Pediatric Fevers Flashcards
Name the 4 serious bacterial infections (SBI)
UTI
Cellulitis
Bacteremia
Bone and Joint infections
Name the 6 invasive bacterial infections (IBI)
Sepsis
Osteomyelitis
Bacterial enteritis
Meningitis
Pneumonia
Pyelonephritis
In under 90 days majority of bacterial infections are due to _______ and the most common bacterial infection is _________ (what organism)
UTI, E. Coli
What are the most common organisms causing bacterial infections in neonates?
-Group B strep, Listeria, E Coli, Chlamydia, Gonorrhea, Klebsiella
What are the most common viral infections in neonates?
HSV, Varicella, Enterovirus, RSV, Influenza
What are the most common causes of bacterial infection in infants (1-3 mo.)?
H. flu, Strep. pneumo, Neisseria meningitidis, E Coli.
Infants older than _ weeks have a decreased risk of having an SBI, more developed immune systems, and are more interactive making physical exams more accurate.
8 weeks
Raises head, crawling movements, visually fixes, alert to sound, what age?
1 month
Holds head midline, lifts chest, smiles socially, what age?
2 months (other lecture ross said social smile at 3 mo.)
Reaches with arms in unison, brings hands midline, looks around, what age?
4 months
Sits unsupported, puts feet in mouth, babbles, stranger danger, what age?
6 months
How are infants immune systems different?
- Decreased opsonin (induces phagocytosis) capabilities
- Decreased macrophage & neutrophil function
- Poor response to encapsulated organisms
At 4 weeks the risk of SBI is __%, by 8 weeks it is _%.
4 weeks 15%
8+ weeks <1%
Which infants can you use protocols on?
Only well appearing young infants (29-59 days old) who were born full term with no comorbidities.
At what age are infants clinically and lab positive?
Infants 60+ days
Can you rely on clinical presentation and labs in infants 29 - 59 days?
Clinically occult (so no) , lab positive (yes)
What is the full work up for neonatal fever under 8 days?
-UA w/ culture
-CRP, procalcitonin (shows sepsis), absolute neutrophils
- 2 blood cultures
-LP w/ viral panel including HSV
-Antibiotics must be onboard
All are admitted to pediatric specialist/FM
(8-21 days same work up & admit)
What is the full workup for neonate age 22-28 days with fever?
Pretty much same as 8-21 days:
- UA w/ culture
-2 blood cultures
- IM (Procalcitonin, ANC, CRP)
-LP for CSF analysis ———> no viral panel?
-Must have antibiotics onboard
All admitted to pediatric specialist/FM
What are the empiric antibiotics for neonates?
Cefotaxime or Ceftazidine (For Gram - >E. coli, Klebsiella)
PLUS
Vancomycin (For Gram + > Group B strep, Listeria)
PLUS
Acyclovir (For HSV)
What is the AAP protocol for infants 29-60 days?
-UA (excludes circumcised males)
-Blood culture
-IM (any one elevated is considered positive)
IM negative —> can observe at home even if UA positive (but must be reliable enough to follow up 12-24hrs), NO LP, only cath if UA positive
If any of the IMs are positive in 29-60 day old infant what is the protocol?
-UA cath & culture
-LP: positive -Admit for IV AB, negative -IV or oral ab can possibly discharge
Ross says any IMs elevated observe in hospital
Antibiotics for >28 days
Ceftriaxone or Ceftazidine
PLUS
Vancomycin
PLUS
Acyclovir (consider HSV risk, risk highest <3weeks)
With fever >8 days what should you consider besides infection?
Kawasaki’s, malignancy
Why should you worry about 1 day HX of fever in unvaccinated infants?
Pneumococcus can kill in 24 hrs, aggressive work up
