Kiddo with Fever Flashcards
(26 cards)
When is a fever in an infant serious?
Under 3 months full septic work-up!!!!
What are complications from a fever?
Seizure, direct cellular effect (damage to DNA), inflammation, systemic effects (gut bacteria translocation), liver failure, AKI, sepsis, organ failure, loss of function of BBB, death
Most common causes of fever in neonates
Listeria
Group B streptococci
HSV
Viral infection is the most common cause of fever without obvious source
High risk neonates for serious bacterial illness (and maternal risk factors)
Maternal risk factors: Group B strep, HIV, active herpes simplex
Prematurity, Autoimmune , factitious fever (overbundling)
Workup for child < 3 weeks
0-28 days:
Admit to hospital
Blood, urine, CSF culture
Emperric Abx treatment
Workup for child 1 month- 3 months
If appear well w/ no complications in PMH:
- CBC, blood culture, urinalysis and culture +/- CXR, lumbar puncture, stool studies depending on CC
Based on test results: can decide on empiric abx +/-hospital admission; must FU in 24 hours
If sick appearing – ADMIT
Workup for child >3 year
If sick appearing - workup
Fever < 39 and well appearing - Nothing
> 39 and well appearing consider: urine analysis and culture, ensure up to date w/ immunizations
Consider treating empirically – if elevated WBC, not up to date w/ immunization
Where is the thermoregulation centre?
Hypothalamus (35.6-37.8)
Why are infants less able to maintain body temperature?
High surface area/ mass ratio
Do not shiver or sweat
How do we sense changes in temp
Thermoreceptors on skin: free never endings
2 types:
- Warm receptors (increase firing 32-45)
- Cold receptors (increase firing 40-26)
Body Reaction to Cold:
Shivering, piloerection, vasoconstriction (sympathetic activation), increase heat production
Body reaction to Heat
Vasodilation (heat loss), sweating, decreased metabolic rate
Pathophysiology in fever
Pathogens release pyrogens –> inc production of IL in phagocytic cells –> IL signals anterior hypothalamus to increase PG production –> PGE2 inc the set point temperature
What is the role of PGE2
Set point of temperature
- peripheral vasoconstriction, increased metabolic heat production, shivering, behavioural changes
Benefits of a fever
Inhibit bacterial growth
Inc efficiency of immune cells
Inc chemotaxis
Mediators of inflammation response
Histamine - increased permeability of blood vessels
Prostaglandin - intensify the effects of histamine and kinins
Leukotrienes - increased permeability and attract phagocytes
Complement - stimulate histamine release, attack neutrophils by chemotaxis, promotes phagocytosis
Common cause of fever in infants (1-3 months)
E.coli H. influenza Varicella Enterococci Streptococcus pneumoniae N. meningitis
3 months- 36 months
Streptococcus pneumoniae
N. meningitis
E.coli
Viruses
> 3 mo
Streptococcus pneumoniae
N. meningitis
Viral
Leukemia,Lymphoma
Initial resuscitation measures for an infant with sepsis.
First hour of resuscitation:
Obtain rapid peripheral IV access, push isotonic crystalloids (normal saline or lactated ringers)
Begin maintenance 10% dextrose if necessary
Begin antibiotics as soon as possible
Indications for lumbar puncture
Indications:
- Infants younger than 1 month
- All infants 1-3 months who appear unwell
- Infants 1-3 months with a WBC less than 5 x10^9 or greater than 15x10^9
Contraindications for lumbar puncture
Increased ICP Respiratory insufficiency Local infection at LP site Shock (unusual skin colour, tachycardia/ hypotension, cold hands/ feet, alerted mental state, poor urine output) Extensive or spreading purpura Coagulation abnormalities
Reye’s syndrome
Disease affects mitochondrial function, causing disturbance in fatty acid - Rare form of acute encephalopathy and fatty infiltration of the liver Using salicylates (generally aspirin) during such illness increases the risk by much as 35 fold
Simple Febrile Seizures
last < 15 minutes, have no focal features, and do not recur within a 24 hour period
Most, > 90%, febrile seizures are simple
