WEEK 1 Pediatric Fever Flashcards
E.coli is a common organism that causes early onset sepsis in the neonate. true or false
true
All neonates with fever should receive empiric treatment with IV antibiotics. true or false
true
Early onset group B strep infection in a baby occurs in the first 24 hours to 2 weeks, and late onset occurs at 2 weeks up to 4 weeks of age. true or false
false
Signs and symptoms of sepsis in the neonate include progressive jaundice, poor feeding, and a temperature less than 35.5 degrees C. true or false
true
All neonates with fever should receive a full sepsis work up. true or false
true
What substance travels to the hypothalamus to signal the body to retain and generate more heat?
pyrogens
What part of the brain regulates body temperature?
hypothalamus
What is a fever in an infant under 2months?
Over 2 months?
Under 2 months = 100.4 or 38
Over 2months = 101 or 38.3
What are the differentials for fever? #6
- bacterial infection
- immunization reaction
- autoimmune & inflammatory disease
- cancer (lymphoma & leukemia)
- medication (abx & seizure)
- tissue damage
List the cause of febrile illnesses in neonates
- Infection acquired at delivery
- group B strep
- In nursery
- At home
- Pneumococcal
- Meningococcal
- Anatomic or Physiologic dysfunction
- Renal
- What is the gold standard for measuring temperature for children less than 3 years?
- When would you use an axillary temp?
- Rectal Thermometer
- Neutropenia cases (rectal temp can tear rectal skin and introduce bacteria)
The mother of a 12-month-old calls the clinic because her son has had a fever of 101.5 for 2 days, and she just noticed a rash on his torso. Which of the following questions is most helpful in determining if the rash may be due to a serious bacterial infection?
Does the rash blanch under pressure?
A 65-day-old male with no PMH presents for a fever of 101 degrees F for 8 hours. The infant received his 2 month vaccines yesterday. He is well-appearing and he has no red flags on history or exam. The nurse practitioner should
Order nothing and recheck the patient in 24 hours
A 40-day-old female born at term presents with a fever of 100.9 F for 12 hours. She has no PMH, takes no medications, she is feeding well, and has normal urine output and stool. Her ROS is negative. The child is nontoxic appearing and has an otherwise normal exam. The FNP understands that the infant will require:
UA, urine culture, and CBC/diff, PCT, CRP, and blood culture
How would you manage a low-risk well-appearing young infant 29-90 days old with Fever without a source?
CBC w/diff
Blood cultures
Catheterized UA & UC
PCT & CRP
CXR if not bronchiolitis
F/U 12-24 hours if labs normal & parents reliable
How would you manage a febrile Neonate (under 28 days) with fever?
Hospitalization
Full Septic work up
LP
CXR
Stool culture
THEN antibiotics an possibly acyclovir
How would you manage an ill-appearing febrile young infant (29-60 days) ?
Hospitalization with full work up
what labs for a febrile, well appearing infant (60-90 days old)?
U/A & U/C
CBC w/differential
BC
PCT
Any child under 2 years old with fever without focus warrants _____ ?
Urinalysis and Urine culture
What lab findings would constitute a preliminary diagnosis of UTI?
- Urine leukocyte esterase
- Nitrites
- Leukocyte count
- Gram stain
What do non-blanching rashes like petechiae and purpura indicate?
Bacteremia
What are some differential diagnoses for Fever without focus?
-
Bacterial infections (usually E. coli)
- Bacteremia
- Pneumonia
- UTI
-
Viral infection *most common*
- Influenza
- RSV
- Enterovirus
-
Noninfectious
- Kawasaki disease
- Autoimmune or inflammatory
- Immunization reaction
What antibiotics would you prescribe to a neonate with a fever without focus?
Ampicillin AND cefotaxime or gentamicin
What would you prescribe a neonate under 28 days if HSV was a concern?
Acyclovir