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Risk-stratifies febrile infants aged 0–60 days for serious bacterial infection (SBI) using the Rochester criteria (Jaskiewicz 1994). An infant who meets all seven criteria is considered LOW RISK and can be managed with careful outpatient follow-up; failure to meet any criterion warrants a full sepsis evaluation and admission.
Low risk requires ALL seven criteria: term (≥ 37 weeks), previously healthy, non-toxic appearance, no focal bacterial infection, WBC 5,000–15,000/µL, urinalysis < 10 WBC/HPF, and (if diarrhea) stool < 5 WBC/HPF. Count = number of criteria met (0–7).
7/7 criteria met = LOW RISK (serious bacterial infection < 1–2% in this subset); fewer than 7/7 = NOT LOW RISK (full sepsis evaluation and empiric antibiotics typically indicated).
The Rochester criteria (Jaskiewicz 1994, based on the original Rochester, NY strategy of Dagan et al.) identify febrile infants 0–60 days at LOW risk of serious bacterial infection (SBI): term gestation ≥ 37 weeks, previously healthy, non-toxic clinical appearance, no focal bacterial infection on examination, WBC 5,000–15,000/µL, urinalysis with < 10 WBC/HPF (or negative screen), and stool with < 5 WBC/HPF when diarrhea is present. Infants meeting all criteria historically had an SBI risk of < 1–2% and could be managed as outpatients with cultures and close follow-up; infants failing any criterion require a full sepsis evaluation. The tool is an adjunct to — not a replacement for — contemporary clinical reassessment and guideline-based management of the febrile neonate.
Specialty
PediatricsCategory
PediatricsDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-16
Formula
Keywords
Normal Range
7/7 criteria met = LOW RISK (serious bacterial infection < 1–2% in this subset); fewer than 7/7 = NOT LOW RISK (full sepsis evaluation and empiric antibiotics typically indicated).
| Classification | Range |
|---|---|
Low risk Term, previously healthy, non-toxic, no focal infection, WBC 5–15k, UA < 10 WBC/HPF, stool < 5 WBC/HPF if diarrhea | 7 of 7 criteria |
Not low risk Full sepsis workup, empiric antibiotics, and admission | 0–6 of 7 criteria |
Risk-stratifies febrile infants aged 0–60 days for serious bacterial infection using the Rochester criteria (Jaskiewicz 1994): term gestation, previously healthy, non-toxic appearance, no focal bacterial infection, WBC 5,000–15,000/µL, urinalysis < 10 WBC/HPF, and stool < 5 WBC/HPF when diarrhea is present.
An infant who meets all seven criteria is considered LOW RISK for serious bacterial infection and can be managed with cultures, close follow-up within 24 hours, and strict return precautions. Failing ANY criterion classifies the infant as NOT LOW RISK, warranting a full sepsis evaluation, empiric antibiotics, and admission.
The Rochester criteria were among the first validated tools to safely identify a subset of febrile young infants at low risk of serious bacterial infection, informing outpatient management strategies and reducing unnecessary admissions while emphasizing the need for cultures and follow-up.
A 45-day-old, term, previously healthy infant presents with fever to 38.3 °C and appears well. WBC 9,000/µL, urinalysis 3 WBC/HPF, no diarrhea, no focal infection.
Inputs:
Rochester criteria — LOW RISK (7/7 criteria met); obtain blood and urine cultures, arrange follow-up within 24 hours, and give strict return precautions.
A rectal temperature of 38.0 °C (100.4 °F) or higher. Axillary and tympanic readings are less reliable in young infants and should be confirmed rectally.
No. Blood and urine cultures should be obtained before outpatient management is considered, and the infant needs close follow-up within 24 hours and clear return precautions.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. Febrile infant management must follow current institutional and AAP guidelines; cultures and reassessment are essential regardless of the calculated risk.
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