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Rochester Criteria (Low-Risk Febrile Infant ≤ 60 days)

The Rochester criteria identify febrile infants ≤60 days at low risk for serious bacterial infection if well-appearing, previously healthy, without focal infection, with WBC 5–15 ×10⁹/L, bands ≤1.5 ×10⁹/L, ≤10 WBC/hpf in spun urine and ≤5 WBC/hpf in stool (if diarrhea). NPV for SBI 98.9%.

  • Age
  • Appears generally well (yes/no, +1)
  • Previously healthy (term ≥37 wk, no perinatal antibiotics, no unexplained hyperbilirubinemia treatment, not hospitalized longer than mother, no chronic illness, no prior antibiotics/hospitalization) (yes/no, +1)
  • Evidence of skin, soft tissue, bone, joint or ear infection (yes/no, +1)
  • Peripheral WBC (×10⁹/L or ×10³/µL)
  • Absolute band count (×10⁹/L or ×10³/µL or /µL or /mm³)
  • Urine WBC (spun sediment)
  • Diarrhea present (yes/no, +1)
  • Stool WBC (if diarrhea)
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Interpretation

ResultMeaning
All criteria metLow risk; careful observation without antibiotics was supported in the original studies
Any criterion not metNot low risk; full sepsis evaluation and empiric antibiotics per protocol

Formula

Low risk if ALL: well-appearing; previously healthy; no skin/soft tissue/bone/joint/ear infection; WBC 5–15 ×10⁹/L; bands ≤ 1.5 ×10⁹/L; spun urine ≤ 10 WBC/hpf; stool ≤ 5 WBC/hpf if diarrhea

Clinical pearls

  • Rochester does not use procalcitonin or CRP; newer rules (PECARN, Step-by-Step, AAP 2021) are more sensitive for invasive infection in infants ≤ 21–28 days.
  • Sensitivity for bacteremia and meningitis in neonates is lower than the NPV suggests; most guidelines still recommend full evaluation in infants ≤ 28 days.

Examples

rochester criteria 40 day old well appearing previously healthy wbc 9 bands 0.5 ua 2 wbc/hpffebrile 3 week old, term, looks well, no focal infection, WBC 16, bands 0.8, urine 3 wbcrochester rule infant wbc 12 bands 2.0 ua 15

FAQ

What are the Rochester criteria?

Criteria to identify febrile infants up to 60 days old at low risk of serious bacterial infection: well-appearing, previously healthy, no focal infection, WBC 5,000–15,000, bands ≤1,500, ≤10 WBC/hpf in urine, and ≤5 WBC/hpf in stool if diarrhea.

Rochester vs PECARN: which is better?

PECARN (urinalysis, ANC, procalcitonin) has higher sensitivity (97.7%) than Rochester; Rochester remains useful where procalcitonin is unavailable.

Evidence

  1. Jaskiewicz JA et al. Febrile infants at low risk for serious bacterial infection: an appraisal of the Rochester criteria. Pediatrics 1994;94:390–6.
  2. Dagan R et al. Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis. J Pediatr 1985;107:855–60.

Pediatrics & Obstetrics · Reviewed 2026-10-14 · Methodology