Pediatric Fever Work-Up

Question 1

What is the most common source of fever?

Answer 1

Viral

Question 2

What is the most common bacterial infection associated w/fever?

Answer 2

UTI

Question 3

What are 5 serious bacterial infections?

Answer 3

1) UTI
2) bacteremia
3) meningitis
4) pneumonia
5) bacterial gastroenteritis

Question 4

What are 4 questions to ask the parents of child p/w a fever?

Answer 4

1) birth hx (premature, vertical transmission of Group B, STDs, complicated delivery, PROM)
2) perinatal hx of mom (Active Herpes, Group B strep)
3) feeding hx
4) making wet diapers

Question 5

T/F: rarely does teething cause an increase in temperature over 100.4 F.

Answer 5

True: teething should not create a significantly high fever

Question 6

What defines a fever in neonates-3 months?

Answer 6

(>38 C) 100.4 F

Question 7

What defines a fever in a child 3-36 months?

Answer 7

(>38-39 C) 100.4-102.2 F

Question 8

What defines a fever in an adult?

Answer 8

(37.8-39.4 C) 100.0-103.0 F

Question 9

What temperature is considered a fever of concern in neonates-3 months?

Answer 9

(>38 C) 100.4 F

Question 10

What temperature is considered a fever of concern in 3-36 months?

Answer 10

(>39 C) 102.2 F

Question 11

What temperature is considered a fever of concern in older children + adults?

Answer 11

(>39.5 C) 103.1 F

Question 12

When is a workup for SBI needed? (4 instances based on pt age/fever)

Answer 12

• Toxic-appearing pt: any age, any fever
• 0-28 days: temp >100.4 (38 C)
• 29-90 days: temp >100.4 (38 C)
• 3-36 months: temp >102.2 (39 C)

Question 13

T/F: PE + hx is a consistent predictor for the neonatal population.

Answer 13

False: it is inconsistent

Question 14

What is a good clinical predictor of wellness?

Answer 14

Social smile

Question 15

What are 5 absolute orders in a septic workup in a toxic pediatric pt of any age?

Answer 15

1) CBC w/diff
2) blood culture
3) UA + urine culture
4) LP
5) empiric abx (typically ceftriaxone)

Question 16

What is the most common overall source of infection in neonate (0-28 days) fevers?

Answer 16

Viral

Question 17

What are the 2 most common bacterial pathogens in neonate (0-28 days) fevers?

Answer 17

#1: E. coli    
#2: Group B Strep

Question 18

What is the workup (full septic workup) of a neonate?

Answer 18

1) CBC w/diff
2) blood culture
3) UA + urine culture
4) LP

Question 19

What are 2 empiric abx regimen options for neonates?

Answer 19

Gentamycin + Ampicillin
or
Ampicillin + Cefotaxime

Question 20

T/F: if one of the full work up tests is positive, no additional tests are indicated.*

Answer 20

False: regardless of one positive finding, will still need to continue w/LP and blood cultures

Question 21

What is the most common overall source of infection in fevers in kids 1-3 months?

Answer 21

Viral

Question 22

What is the most common bacterial pathogen in fevers in kids 1-3 months?

Answer 22

E. coli

Question 23

What is the workup of a well-appearing 29-90 day old w/temp >100.4?

Answer 23

1) CBC w/diff
2) UA + UCx
3) blood culture

Question 24

What is the workup of a toxic appearing 29-90 day old w/temp >100.4?

Answer 24

1) CBC w/diff
2) UA + UCx
3) blood culture
4) LP
5) empiric abx → admit

Question 25

What are 8 risk factors for invasive bacterial infection (IBI)?

Answer 25

- Age <28 days increased - Prematurity <37 weeks gestation - Ill appearance - Rectal temp of >104 F or 101.5 F - Comorbidities, chronic illness - Previous abx (last 7 days) - Maternal risk of infection (GBS, genital herpes) - Social barriers to care

Question 26

What is the temperature a fever is dxed at in 3-36 months?

Answer 26

102.2 F (39 C)

Question 27

What determines the approach to a child 3-36 months with a fever w/o a source?

Answer 27

Immunization status

Question 28

What does incomplete immunization mean?

Answer 28

Not having received the primary booster series containing Hib (H. flu type B) and pneumococcal

Question 29

The majority of well appearing children w/o source of fever likely have what type of infection?

Answer 29

A nonspecific self-limited viral illness

Question 30

What are 4 main sources of fever in a child >6 months w/immunizations UTD?

Answer 30

1) viral illness 2) UTI 3) pneumonia 4) otitis media

Question 31

When do you do an LP in a 3-36 month old w/a fever?

Answer 31

Toxic appearing or neuro sx only

Question 32

What 2 things do you order in a child <6 months w/a fever w/o a source?

Answer 32

1) UA + UCx | 2) CBC w/diff

Question 33

When do you order a blood culture in a child <6 months w/a fever w/o a source?

Answer 33

If WBC >15K

Question 34

In what age do you do a UA/UCx in females >6 months + UTD immunizations?

Answer 34

<24 months

Question 35

In what age do you do a UA/UCx in males >6 months + UTD immunizations?

Answer 35

<6 months circumcised | <12 months uncircumcised

Question 36

What 2 abx are used in neonates?

Answer 36

Gentamycin (b/c cannot tolerate ceftriaxone-jaundice) + Ampicillin (listeria coverage)

Question 37

What 2 abx are used in 1-3 month olds?

Answer 37

Ceftriaxone + Vancomycin (+ Ampicillin if need listeria coverage)

Question 38

What 2 abx are used in 3-36 month olds?

Answer 38

Ceftriaxone + Vancomycin (if know source-tx source)