No fever

NHS Tayside ED Guidance
NHS Tayside

Important: around 50% of young infants diagnosed with bacterial meningitis are afebrile on presentation. Do not be reassured by lack of fever in an unwell infant.

Consider perinatal risk factors1

Clinical features in infants under 3 months (% of cases):

  • Poor feeding (67%)
  • Lethargy (63%)
  • Irritability (63%)
  • Fever (53%)
  • Respiratory distress including grunting (44%) and/or need for mechanical ventilation in a term baby
  • Poor perfusion (44%)
  • Temperature instability (20%)
  • Apnoea (23%)
  • Bulging fontanelle (20%)
  • Seizures (24%)
  • Coma (5%)
  • Neck stiffness (3%)
  • Irritability in combination with fever (41%)

Think: Could this be a case of bacterial meningitis?

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