Fever in a neonate / child Flashcards
What investigations should you do in every neonate with fever?
- Full blood count
- Blood culture + stool culture, if diarrhoea is present
- C-reactive protein
- Urine testing for UTI
- CXR only if respiratory signs are present
How do you risk stratify children who are feverish?
Using the NICE traffic light system
List the categories of the traffic light system for identifying serious illness.
- Colour
- Activity
- Respiratory rate
- Circulation and hydration
- Other
Each of these has headings under green (low risk), amber (intermediate risk), red (high risk) for serious illness.
Describe the traffic light table.
How should you measure the temperature of an infant?
<4 weeks- electronic thermometer in the axilla (not rectal or oral in children <5yrs)
4 weeks to 5 years - electronic/infra-red tympanic/chemical dot thermometer
What features in fever place children in the “high risk” group for serious illness?
- pale/mottled/ashen/blue skin, lips or tongue
- no response to social cues
- appearing ill to a healthcare professional
- does not wake or if roused does not stay awake
- weak, high-pitched or continuous cry
- grunting
- respiratory rate greater than 60 breaths per minute
- moderate or severe chest indrawing
- reduced skin turgor
- bulging fontanelle
What risk group for fever would this consist of:
- pallor of skin, lips or tongue reported by parent or carer
- not responding normally to social cues
- no smile
- wakes only with prolonged stimulation
- decreased activity
- nasal flaring
- dry mucous membranes
- poor feeding in infants
- reduced urine output
- rigors
intermediate risk for serious illness
In what group would you get cap refill >=3 seconds?
Intermediate risk
What should you investigate if the child’s fever has lasted >5 days?
Kawasaki disease
What comprises tachycardia in
- <12 month olds
- 12-24 month olds
- 2-5 year olds
- >160
- >150
- >140
How do signs/symptoms of meningococcal disease differ from bacterial meningitis in a child?
Consider meningococcal disease in any child with fever and a non-blanching rash, particularly if any of the following features are present:
- an ill-looking child
- lesions larger than 2 mm in diameter (purpura)
- a capillary refill time of 3 seconds or longer
- neck stiffness
Consider bacterial meningitis in a child with fever and any of the following features:
- neck stiffness
- bulging fontanelle
- decreased level of consciousness
- convulsive status epilepticus
What might be the viral cause of fever with seizures in a child?
Herpes simplex encephalitis =
- focal neurological signs
- focal seizures
- decreased level of consciousness
A 3 month old comes in with fever and vomiting, poor feeding, lethargy, irritability, abdominal pain/tenderness and urinary frequeny/dysuria. What is the likely cause of the fever?
UTI
In addition to fever, what else might you see in a child with Kawasaki disease?
- bilateral conjunctival injection without exudate
- erythema and cracking of lips; strawberry tongue; or erythema of oral and pharyngeal mucosa
- oedema and erythema in the hands and feet
- polymorphous rash
- cervical lymphadenopathy
How quickly should children with any of the red list features be assessed?
Within 2 hours - must be seen face to face
