This episode of EM Pulse dives into one of the most stressful scenarios in the ED: the febrile infant in the first month of life. Traditionally, a fever in this age group has meant an automatic “full septic workup,” including the dreaded lumbar puncture (LP).

But times are changing. We sit down with experts Dr. Nate Kuppermann and Dr. Brett Burstein to discuss a landmark JAMA study that suggests we might finally be able to safely skip the LP in many of our tiniest patients.

The Study: A Game Changer for Neonates

Our discussion centers on a massive international pooled study evaluating the PECARN Febrile Infant Rule specifically in infants aged 0–28 days. While previous guidelines were conservative due to a lack of data for this specific age bracket, this study provides the evidence we’ve been waiting for.

Defining the Danger: SBI vs. IBI

The experts break down why we are shifting our terminology and our clinical focus.

Serious Bacterial Infection (SBI) 

Historically, this was a “catch-all” term including Urinary Tract Infections (UTIs), bacteremia, and meningitis. However, UTIs are generally more common, easily identified via urinalysis, and typically less life-threatening than the other two.

Invasive Bacterial Infection (IBI) 

This term refers specifically to bacteremia and bacterial meningitis. These are the “high-stakes” infections the PECARN rule is designed to rule out. Dr. Kuppermann notes that we should ideally view bacteremia and meningitis as distinct entities, as the clinical implications of a missed meningitis case are far more severe.

The HSV Elephant in the Room

One of the primary reasons clinicians hesitate to skip an LP in a neonate is the fear of missing Herpes Simplex Virus (HSV) infection.

Practical Application: Shared Decision-Making

This isn’t just about the numbers—it’s about the parents.

“Families don’t mind their babies being admitted… They do not want the lumbar puncture. It is the single most anxiety-provoking aspect of care.” — Dr. Brett Burstein

The PECARN “Low-Risk” Criteria:

 (Remember, this rule applies only to infants who are not ill-appearing.)

The Bottom Line: If an infant is well-appearing and meets these criteria, physicians can have a nuanced conversation with parents about the risks and benefits of forgoing the LP, while still admitting the child for observation (often without empiric antibiotics) while cultures brew.

Key Takeaways

We want to hear from you! Does this change how you approach febrile neonates in the ED? How do you handle shared decision-making with parents? Connect with us on social media @empulsepodcast or on our website ucdavisem.com.

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guests:

Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences

Dr. Brett Burstein, Clinician-Scientist and Pediatric Emergency Medicine Physician at Montreal Children’s Hospital, McGill University

Resources:

Burstein B, Waterfield T, Umana E, Xie J, Kuppermann N. Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. 2026 Feb 3;335(5):425-433. doi: 10.1001/jama.2025.21454. PMID: 41359314; PMCID: PMC12687207“Hot” Off the Press: Infant Fever Rule

“Hot” Off the Press: Infant Fever Rule

Do I really need to LP a febrile infant with a UTI?

PECARN Infant Fever Update: 61-90 Days

Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281.

Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996.

****Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Reimagining Care Beyond Hospital Walls

Hospitals are a finite resource—but patient needs are not. This episode continues our multi-part series on taking medicine to where patients are—rather than making them come to us. From preventative care to pediatricians meeting families in their own environments, the series has explored how medicine is evolving beyond traditional settings. In this episode, we explore one of the most compelling—and long-overdue—ideas yet: care at home.

What Is Home-Based Medical Care?

Joined by Dr. Kelly Owen, Professor of Emergency Medicine at UC Davis and Medical Director for Express Care and Dispatch Health, the conversation dives into what home-based care really looks like—from urgent care at home to ED-to-home follow-ups and post-hospital discharge support designed to prevent readmissions.

A Patient-Centered Solution That Works

Through a powerful real-world case, the team illustrates how mobile medical units can deliver wraparound care—medications, follow-up appointments, and clinical evaluation—right in a patient’s living room, avoiding unnecessary hospital stays while improving outcomes and patient satisfaction.

Why This Model Matters Now

With emergency departments stretched thin, home-based care offers ways to:

The model is compelling: high patient satisfaction, low ED escalation rates, and health care dollars saved—all while keeping patients at the center.

The Future of “Medicine on the Go”

As technology and remote monitoring continue to evolve, this episode makes the case that home-based care isn’t a niche experiment—it’s a scalable, sustainable future for emergency and outpatient medicine.

Tune in to hear how taking medicine to where patients are is transforming care—for the better.

Was this series helpful for you? What other topics would you like to see us cover? Let us know on social media @empulsepodcast or at ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guests:

Dr. Kelly Owen, Professor of Emergency and Medical Director of Express Care and Dispatch Health at UC Davis

Resources:

‘The next frontier of emergency medicine’: House calls following emergency room

by Liam Connolly, April 30, 2024.

UC Davis Health embarks on innovative care at home journey

by Liam Connolly, July 18, 2023.

 AMA’s Return on Health: Telehealth framework for practices.

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

We’re stepping out of our Medicine on the Go series for a rapid-response episode on something hitting all of us hard right now: **influenza**. A lively debate among our colleagues sparked this conversation—especially around a newer flu antiviral, baloxavir (Xofluza). Who’s using it? When does it make sense? How much does it cost patients? And how does it really compare to the longtime staple oseltamivir (Tamiflu)? The questions came fast, the opinions were strong, and we knew it was time to dig in. With flu season in full swing, this episode is all about practical decision-making at the bedside.

Back to Basics: How Flu Antivirals Work

To help break it all down, we welcome back our trusted ED pharmacist, Haley Burhans. We begin with a quick review of how influenza antivirals have evolved.

, approved in 1999, was the first widely used antiviral and works by blocking the neuraminidase enzyme. Over time, concerns about resistance led to the development of newer options. That brings us to baloxavir (Xofluza), approved in 2018. Xofluza works differently by stopping viral replication earlier in the virus life cycle. While both medications aim to shorten illness and reduce complications, they differ in how they work, how they are dosed, and which patients benefit most.

Who Should Get What—and When?

Next, we focus on real-world ED decision-making. Who should receive Tamiflu, and who is a good candidate for Xofluza? We review use in children, pregnant patients, hospitalized patients with severe or worsening illness, immunocompromised patients, and those at higher risk due to conditions like asthma, lung disease, diabetes, heart disease, obesity, or older age. Timing is critical. Both medications work best when started within 48 hours of symptom onset. However, oseltamivir is still recommended even after that window for patients who are hospitalized or severely ill. We also discuss when antivirals can be used for post-exposure prpphylaxis.

What Does the Evidence Say?

We then take a closer look at the data behind antiviral treatment. Both Tamiflu and Xofluza shorten the time to symptom improvement. Observational studies suggest oseltamivir may reduce hospital length of stay and in-hospital death in adults and shorten hospital stays in children. Trial data also suggest baloxavir may be more effective against influenza B. We compare dosing strategies—five days of twice-daily Tamiflu versus a single-dose Xofluza—and review side effects and pediatric considerations.

Real-World Barriers: Access and Cost

Finally, we tackle the practical issues clinicians face every day. Tamiflu is widely available and familiar to most providers. Xofluza, on the other hand, often requires prior authorization and may be harder for patients to obtain. We discuss insurance barriers, out-of-pocket costs, manufacturer coupons, and situations where Xofluza may or may not be a realistic option.

Take-Home Message

This episode is a practical, evidence-based conversation designed to help emergency clinicians make confident decisions during flu season. Whether you’re treating a high-risk patient, considering a single-dose option for uncomplicated flu, or simply trying to stay current, this discussion delivers clear, useful guidance you can use on your next shift!

What’s your go to flu treatment? What other medications would you like to learn more about? Hit us up on social media @empulsepodcast or at ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guests:

Haley Burhans, PharmD, Emergency Medicine Clinical Pharmacist at UC Davis

Resources:

CDC: Influenza Antiviral Medications: Summary for Clinicians

AAP: Recommendations for Prevention and Control of Influenza in Children, 2025–2026: Policy Statement

ACEP Influenza Resources and Updates

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

The next episode of our Medicine on the Go series features Dr. Serena Yang, Professor and Division Chief of General Pediatrics and Vice Chair of Community Engagement at UC Davis Health, as she shares how UC Davis Children’s Hospital’s Pediatric Mobile Clinic is bringing specialty care directly into schools and under-resourced communities across the Sacramento region. Learn how this innovative mobile model addresses urgent needs in child development, mental health, and asthma, removes barriers to care, and builds trust through strong school and community partnerships—offering an inspiring blueprint for delivering equitable pediatric care beyond the clinic walls.

Does your health system have a mobile outreach clinic? Would you consider starting one? We’d love to hear from you! Share with us on social media @empulsepodcast or connect with us on ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guest:

Dr. Serena Yang, Clinical Professor and Division Chief of General Pediatrics, and Vice Chair of Community Engagement at UC Davis

Resources:

UC Davis Pediatric Mobile Clinic Program

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In the second episode of our Medicine on the Go series, we step beyond the ED to explore how UC Davis Health and Sacramento County are partnering to deliver care directly to the community through the Wellness Without Walls (W3) street medicine program.

We’re joined by Dr. MK Orsulak, Assistant Professor of Family Medicine at UC Davis. We discuss how a mobile clinic staffed by interdisciplinary teams brings primary care, wound care, mental health services, HIV/STI testing, vaccinations, and substance use treatment to people experiencing homelessness—meeting patients where they are and reducing preventable ED visits.

This episode offers a powerful look at how innovative, cross-system collaboration can extend emergency care beyond hospital walls and improve access to the right care at the right time.

Do you have a program similar to W3 in your area?

We’d love to hear about it! Share with us on social media @empulsepodcast or connect with us on ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guest:

Dr. MK Orsulak, Assistant Professor of Family and Community Medicine at UC Davis

Resources:

Sacramento County Department of Health Services: Wellness Without Walls (W3)

Street medicine team improves lives of unhoused patients, by Edwin Garcia, Feb 27 2024

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this first installment of our Medicine on the Go series, we explore how care is moving beyond hospital walls and directly into the community through UC Davis Fire Department’s innovative mobile mental health crisis unit, Health 34. You’ll hear how this no-cost, 24/7 team—staffed by providers with paramedic backgrounds and lay counselor training—meets people where they are to prevent crises, support mental health needs, and connect patients to the right resources before problems escalate. Health 34 Provider, Blythe Clark, joins us to share the origins of the program, how it works, who it serves, and what other communities can learn from this model. We’ll explore how prehospital services can act as a powerful preventative tool and how collaborations like this could reshape the future of care far beyond campus.

Do you have a program similar to Health 34 in your area? We’d love to hear how it’s working and what you’ve learned. Share with us on social media @empulsepodcast or connect with us on ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guest:

Blythe Clark, Health 34 Provider, UC Davis Fire Department

Resources:

Health 34

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode of EM Pulse, guest host Dr. Neelou Tabatabai joins Julia in a discussion with ED nurse and TeamSTEPPS advocate, Leigh Clary, to explore how structured communication tools can transform even the most high-stress medical and trauma resuscitations. Through a real-life story of conflict and resolution in the emergency department, Leigh illustrates how TeamSTEPPS strategies—like assertive communication, the Two-Challenge Rule, and CUS words—empower teams to speak up, de-escalate tension, and protect patient safety. Together, they unpack how calm, composed dialogue preserves respect, strengthens teamwork, and ensures every voice is heard when it matters most.

Do you use TeamSTEPPS or a similar model in your ED? We’d love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Guest Host:

Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis

Resources:

TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica

TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, John Webster, MD, MBA, Lauren Toomey, RN, BSBA, MIS, and Mary Salisbury, RN, MSN.

TeamSTEPPS Pocket Guide – Agency for Healthcare Research and Quality

EM Pulse: TeamSTEPPS, September 17, 2021 

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode, we dive into the charged world of Morbidity and Mortality conferences—where good intentions can collide with fear, shame, and silence. We’ve all felt that jolt of adrenaline sitting in the audience—or worse, standing at the podium. Our guest expert, Dr. Jaymin Patel, helps us unpack why the traditional M&M model no longer works and how we can rebuild it into something better: a space that turns mistakes into meaningful learning, supports both patient and provider healing, and helps us face our ghosts without fear.

How do you think we can improve M&M? Share your ideas with us on social media @empulsepodcast or connect with us on ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guest:

Dr. Jaymin Patel, Assistant Professor of Emergency Medicine and Assistant Residency Program Director at UC Davis

Resources:

ALiEM: The M&M Shame Game; Case by Dr. Tamara McColl  

Nussenbaum B, Chole RA. Rethinking Morbidity and Mortality Conference. Otolaryngol Clin North Am. 2019 Feb;52(1):47-53. doi: 10.1016/j.otc.2018.08.007. Epub 2018 Oct 5. PMID: 30297182.

Wittels K, Aaronson E, Dwyer R, Nadel E, Gallahue F, Fee C, Tubbs R, Schuur J; EM M&M Culture of Safety Research Team. Emergency Medicine Morbidity and Mortality Conference and Culture of Safety: The Resident Perspective. AEM Educ Train. 2017 May 4;1(3):191-199. doi: 10.1002/aet2.10033. PMID: 30051034; PMCID: PMC6001737.

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

What happens when a febrile infant presents at 61 days old? Are they suddenly low risk for invasive bacterial infections? In this episode, we explore the gray zone of managing febrile infants aged 61–90 days with the help of two new clinical prediction rules from PECARN. Joining us are two powerhouses in pediatric emergency medicine: Dr. Nate Kuppermann and Dr. Paul Aronson, who walk us through their recent study published in Pediatrics. We discuss why prior research has traditionally stopped at 60 days, what the new data shows about risk in this slightly older age group, and how these rules might help guide clinical decision-making. This study fills a long-standing gap—but should we start using the rules now? Tune in for a nuanced discussion on sensitivity, missed cases, practical application, and the future of risk stratification in young infants with fever.

What is your practice in terms of work-up of 2-3 month old febrile infants? Will this change what you do? Hit us up social media @empulsepodcast or connect with us on ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guests:

Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences

Dr. Paul Aronson, Professor of Pediatrics (Emergency Medicine); Deputy Director, Pediatric Residency Program at Yale University School of Medicine

Resources:

“Hot” Off the Press: Infant Fever Rule

Do I really need to LP a febrile infant with a UTI?

Aronson PL, Mahajan P, Meeks HD, Nielsen B, Olsen CS, Casper TC, Grundmeier RW, Kuppermann N; PECARN Registry Working Group. Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections. Pediatrics. 2025 Sep 1;156(3):e2025071666. doi: 10.1542/peds.2025-071666. PMID: 40854562; PMCID: PMC12432541.

Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281.

Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996.

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Dive into the second half of our envenomation series! Dr. Jonathan Ford, a UC Davis Medical Toxicologist and Professor of Emergency Medicine, returns to the podcast to tackle scorpions and spiders. We’re going beyond the basics to discuss the “why” and “how” of these bites and stings. Learn about the neurotoxic effects of bark scorpion venom and the life-threatening airway risks. Explore the mechanism behind black widow bites that leads to intense pain and spasms, and the crucial role of antivenom in severe cases. Plus, we’re setting the record straight on a common myth—the brown recluse—and the proper supportive care for its nasty bite. Join us to discover the latest evidence-based approaches that could change how you manage your next bite or sting.

Have you had a patient with a serious or challenging envenomation?  How did you manage it? Share your story with us social media @empulsepodcast or connect with us on ucdavisem.com

Hosts:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis

Guest:

Dr. Jonathan Ford, Professor of Emergency Medicine and Medical Toxicologist at UC Davis

Resources:

Quan D. North American poisonous bites and stings. Crit Care Clin. 2012 Oct;28(4):633-59. doi: 10.1016/j.ccc.2012.07.010. PMID: 22998994.

Levine M, Friedman N. Terrestrial envenomations in pediatric patients: identification and management in the emergency department. Pediatr Emerg Med Pract. 2021 Sep;18(9):1-24. Epub 2021 Sep 2. PMID: 34403224..

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.