Child with fever Flashcards
Fever in the 0– 28 day Neonate
Fever of 38 C or 100.4 Or higher
Concern for: meningitis, pneumonia, sepsis, UTI, otitis media, viral infection
Work up: CBC, blood culture, urinalysis, urine culture, CSF cell count and culture, +/- CRP
Most common organisms: Group B Streptococcus, E. coli, Listeria, HSV, GN, Enterococcus, Staphylococcus
Management:
Admit to the hospital
Broad-spectrum antibiotics - Ampicillin + Cefotaxime Or gentamicin
+/- Acyclovir For ill, Seizures, skin lesions (vesicles), or CSF pleocytosis To cover HSV encephalitis
Fever in 29 to 90 day infant - Ill appearing
Work up: CBC, blood culture, urinalysis, urine culture, CSF cell count and culture
CXR For Any respiratory symptoms
Most common organisms: Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis
Management:
Admit to hospital
Cefotaxime Or ceftriaxone
+/- Ampicillin if Less than eight weeks to cover Listeria
+/- Vancomycin For skin infections or signs of meningitis (MRSA as well as resistant strains of S. pneumo)
Fever in the 29-90 day infant - well appearing
Work up: CBC, blood cultures, urinalysis
CSF - Only with Signs of meningitis
CXR For any respiratory symptoms
Management:
If parent is reliable - Close out patient follow-up
Ceftriaxone IM Single dose and follow-up in 24 hours
Fever without a source 3-36 month child - ill appearing
Fevers greater than 39 C or 102.2F
Generally last less than one week and usually self-limited - Caused by viral infections
Concerned for serious bacterial infections: Meningitis, pneumonia, Focal skin infections, UTI
Work up: CBC, Blood cultures, urinalysis, CSF only with signs of meningitis
CXR For any respiratory symptoms or if WBC >20K
Most common organisms: Streptococcus pneumonia, Staphylococcus aureus, Neisseria meningitidis, Haemophilus influenzae type B
It’s unstable: Admit and starts empirical antibiotics
If outpatient: Ceftriaxone IM x1 and follow up in 24 hours
If fever persists for >48 hours reculture
Fever without a source in 3-36 mo child - well appearing, incompletely immunized
Work up: CBC, blood culture, urinalysis, urine culture, CSF only with signs of meningitis
CXR For any respiratory symptoms or if WBC >20K
If WBC >15K - Ceftriaxone IM x1
If fever persist longer than 48 hours reculture
Fever without a source in 3-36 mo child - well appearing, completely immunized
UA and urine culture for girls less than 24 months old, and uncircumcised boys less than one -year-old
No empiric antibiotics
reculture if fever persists longer than 48 hours
Febrile seizures
Bacterial or viral infections - Not including meningitis or encephalitis
Most commonly Occurs 6 mo - 5 y
Can be simple or complex seizure
Complete fever workup + BMP To check electrolytes, +/- LP
Treatment:
Seizure > five minutes and witnessed - ABCs, short acting benzo (lorazepam)
Tylenol or ibuprofen at the onset of the febrile illness - Not always recommended
Risk:
Have slightly higher risk of developing epilepsy
More likely to have future febrile seizures
When should a child with a febrile seizure have an LP?
In the presence of the meningeal signs and symptoms, Incompletely immunized 6-12 mo, Already on antibiotics
