Pediatric Complaints Flashcards
fever workup: neonates (0-28 days)
FULL SEPSIS WORKUP:
-CBC, CMP, UA / urine cultures, CXR, blood cultures, lumbar puncture with CSF cultures
*you will ADMIT the neonate because their risk of serious infection in this age range is high
common causes of fever: neonates (0-28 day)
- non-herpetic virus (adenovirus, rhinovirus, etc)
- UTI (E. coli)
- bacteremia (GBS)
- meningitis
*most common bacterial pathogens: group B strep (GBS), E. coli, Listeria, Enterococcus, Herpes Simplex
classic symptom associated with group B strep in neonates
apnea
classic symptom associated with E. coli infection in neonates
livedo reticularis
empiric ABX for sepsis workup in neonates (0-28 days)
ampicillin + gentamicin** (<7 days of life)
**ampicillin + gentamicin or cefotaxime (>7 days of life)
*acyclovir should be given if < 3 weeks
fever workup: young infants (1-3 months)
*CBC
*INFLAMMATORY MARKERS: ESR/CRP, procalcitonin, lactic acid, etc
*blood cultures
*urinalysis / urine cultures
Step-by-Step Approach for risk stratification of young infants (1-3 months) with fever
*NEED these 4 things to be below the criteria to discharge:
1. procalcitonin < 0.5
2. ANC < 10,000
3. normal UA
4. CRP < 20
*if anything is above the criteria, then they need the full sepsis/neonatal workup
fever workup: older infants and young children (3-24 months)
*urinalysis / urine cultures
*CXR
ddx for causes of bacterial infection presenting with fever in pediatrics
*UTI
*pneumonia
*uncommon but possible: meningitis, encephalitis
criteria for febrile seizures
*convulsion in the setting of a temp > 38 C (100.4 F)
*child older than 6 months but younger than 5 years
*no CNS infection or inflammation
*no metabolic abnormalities
*no previous afebrile seizures
simple vs. complex febrile seizures - defined
*simple febrile seizures: generalized, < 15 minutes, only 1 episode in 24 hours
*complex: any other febrile seizure
*patients with complex seizures:
-are more likely to be younger and have abnormal development
-have a higher risk of recurrent febrile seizures
-have a higher risk of future nonfebrile seizures
febrile seizures - presentation
*MUST have a seizure (typically > 39 C or 102.2 F)
*postictal phase: associated with drowsiness, confusion, and/or agitation (prolonged drowsiness is concerning for other etiologies)
simple febrile seizure - management
- fever control (antipyretics)
- reassurance
Kawasaki disease - alternate name
*mucocutaneous lymph node syndrome
Kawasaki disease - clinical presentation
1. fever > 5 days (typically above 101 F)
2. conjunctivitis: bilateral, nonexudative
3. mucositis: dry, cracked-appearing lips along with a bright red, “strawberry” tongue
4. rash: macular, morbilliform rash of extremities and trunk, often involving palms & soles
5. extremity changes: focal edema in hands and feet; skin peeling of distal extremities
