pediatric fever Flashcards
fever
= T > 38C (100.5F). core temp = most accurate, rectal = most commonly used
hypothalamus
regulates core temperature. infections alter set point. hypothalamic injury can cause erratic control
hyperpyrexia
= purposeful temp elevation >= 41.5C
hyperthermia
= uncontrolled temp reg
Tx
not necessary! but potential role in preventing febrile seizures. elucidating/treating underlying cause = more important. antipyretics make people more comfotable
fever epidemiology
20% of all pediatric ED visits
highest risk
youngest children at highest risk of severe infection 2/2 impaired host defenses (neutophil fxn, lymphocyte production, complement fxn), decreased pathogen clearance, impaired ability to localize infection
common causes
viral: URI (e.g. RSV, influenza), GI (e.g. rotavirus), enteroviruses. bacterial: otitis media, strep pharyngitis, sinusitis, pna
0-56 days: serious infections
bacteremia, meningitis, UTI, bacterial enteritis, skin/soft tissue infection, bone/joint infections
0-56 days: Sx
fever, irritability, lethargy, poor feeding, resp. distress, D/V, NO Sx = common!
0-56 days: organisms
E. coli, GBS, listeria (<21 days)
0-28 days
Abx + anti-virals + full septic w/u (CBC, UA, UCx, BCx, LP, CXR if resp. Sx)
29-56 days
philadelphia criteria. needs reliable caregiver and ability to f/u at 24hrs in ED. if low-risk criteria met, can f/u as outpatient, no Abx! PE: well-appearing, w/o infection focus. Hx: nl PMH and perinatal Hx. lab criteria: WBC 5-15K, UA <10, CXR w/o infiltrate
2-36 mo: occult bacteremia
often hib, s. pneumo. increased incidence w/age =39C. manage w/WBC, ANC, BCx, t/c empiric Abx. But this is uncommon now. if well-appearing, no source, no Tx.
2-36 mo: occult UTI
e. coli, enterics, enterococcus. fever is often only sign. 3.3-5.3% prevalence. can occur despite URI, otitis, gastroenteritis. risk factors: caucasian > latino > AA. Age = 39C, duration of fever >= 2 days, no obvious source. if >= 3 risk factors = 88% sensitivity. 10x increased risk in uncircumcised males. Tx w/cefixime, TMP-SMX
