 hours of work-up completion
  • Average length of stay (days)

Educational Module

Download Fever and Sepsis Evaluation in the Neonate Educational Module

Key References

  • Jain et al, Management of Febrile Neonates in the US Pediatric Emergency Departments. 2014. Pediatrics. Volume 133, Issue 2.
  • American Academy of Pediatrics. [Herpes Simplex Virus] In: Kimberlin, DW, Brady MT, Jackson, MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Itasca, IL: American Academy of Pediatrics; 2018: 437-449.

Pathway Contacts

  • Melissa Held, MD
  • Grace Hong, APRN
  • Anand Sekaran, MD


The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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