Ep 212 PECARN Febrile Young Infant Prediction Tool: When To Safely Forgo LP and Empiric Antibiotics
Jan 27, 2026
Dr. Nathan Cooperman, emergency physician and prediction-rule pioneer, and Dr. Bret Burstein, pediatric emergency researcher and lead author of the 2025 JAMA study, discuss modern risk stratification for febrile young infants. They cover biomarker-driven rules (procalcitonin, ANC, UA), which infants were included or excluded, HSV considerations, urine collection nuances, and how to use shared decision-making to safely reduce LPs and antibiotics.
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Apply The Updated PECARN Prediction Tool
- Use the updated PECARN rule: negative urinalysis, procalcitonin <0.5, or ANC <4,000 to identify low-risk febrile infants.
- Apply this prediction tool to support clinical judgment, not to replace it.
Handle Urine Testing Pragmatically
- Consider a bagged urine dip as acceptable if negative; if positive, obtain a catheterized specimen for urinalysis and culture.
- Define a negative urinalysis as no leukocyte esterase, no nitrites, and low WBCs on microscopy.
Negative Bag UA Can Be Trusted
- A negative bagged urinalysis is highly sensitive and specific and can avoid unnecessary catheterization.
- If the bag urinalysis is positive, catheterize for confirmatory testing to prevent contaminated cultures.