Pediatric Fever (Exam 2)

Question 1

A fever is a temp greater than?

Answer 1

100.4

Question 2

Can bundling or teething cause a fever?

Answer 2

No, maybe elevated, but not over 100.4

Question 3

Are tympanic temps just as accurate as rectal?

Answer 3

No, must get rectal temp

Question 4

T/F The higher the fever the sicker the infant.

Answer 4

False, fever is a fever

Question 5

What is the cause of a majority of serious bacterial infections SBI’s?

What is the causative organism?

Answer 5

UTI, most commonly from E. Coli

Question 6

T/F breastfed infants are immunocompetent?

Answer 6

False, they have immature opsonin capabilities, decrease macrophage and neutrophil function, poor Ig response to encapsulated bacteria

Question 7

T/F The older the kid, the higher the chance of SBI.

Answer 7

False, <4 weeks 15% SBI, 4-8wks <5% SBI

Question 8

Does a fever over 100.4 require a work-up for bacterial illness regardless of PE?

Answer 8

Yes

Question 9

What are the 5 common pathogens in neonatal fever?

Answer 9

GBS, E. Coli, Listeria, Klebsiella, Herpes

Question 10

What labs should you order for neonatal fever?

Answer 10

UA
CBC
BCx (blood culture)
LP (lumbar puncture)

Question 11

How should you treat neonatal fever?

Answer 11

systemic Abx and admit

Question 12

What is the most likely cause of pediatric fever, bacteria or virus?

Answer 12

Virus

Question 13

Neonates are what age (in days)?

Answer 13

<28 days

Question 14

Protocol eligible Infants are what age (in days)?

Answer 14

29 days to 59 days

Question 15

What age are infants (in days)?

Answer 15

> 60 days

Question 16

Is a parents gestalt predictive of infection?

Answer 16

Yes, have to listen to parent

Question 17

Protocol eligible infants (age 29-59 days) assumes what?

Answer 17

They are term babies (>38 weeks + 6 days) Early term is 37wks to 38wks6days. Ross says for test purposes FULL TERM is 40weeks
PE that is benign (check eyes, ears, mouth,d iaper) and CHILD MUST BE CONSOLABLE
Non-toxic
No previous abx

Question 18

What are the 3 protocols?

Answer 18

Philadelphia
Rochester
Boston

Question 19

What 4 things do all the protocols suggest you do?

Answer 19

1. Get a WBC count 
Positive WBC is <5,000 or >15,000 and/or absolute neutrophil count ANC >1500
2. Do a UA
Positive if >10wbc/hpf
3. CXR if resp sx
4. Lumbar puncture (LP)
Positive if >10 wbc/mm3

Question 20

If any of the 4 things for the 3 protocols are positive, such as WBC, UA, CXR, or LP, what should you do?

Answer 20

Admit and empiric abx

Question 21

If protocol tests are negative, what are your 2 choices?

Answer 21

1. No abx, d/c and f/u in 24hrs

2. Abx and LP and d/c and f/u in 24hrs

Question 22

Your peds pt has low risk labs, but they have obvious bronchiolitis, what do you need to do?

Answer 22

UA

F/u in 24hrs

Question 23

If your peds pt has a fever but you can’t identify the source, and they are w/in protocol age 29-59 days, what are your abx choices?

Answer 23

1. Ceftriaxone or cefotaxime covering Strep pneumo, H influ, and E coli
2. Ampicillin (up to 6 weeks of age) for Listeria and GBS
3. Vanco for MRSA
4. Acyclovir for all

Question 24

If you give abx to your peds pt with no source of fever who is within protocol age, what do you HAVE to do?

Answer 24

LP

Question 25

What 3 bugs does ceftriaxone or cefotaxime cover?

Answer 25

Strep pneumo H influ E coli

Question 26

What 2 bugs does ampicillin cover for?

Answer 26

Listeria | GBS

Question 27

What bug does vanco cover?

Answer 27

MRSA

Question 28

What is acyclovir for?

Answer 28

Herpes infections

Question 29

Should you give azithromycin?

Answer 29

No, the road to hell is paved with azithro

Question 30

If peds pt is >59 days old and has fever, what should you ask the parent?

Answer 30

What is their immunization status?

Question 31

For a peds pt >59 days, what should you strongly consider ordering even if they have bronchiolitis?

Answer 31

UA

Question 32

If your >59 days peds pt with a fever has elevated wbc on cbc, what should you do next?

Answer 32

LP

Question 33

Your peds pt has been vaccinated, has a fever, but they don’t appear ill. If they just received their 1st round of vaccinations they are 6wks and w/in protocol age. If the fever is w/in 72 hours, what is all you need to do?

Answer 33

UA

Question 34

If the child is unvaccinated?

Answer 34

Ignore everything I just said for all previous slides

Question 35

Unvaccinated infants less than 60 days old. What should you think?

Answer 35

Pneumococcus Can kill in 24 hours, so worry about the fever on day 1 Lab values have greater importance, elevated cbc is really ominous Very aggressive work-up and probably admission

Question 36

New protocol for 29 to 90 days “step by step”. What are the steps for the algorithm?

Answer 36

-Well appearing with normal pediatric assessment triangle (Appearance, Work of Breathing, Circulation to skin) -age >28 days old -Leukocyturia -Procalcitonin <0.5ng/ml -CRP <= 20mg/L -ANC (absolute neutrophil count) <= 10,000 If all these present, low risk patient

Question 37

If infant is positive for any of the “step by step” protocol steps then they fail the protocol and need a work-up. What should you do?

Answer 37

Abx LP BCx Admit

Question 38

Do not give abx unless you do what?

Answer 38

LP