Week 1: Pediatric Fever Flashcards
How is a fever defined in:
A child <2mo
A child >3mo
<2mo: 100.4F
>3mo: 101F
What should you suspect in a fever >105.8?
At what temperature may brain damage occur?
CNS dysfunction
107.6
How is fever without focus defined?
Acute fever of unknown etiology after thorough evaluation of a child less than 24 months old
What is the typical causative agent of fever in children?
Viral cause of most fevers (RSV, influenza, enterovirus, rotavirus, adenovirus, HSV, parechovirus)
What criteria indicates automatic inpatient sepsis workup?
Fever > 100.4F in neonate (<3 mo) and ill appearing
What should the workup plan be for an infant with fever between 29-60 days old?
may work up outpatient if uncomplicated course/not toxic appearing (low risk criteria)
If high risk - admit for testing
What should the workup plan be for an infant with fever between 60-90 days old?
UA/culture, CBC, culture, PCT outpatient if well appearing
What are the red flags for serious bacterial infection (SBI)?
Ill/toxic appearing (even in absence of fever) Dusky, ashen, blue Lethargy, weak, poor feeding Tachypnea/tachycardia Low UOP Bulging fontanel Unreliable caregivers
When is a UA w/culture required vs. recommended as part of the workup for fever?
required for all infants < 3 m.o
recommended toddler 3-24 m.o, T > 102.2, female < 12 m.o, uncircumcised males, fever > 24-48 hours
What are the most common SBIs?
UTI, PNA, bacteremia
Occult bacteremia d/t E. coli 🡪 birth – 24 mo at risk
E. coli 🡪 leading cause of UTI/meningitis
Group B Strep 🡪 2nd leading cause of UTI/meningitis
What is the management plan for pediatric fever?
First line: Acetaminophen 10-15 mg/kg q 4-6
2nd line: Ibuprofen 5-10 mg/kg/dose q 6-8 hrs (only if > 6 mo, dose dependent on temp)
Non-pharm intervention: Tepid water baths/room temp around 72 deg – no ice baths/alcohol sponging
How is fever of unknown origin defined?
T > 101F on several occasions, more than 3 weeks duration, failure to reach diagnosis despite 1 week of thorough evaluation
What are common causes of FUO?
< 6 y.o – most commonly UTI/pyelonephritis, URI, localized infection, juvenile arthritis, leukemia
Adolescents – TB, IBD, autoimmune disorders, STI, abscesses, lymphoma
Consider EBV, Lyme
Which children are at higher risk for UTI?
Uncircumcised males <6mo
All females >6mo
What is an uncomplicated vs. complicated UTI?
Uncomplicated: > 2y.o, lower UTI, no comorbidities, routine pathogen
Complicated: < 2 y.o, upper UTI, comorbidities, abnormal anatomy, drug resistant pathogen
