Approach to a fever (0-60 days) Quiz: Ace Your Exams

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A 15-day-old girl is brought to the emergency department by her parents because of one day of fussiness and not nursing well and a rectal temperature of 38.4 °C (101.1 °F). The patient was born at 38 weeks' gestation without complications. The pregnancy was unremarkable. Maternal prenatal labs (including group B streptococcus carriage) were negative. There have been no known sick exposures. Until this illness, the patient has been breastfeeding well with appropriate weight gain. Parents deny upper respiratory or gastrointestinal symptoms. Temperature is 38.6°C (101.5°F), pulse is 180/min, respirations are 44/min, blood pressure is 74/48 mmHg, and oxygen saturation is 99% on room air. On physical examination, the patient appears alert and fussy in parent’s arms. The anterior fontanelle is open and flat. There is <2 second capillary refill and 2+ peripheral pulses. The patient is tachypneic without increased work of breathing. Cardiopulmonary and abdominal examinations are within normal limits. There is no rash. Lab work is obtained and includes complete blood count (CBC), inflammatory markers, blood culture, urinalysis, urine culture, cerebrospinal fluid (CSF) studies and culture, and respiratory viral panel (RVP). Results are pending. Which of the following is the best next step in management?  

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