Pediatric Fevers

Question 1

Name the 4 serious bacterial infections (SBI)

Answer 1

UTI
Cellulitis
Bacteremia
Bone and Joint infections

Question 2

Name the 6 invasive bacterial infections (IBI)

Answer 2

Sepsis
Osteomyelitis
Bacterial enteritis
Meningitis
Pneumonia
Pyelonephritis

Question 3

In under 90 days majority of bacterial infections are due to _______ and the most common bacterial infection is _________ (what organism)

Answer 3

UTI, E. Coli

Question 4

What are the most common organisms causing bacterial infections in neonates?

Answer 4

-Group B strep, Listeria, E Coli, Chlamydia, Gonorrhea, Klebsiella

Question 5

What are the most common viral infections in neonates?

Answer 5

HSV, Varicella, Enterovirus, RSV, Influenza

Question 6

What are the most common causes of bacterial infection in infants (1-3 mo.)?

Answer 6

H. flu, Strep. pneumo, Neisseria meningitidis, E Coli.

Question 7

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.

Answer 7

8 weeks

Question 8

Raises head, crawling movements, visually fixes, alert to sound, what age?

Answer 8

1 month

Question 9

Holds head midline, lifts chest, smiles socially, what age?

Answer 9

2 months (other lecture ross said social smile at 3 mo.)

Question 10

Reaches with arms in unison, brings hands midline, looks around, what age?

Answer 10

4 months

Question 11

Sits unsupported, puts feet in mouth, babbles, stranger danger, what age?

Answer 11

6 months

Question 12

How are infants immune systems different?

Answer 12

1. Decreased opsonin (induces phagocytosis) capabilities
2. Decreased macrophage & neutrophil function
3. Poor response to encapsulated organisms

Question 13

At 4 weeks the risk of SBI is __%, by 8 weeks it is _%.

Answer 13

4 weeks 15%
8+ weeks <1%

Question 14

Which infants can you use protocols on?

Answer 14

Only well appearing young infants (29-59 days old) who were born full term with no comorbidities.

Question 15

At what age are infants clinically and lab positive?

Answer 15

Infants 60+ days

Question 16

Can you rely on clinical presentation and labs in infants 29 - 59 days?

Answer 16

Clinically occult (so no) , lab positive (yes)

Question 17

What is the full work up for neonatal fever under 8 days?

Answer 17

-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)

Question 18

What is the full workup for neonate age 22-28 days with fever?

Answer 18

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

Question 19

What are the empiric antibiotics for neonates?

Answer 19

Cefotaxime or Ceftazidine (For Gram - >E. coli, Klebsiella)
PLUS
Vancomycin (For Gram + > Group B strep, Listeria)
PLUS
Acyclovir (For HSV)

Question 20

What is the AAP protocol for infants 29-60 days?

Answer 20

-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

Question 21

If any of the IMs are positive in 29-60 day old infant what is the protocol?

Answer 21

-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

Question 22

Antibiotics for >28 days

Answer 22

Ceftriaxone or Ceftazidine
PLUS
Vancomycin
PLUS
Acyclovir (consider HSV risk, risk highest <3weeks)

Question 23

With fever >8 days what should you consider besides infection?

Answer 23

Kawasaki’s, malignancy

Question 24

Why should you worry about 1 day HX of fever in unvaccinated infants?

Answer 24

Pneumococcus can kill in 24 hrs, aggressive work up