Febrile Infant Flashcards
What is the most accurate way to obtain a temperature?
Rectal
Is fever itself dangerous? What good does it do?
Not dangerous itself
Recruits WBC’s and slows replication of virus and bacteria
Most fevers in kids are caused by?
Viruses
What are the SBI’s we need to rule out in febrile infants?
Sepsis, meningitis, PNA, bacteremia, bacterial enteritis, UTI, soft tissue or skin infection
What is the most common SBI in kids?
UTI
What are the three main categories for febrile infants?
First month or ill-appearing or high risk
Second month and well appearing
Third month and older
What are the features of a high risk patient?
toxic appearance immune compromise premature Hx of NICU stay (exposure to bugs) comorbidities Significant infectious exposure
What percent of febrile neonates have an SBI?
5–15%
What percent of febrile neonates that appear totally normal have an SBI?
about 5%
This is why we admit all kids <29 days old with a fever
What is the management of kids in first month of life, or are toxic appearing or high risk?
Labs: CBC, CRP, procalcitonin, blood and urine Cx, UA, LP
IV antibiotics
Admission
Consider CXR, RPP, Stool studies
What are the most common causes of SBI in neonates?
E. coli GBS Gram (-) enterococci Listeria MRSA Herpes
Why is Herpes so scary in neonates?
Very bad complications
<50% have any skin findings
Can be without fever or hypothermic
If a neonate is positive for a URI, can you stop there in your evaluation and treatment?
still 5% risk of SBI and treatment should be the same
What is the abx regimen for neonates/high risk/toxic appearing?
Cefotaxime + Ampicillin
Give Vanco if toxic appearing or NICU stay
Acyclovir if concern for herpes (many providers just give it)
Should abx be held until LP is done?
Abx are given BEFORE LP if the patient is really sick
When can risk predictive rules be used in kids that are >29 days old?
Only if they are well-appearing. If toxic or high risk, they go back into the 0–29d category and are treated aggressively
What are low risk features in kids >1 month old?
Normal WBC, procal level, and CRP
Negative UA
Low Bands
What is the standard workup for febrile kids 1 month old and well-appearing?
Labs: CBC, CRP, Procal, UA, blood Cx, Urine Cx
Have low threshold for LP, but it is not for everyone
CXR only if needed
When are abx given to kids 29–60d and well-appearing?
Abx only if there is a source identified or if CSF culture is pending
Admission if high risk
When can febrile kids 29–60days go home?
Well-appearing, low risk, good social situation, follow up in 24 hours
Give abx for home if source identified or CSF cultures are pending
They get admitted if any high risk features (abnormal labs of any kind or vital abnormalities)
What is the preferred abx regimen for kids 29–60days?
Ceftriaxone and vanco
What is different about febrile kids >2 months old in regard to initial evaluation?
These kids more reliably show signs or symptoms if they actually have a significant infection whereas younger kids do not. A good clinical exam is all that is needed initially, but a UA should be considered as UTI accounts for 90% of bacterial infections.
What is the WBC cutoff for UA to be positive?
> 10 cells per hpf
What causes of meningitis are covered by ampicillin in the neonate?
GBS, E. coli, and listeria
