Paeds Fever and Sepsis

Question 1

What characteristics of a fever are prognostic?

Answer 1

None.

Question 2

Approach to febrile child based on (corrected) age:

Answer 2

<28 days
FULL WORK UP and EMPIRIC ANTIS
- FBC, CRP, blood cultures
- CXR
- Urine (SPA)
- LP

___________

<3mo
WELL:
- URINE SAMPLE (SPA or in-out) + bloods
- FU at 24/24

UNWELL
- FULL WORK UP and EMPIRIC ANTIS

___________

>3mo
WELL:
- Consider doing nothing
- URINE if fever >48 hours, RF

UNWELL
- FULL WORK UP +/- the LP and EMPIRIC ANTIS

Question 3

Urine collection methods and when to use them:

Answer 3

SPA
- Gold standard
- Use if high-stakes or can’t wait
- 1% contam

In-out
- Bladder too empty for SPA
- 10% contam

Clean-catch (precontinent) or MSU (toilet trained)
- 25% contam
- Clean with saline gauze

Question 4

Recommended method of taking temperature in children:

Answer 4

Axillary temp <3mo (rectal 2line)

Tympanic >3mo

Question 5

Empiric antibiotics for sepsis in NEONATE:

Answer 5

BENPEN 60/kg + CEFOTAXIME 50/kg

________
GBS, Listeria, Hib, E.Coli

Question 6

Empiric antibiotics for sepsis in INFANT or CHILD:

Answer 6

FLUCLOXACILLIN 50/kg + CEFTRIAXONE 50/kg

________
Neisseria meningitidis, GAS, Strep pneum, Staph aereus, Hib, E.coli

Question 7

What is ‘early onset’ and ‘late onset’ sepsis in neonates?

Answer 7

Early = within 48 hours of life
–> High mortality (30%)
–> Usually vaginal flora
–> GBS, Listeria

Late = > 48 hours
–> Better prognosis
–> Usually hospital-acquired
–> Staph epidermidis, aureus

Question 8

What is ‘occult bacteraemia’?

Answer 8

+ blood cultures when:
- No source apparent
- Child seems well

ie. non-focal, just floating bugs

Generally <3 years old and unvaccinated because Hib, pneumococcus

Question 9

Most common causative organism in occult bacteraemia? Empirical antibiotic?

Answer 9

S. pneumoniae, Hib, Neisseria

IV CEFTRIAXONE or AUGMENTIN PO covers them all!