Purpose: To determine whether febrile infants are low risk for serious bacterial infection. It reassures against serious infection (Occult Bacteremia).
Indications: Use to assess infants ≤60 days of age with a fever (rectal temp ≥38°C or 100.4°F) without a source.
| ROCHESTER CRITERIA (Reassuring if all criteria are present) | |
| History (Term with No prior illness) | Term infant (≥37 weeks gestation) |
| No prior hospitalizations | |
| Not hospitalized longer than mother after delivery | |
| No perinatal antibiotics | |
| No Chronic or underlying disease | |
| No unexplained hyperbilirubinemia | |
| Physical Exam | Well appearing infant |
| No evidence of ear, skin, soft tissue, joint or bone infection | |
| Lab Values (Defines lower risk patients) | WBC 5,000-15,000/mm³ |
| Absolute Band neutrophils ≤1,500/mm³ | |
| Urine WBCs (in UA) <10 WBC/HPF | |
| If diarrhea is present, stool smear fecal leukocytes <5 WBC/HPF | |
| DECISION MAKING | |
| High-risk Patients | Hospitalize + empiric antibiotics |
| Lower risk patients | Home; No antibiotics; Follow-up required. |
| Occult Bacteremia risk | -Well-appearing febrile infant risk: 7-9% -All Rochester reassuring criteria present: <1% -Supports discharge to home with close follow-up and no empiric antibiotics |
| Reported statistics | Test Sensitivity: 92% Test Specificity: 50% Positive Predictive Value: 12.3% Negative Predictive Value: 98.9% |
Rochester Criteria online on MDCal.com
Other Criteria for working up a febrile infant.