Pediatric Fever- Ross Flashcards by Tessa Herbert

What is a peds fever defined as

<28 days= 100.4

>28 days= 100.8

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Can bundling cause a fever

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Can teething cause a fever

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What is the most effective way to check peds temp

rectal

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What are the causes of serious bacteral infections in young infants

UTI
Cellulitis
Bacteremia
Bone and joint infxn

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What are the causes of invasive bacterial infxn in young infants

Meningitis
Pneumo
Sepsis
Osteomyelitis
Bacterial enteritis
Pyleonephritis

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What is the most common source of infxn in pts less than 90 days old

UTI

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What is the most common causative agent of bacterial infxn in infants <90 days old

E. coli

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What causes the majority of fevers in infants

viral pathogens

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What viral infxn is important to rule out in infants

herpes

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What are the most common bacterial causes of fever for pts 0-28 days

GBS
Listeria
E. coli
C. trachomatis
N. gon

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What are the most common viral cause of fever in 0-28 days

HSV
varicella
enteroviruses
RSV
Flu

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What are the most common bacterial causes of fever in pts 1-3 months

H. flu
S. pneumo
N. men
E. coli

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What are the most common viral causes of fever in pts 1-3 months

varicella
enterovirus
RSV
Flu

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What are the most common bacterial causes of fever in pts 3-36 months

S. pneumo
N. men
E. coli

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What are the most common bacterial causes of fever in pts 3 years to adulthood

S. pneumo
N. men
E. coli
GABS

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What are the gross motor milestones for a one month old

raises head slightly from a prone position

makes crawling movements

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What are the visual/motor/problem solving milestones for a 1 month old

Visually fixes

Has a tight grasp and follows objects to midline

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What are the gross motor milestones of a 2 month old

holds head in midline

lifts chest off table

What are the language/social/ and adaptive milestones of a 2 month old

smiles socially

What are the visual/motor/problem solving milestones for a 4 month old

reaches with arms in unison

brings hands to environment midline

What are the gross motor milestones of a 6 month old

sits unsupported

puts feet in mouth in supine position

What are the language/social and adaptive milestones of a 6 month old

babbles

recognizes strangers

Why aren’t infants that breast feed completely immunocompetent

They have decreased opsonin capabilities, leading to decreased macrophage and neutrophil fxn
poor Ig response to encapsulated orgs

When is a pt at highest risk of SBIs

4 weeks old or less (first month of life)

How do you manage febrile neonates with no known cause

admit and give a full work up - you won't get clues from physical exam and labs will be negative

When does as pt become risk stratifiable (based on labs or physical exam)

At one month old

What is the work up for febrile neonates

``` UA CBC BC LP Admission and call to neotalogist (with ABX on board) ```

What protocols can be used to risk stratify an infant

Philadelphia protocol Rochester protocol Boston protocol

Find out if we need to know the protocols (on back of notecard to refer to if needed)

At what age can you start using risk stratification tools for febrile bbs

28 days old

What should you always do if you are giving an infant antibiotics for fever with unknown eitology

What is something all protocols require when risk stratifying febrile babies

Get WBC -> pos if <5000 or >15000 or ANC >1500 Do UA- + if >10WBC/HPF CXR if resp sx LP- + if >10WBC mm3

What are the low risk screen questions that can be answered to find out if a pt needs LP

REceived at least one pneumococcal vaccine and H flu vaccine within 2 months of life No chronic med conditions No hx or exam findings suggesting meningitis

If an infant has a fever and it seems to be obvious broncholitis, how do you follow up

Still do a UA and 24 hour follow up to confirm

What are the recommended emperic tx abx for infants (29-59 days old)

Ceftriaxone or cefotaxime (s.pneumo, h. flu, ecoli) Ampicillin (listeria and GBS) Vanco for MRSA Acyclovir for ALL

What should you be checking in infants that are >60 days old and febrile with no obvious source

Immunization status UA always even if you think bronchiolitis CBC before considering LP

How do you tx febrile infants <60 days old that aren't vaccinated

tx them as though they have pneumococcal meningitis->admit pt

What is the step by step protocol method of risk strat for pediatric fever

``` Follow each step in order: Well appearing with normal peds assessment triangle -> Age >28 days old -> Leukocyturia neg -> PCT <0.5 ng/mL -> CRP <20 ng/L and ANC <10,000 mm3 -> Then they are a low risk pt ```

How do you use the step by step protocol to risk stratify

If you answer yes to any of the steps the pt fails the protocol and needs a work up

What is the age criteria for the Rochester Criteria

<60 Days

What is the hx for the rochester criteria

Term infant No perinatal ABX No underlying dx No hospitalization longer than mom

What are the physical exam criteria for the rochester criteria

Well-appearing | No ear, soft tissue, or bone infxn

What are the lab parameters that define a low risk pt according to rochester criteria

WBC>5000, <15000 ANC <1500 UA

Which parameter allows you to forego LP on low risk pts

rochester criteria

What is one of the earliest signs of distress in peds pts

resistance to attempts to socialize