For healthcare professionals

Rochester Criteria

The Rochester criteria identify febrile infants 60 days old or younger who are at low risk of a serious bacterial infection. An infant is low risk only when every history, examination and laboratory criterion is met. They were appraised by Jaskiewicz and colleagues in 1994. This tool is written for clinicians and is not a diagnosis.

Last reviewed: 2026-11-02 By the uncovermyrisk.com editorial team Educational only, not medical advice.

A baby who is hard to wake, floppy, has trouble breathing, turns blue or has a seizure: call 911 now.General safety advice (not part of the published criteria). The criteria are for infants already being assessed; they do not replace urgent care.

Source

Jaskiewicz JA and colleagues, Pediatrics 1994. The criteria are taken from Table 2 of an open-access (CC BY 4.0) review, DePorre AG and colleagues, Critical Care 2017; the stool rule for diarrhea and the performance figures are from an open-access (CC BY) review, Esposito S and colleagues, Mediators of Inflammation 2018. The tests check that every criterion is required and that the age limit applies.

Validated in

Febrile infants 60 days old or younger (DePorre 2017). The original studies did not include premature infants or infants with known medical conditions, and did not separate neonates from older infants (Esposito 2018).

Limits

Some infants with serious infection are still classed as low risk: across validation studies the negative predictive value ranged from 93.8% to 98.9% and the positive predictive value from 12.3% to 35.1% (Esposito 2018). In a study of 2,185 infants under 3 months, the Rochester criteria had a sensitivity of 81.6% for invasive bacterial infection, against 92% for the newer step-by-step approach (Wilcox 2024). Infants with bacterial meningitis or pneumonia may be classed as low risk, because these are hard to diagnose early from clinical findings and blood tests alone (Esposito 2018). Esposito 2018 prints the white cell range as 'between 5000 and 15,000'; this page follows DePorre 2017 ('over 5000 and under 15,000'). Newer guidelines use C-reactive protein and procalcitonin (Wilcox 2024).

The criteria

A febrile infant 60 days old or younger is at low risk only if all of these are met (DePorre 2017):

History

Born at term
No prior antibiotics
No underlying disease
Not hospitalized longer than the mother after birth

Examination

Well appearing
No signs of focal infection (for example ear, soft tissue or skeletal infection)

Laboratory

White blood cell count over 5,000 and under 15,000/mm³
Absolute band count under 1,500/mm³
Urinalysis: 10 white cells per high-power field or fewer
Chest X-ray without infiltrate, if one was done (tick if not done)
Stool smear: 5 white cells per high-power field or fewer, if the infant has diarrhea (tick if no diarrhea)

The stool smear applies to infants with diarrhea (Esposito 2018). The criteria were appraised by Jaskiewicz and colleagues (Jaskiewicz 1994).

Worked example: a well-appearing 40-day-old born at term, with no prior illness or antibiotics, no focal infection, a white cell count of 18,000/mm³ and otherwise normal results, is not low risk, because the white cell count is 15,000/mm³ or higher.

What the studies found

In the first study that led to the criteria, 1 of 144 low-risk infants (0.7%) had a serious bacterial infection, against 22 of 89 (25%) in the high-risk group; sensitivity was 92.4%, specificity 49.9%, positive predictive value 12.3% and negative predictive value 98.9% (Esposito 2018). The authors suggested that low-risk infants could stay at home without antibiotics with follow-up, and that high-risk infants be admitted for empiric antibiotics (Esposito 2018).

In a multicentre prospective study of 2,185 infants under 3 months, a sequential step-by-step approach using clinical and laboratory markers had a sensitivity of 92% and a negative predictive value of 99.3% for invasive bacterial infection, against 81.6% and 98.3% for the Rochester criteria (Wilcox 2024).

Related calculators

For a child with a minor head injury, see the PECARN head injury rule. For a child with abdominal pain, see the Pediatric Appendicitis Score. Other bedside scores are listed under For healthcare professionals.

Sources

DePorre AG, Aronson PL, McCulloh RJ. Facing the ongoing challenge of the febrile young infant. Crit Care. 2017;21(1):68. doi:10.1186/s13054-017-1646-9. PMID 28320432. Open access (CC BY 4.0). Table 2 (Rochester criteria: age, history, examination, laboratory parameters, management for high and low risk). pmc.ncbi.nlm.nih.gov/articles/PMC5360075/
Esposito S, Rinaldi VE, Argentiero A, et al. Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection. Mediators Inflamm. 2018;2018:4869329. doi:10.1155/2018/4869329. PMID 30581369. Open access (CC BY). Rochester criteria section and Table 1 (stool smear in diarrhoea, 144 low-risk infants, sensitivity, specificity, PPV and NPV, validation range, limits). pmc.ncbi.nlm.nih.gov/articles/PMC6287153/
Wilcox H, Umana E, Fauteux-Lamarre E, Velasco R, Waterfield T. Conundrums in the Management of Febrile Infants under Three Months of Age and Future Research. Antibiotics (Basel). 2024;13(1):88. doi:10.3390/antibiotics13010088. PMID 38247647. Open access (CC BY). Inflammatory markers section (step-by-step approach versus Rochester criteria in 2,185 infants). pmc.ncbi.nlm.nih.gov/articles/PMC10812496/
Jaskiewicz JA, McCarthy CA, Richardson AC, et al. Febrile infants at low risk for serious bacterial infection: an appraisal of the Rochester criteria and implications for management. Pediatrics. 1994;94(3):390-396. PMID 8065869. pubmed.ncbi.nlm.nih.gov/8065869/

Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-02. Spotted an error? See About.