Febrile Child Flashcards
What is the most common childhood CC?
in acute care
Febrile child
Fever is defined as >_____F or _____C
100.4F or 38C
The biggest concern of a febrile baby is ____
invasive bacterial infection (IBI) formerly referred to as Serious Bacterial Infection (SBI)
Benefits of having a fever
inhibits growth of viruses and bacteria
controlled by the CNS
In children, what is the standard method to take temp?
rectal
Oral is okay if they cooperate
Axillary is usu lower than actual (no conversion equation)
infared is sufficient
Bacterial meningitis is MC in what part of your life?
within 1st mo of life
a baby is sick within 7 days of life. How did they most likely get it?
vertical transmission from parents
Can be from community or hospital acquired tho
5-10% of neonates with early onset Group B sepsis (GBS) have concurrent ______
meningitis
Kids with meningitis may present with _____
seizures (20-50%)
Decreased oral intake and acute change in sleep patterns can be clues to _____
invasive infection
Uncircumcised baby presents with FTT, jaundice, and vomiting. What is the most likely Dx?
UTI
a wheezing child most likely has what infx?
viral bronchiolitis
Your preceptor tells you to check for signs of meningitis in a febrile baby. It can fully flex its head and has an unremarkable Hx. Can you rule out meningitis?
No, neonates with meningitis can present with full neck flexion and unremarkable history, so always maintain high index of suspicion
No focal source is found in febrile baby <28 days. What should you order?
- Urinalysis and urine culture
- CBC
- Procalcitonin or CRP
- Blood Culture
- Lumbar Puncture, run CSF and culture
Lumbar puncture is to be done in all children <28 days
Low glucose and elevated WBC (pleocytosis) is indicative of infection
Run PCR to test for HSV
What labs do you order for the CSF after doing a lumbar puncture on a baby?
- Low glucose and elevated WBC (pleocytosis) is indicative of infx
- PCR test for HSV
What type of rash does meningitis cause
Petechial rash
Admit a pt for at least ____hrs on empiric ABX
24-36
2 MC pathogens you absolutely need to cover with ABX
GBS (Group B Strep)
Listeria
E coli
most S pneumonia
N meningitides
Empiric ABX for febrile child
ampicillin and gentamicin
or
ampicillin and cefotaxime
If febrile neonate is still ill-appearing after empiric ABX, add on ______
Acyclovir
When can you discharge a recovering febrile neonate
if cultures and WU are (-)
What CANT neonates get ceftriaxone?
biliary sludging -> kernicterus
Age range for young infant
28-60 days
MC cause of unexplained fever and bactermia in young infants & those 3mo-3yo
UTI
UTI and Bronchiolitis can occur at same time
are young infants at higher risk for IBI if they have a confirmed viral infx?
Invasive Bacterial Infection (IBI)
NO
Infants 3 months or younger with confirmed viral infection are at lower risk of IBI when compared to kid with no identified virus
Have high concern for septic shock if young infant presents with HR > ____ and RR > _____
HR > 160
RR > 60
does bacterial meningitis show more SS in neonates or young infants?
neonates
is a bulging fontanelle an early or late sign of a febrile young infant with poss meningitis
LATE
The labs for a febrile neonate and young infant are the same except that you only do a lumbar puncture on a young infant if….
there is more than one inflammatory marker elevated
Trmnt for febrile young infant
- Treat focal source of infx
- ONLY US (+) -> discharge home on ABX (Cefuroxime)
- ONLY CBC (+) -> consider discharge home on ABX
- Well-appearing infants over 28 days old can be given single IM dose of ceftriaxone and encouraged to have 24 hour follow-up
- If deciding to admit a patient, begin on empiric antibiotics and observe 24-36 hours, and discharge home if culture results are negative.
Febrile child 3mo - 3yo
MC pathogens of bacterimia in this age group
- Steptococcus pneumonia
- H. flu type B (prior to vacc)
Febrile child 3mo - 3yo
most common bacteria causing UTI
E. coli
MC bacteria causing blood stream infx
Staph aureus (15%)
associated with skin, soft tissue, or msk infx
Febrile child 3mo - 3yo
Initial order for WU of fever and bacteremia with unknown ET
Urine Analysis
(+) -> urine and blood cultures
Febrile 3mo - 3yo
Lab findings suggestive of serious bacterial infx
- UA with WBCs, bacteria, or positive leukocyte esterase and nitrite findings
- WBC >15K
- Absolute Neutrophil Count (ANC) >10K
- CRP >40mg/L
- Procalcitonin > 0.5ng/mL
Pts are demanding ABX for their non-toxic 1yo. Wdyd?
stand your ground and explain that empiric ABX is not reccommended for children 3mo - 3yo
Fever of unknown origin (FUO) is defined as a fever >______C (_____F) at least once per day for ____ days with no apparent Dx after initial outpt or hospital eval.
38.3C (101F)
8+ days
Most common infections that initially present as fever of unknown origin
Bartonellosis
UTI
Others: bacterial, fungal, viral
MC inflammatory diseases that initially present as fever of unknwon origin
juvenille idiopathic arthritis
SLE
MC malignancies that initially present as fever of unknwon origin
leukemia
lymphoma
PE of pt with fever of uknown origin should focus on which body parts?
skin, lymph nodes
liver, spleen
eyes
fever of unknown origin
lab orders
- CBC with peripheral smear
- CMP
- CRP
- ESR
- Urinalysis and blood culture
- HIV serology
- Hepatitis A and B serology
- Tuberculosis screening tests or interferon gamma release assays
- Throat culture
- CMV, EBV testing
- ANA
- RF
- Ferritin
- Complement proteins
fever of uknown origin
Imaging/study orders
Chest X-ray
ECHOcardiography
CT chest
CT head→ MRI
CT abdomen/pelvis
PET Scan
Endoscopy
4yo child presents with:
* Fever>5 days
* Bilateral conjunctivitis
* Oral mucosal change (strawberry tongue)
* Extremity changes
* Cervical Lymphadenopathy
* Diffuse non-specific rash
What infx is this most likely? why is it VITAL that you dont miss this Dx in children under 5yo
Kawasaki disease
Kids get really sick, can develop heart disease due to vasculitis associated with coronary arteries, sometimes requiring heart transplants
Treat a fever with _____
Antipyretics
* Acetaminophen:10-15mg/kg every 4-6 hours
* Ibuprofen: 10mg/kg every 4-6 hours (not indicated in children under 6 months old
Pyretic = Feverish
Antipyretics cause the hypothalamus to override a prostaglandin-induced increase in temperature. The body then works to lower the temperature, which results in a reduction in fever
Which age grp of febrile children ALWAYS get a lumbar puncture to eval for meningitis
Neonates
