Fever in Pediatrics Flashcards
Definition of pediatric fever
over 38ºC or 100.5F
2 Endogenous pyrogens important in fever:
IL1 IL6
Site of fever regulation: Effect of infection Effect of hypothalamic injury
Hypothalamus regulates core temperature infections alter this set point hypothalamic injury can cause erratic control
Hyperpyrexia =
purposeful temp. elevation ≥ 41.5 C
Hyperthermia =
uncontrolled temperature elevation
Role in treating fever specifically:
May help control febrile seizures
Common Viral and Bacterial Febrile Infections:
Viral = URI (e.g., RSV, influenza), GI (e.g., rotavirus), enteroviruses Bacterial = otitis media, strep pharyngitis, sinusitis, pneumonia
Issue with treating pediatric fevers:
Infections and management vary tremendously by age.
“the febrile infant” =
0-56 days
The febrile infant is a risk of serious bacterial infections, such as:
bacteremia meningitis UTI bacterial enteritis skin/soft tissue infection bone/joint infections
Signs and symptoms of febrile infant:
fever irritability lethargy poor feeding resp. distress N/V NO SYMPTOMS!
Common organisms under <30 days:
E. coli GBS Listeria
HSV 1 and 2 may also produce severe infection if…
infant is < 21 days old
Work-up and management of febrile infants 0-28 days old:
ABX + anti-virals started and all get septic work-up → CBC, UA, UCx, BCx, LP, CXR if respiratory symptoms
Work-up and management of febrile infants 29-56 days old:
Philadelphia Criteria:
- Needs reliable caregiver and ability to f/u at 24 hours in ED
- Low-risk criteria: if met, can be f/u as outpatient and NO ABX!
- PE: well-appearing and w/out focus of infection
- Hx: normal past history and normal perinatal hx
- Lab criteria:
- WBC 5-15K
- Immature to total (I/T) ratio < 0.2
- UA < 10 WBC/hpf + (-) gram stain
- CSF < 10WBC/hpf + (-) gram stain
- CXR w/o infiltrate
“Febrile Young Child” =
2-36 months old
2 most common causes of fever in ages 2-36 months:
Occult bacteremia
Occult UTI
Occult bacteremia in child 2-36 months:
- Common organisms:
- Specific sub-pops with higher incidence
- Management?
- Hib and S. pneumo
- Kids younger than 36 months and with a fever over 39C
- Manage w/ WBC, absolute neutrophil count, blood culture and treat with empiric ABX
Occult UTI in child 2-36 months:
- Common organisms
- What is commonly the only presenting symptom:
- Possible sources of infection:
- Risk factors for developing UTI
- Sensitivity for dx UTI if >3 risk factors are present?
- Role of circumcision
- Which urine should you test?
- Tests to run on urine?
- Treatment for gram (-) enterics?
- E. coli, enterococcus, gram (-) enterics
- Fever is often only presenting sign
- Can occur despite source of otitis, URI, or gastroenteritis
- Risk factors:
- Caucasian > Latino > AA
- age ≤ 12 months
- fever ≥ 39C
- duration of fever ≥ 2 days
- no source of fever
- 88% sensitivity
- 10x risk increase in uncircumcised males
- Test catheterized or suprapubic urine only
- UA, urine dipstick, urine cxs
- cefixime, TMP-SMX
Criteria for positive findings of urine analysis for child with UTI:
Dipstick is + for nitrites and +/- leukesterase
Microscopic UA has >10-15 WBC/hpf
At what age is fever in pediatrics similar to that of adults?
> 3 yrs
Fever in kids over 3 yrs
Overwhelming majority caused by:
Dx tests:
Most caused by viruses
If pharyngitis - rapid strep tests
Dysuria - UA and cultures
Tachypnea - lung auscultation, if there are rales do CXR
