Pediatric Fever

neonate, 3, 3

Pediatric Fever: Groups

-< 28 days old (fever in a _______)

-1 - _ months old

-3 months - _ years old

rectal, 100.4, autoimmune, environmental

Pediatric Fever: Background and Etiology

-Definition → ______ temp of ______ F or greater

-Etiology → infection, __________ disease, metabolic disease, inflammatory conditions, medications, excessive ___________ heat, or malignancy 

cytokines, hypothalamus, prostaglandin, elevation

Fever: Pathogenesis

-Release of endogenous pyrogens (_______) into circulation → reach ___________ → release arachidonic acid → acid metabolized to ____________ E → ________ of hypothalamic thermostat

bacterial, UTI, arthritis, feeding, ill, 28, antibiotics, well, closely

Fever in Infants Younger Than 3 Months

-Higher risk of serious __________ infections

• Bacteremia, ___, pneumonia, meningitis, bacterial diarrhea, osteomyelitis, septic ________

-Often don’t show significant symptoms except fever and poor _______

-Infants < 3 months who appear ____ and all infants < __ days

• Admit, workup, empiric __________

-Infants > 4 weeks who are ____ appearing, no history of prematurity or prior antimicrobial therapy

• Some diagnostics, followed _______ Q24H x 72 hours

strep, Salmonella, E.coli, HSV, Shigella

Fever in Infants Younger Than 3 Months: Causes

-Bacteremia

• Neonates → group B ____, E. coli, Listeria

• 1-3 month olds → S. pneumoniae, H. influenzae type B, __________, N. meningitides

-UTI

• _.___, Klebsiella

-Pneumonia

• S. pneumoniae, GBS, S. Aureus

-Meningitis

• GBS, E.coli, Listeria, S. pneumoniae, N. meningitides, Hib, ___, enteroviruses

-Bacterial Diarrhea

• Salmonella, ________, E. coli

-Septic arthritis/osteomyelitis

• S. aureus, GBS

distress, fever, feeding, jaundice

Signs of Sepsis in Neonates

-Grunting 

-Respiratory _________

-Lethargy

-Irritability 

-______ or hypothermia 

-Hypo or hyperglycemia 

-Apnea

-Poor ________

-Cyanotic spells 

-Petechiae 

-Unexplained ___________

CBC, UA, culture, CXR, LP, HSV

Evaluation in Ill Infants < 3 Months and All Infants < 28 Days

-___ with diff → low or high WBCs

-Blood culture

-__ → signs of UTI

-Urine _______

-Blood glucose

-Inflammatory markers (CRP, procalcitonin)

-___ → signs of pneumonia

-__ with CSF evaluation

-Stool studies

-Evaluation for ___ (esp in those < 4 weeks)

fever, UTI, source, ill, without, outpatient

Fever in Children 3 Months to 3 Years

-_____ could still be the only symptom and still have serious bacterial infection

• ____ is the most common

-Most will demonstrate a _______ of infection through history, physical, or simple labs

-Further workup indicated in significantly ___ children or ongoing fever _______ known cause

• Admit significantly ill children

-Children who are fairly well can be treated and/or monitored as an ________

• Follow Q24H x 72 H

ampicillin, negative, Ceftriaxone

Treatment

-Birth to 3 Months 

• IV _________ or cefotaxime + gentamicin 

• Continued until blood, urine, and CSF cultures are _________ or reveal specific pathogen 

- > 3 months 

• ___________ or Cefotaxime + vancomycin initially 

• Tailored if particular pathogen identified 

Immediately

When should these children be seen?

-Child is younger than 3 months

-Fever is > 105

-Child is crying inconsolably or whimpering

-Child is crying when moved or even touched

-Child is difficult to awaken

-Child’s neck is stiff

-Purple dots or spots on the skin

-Child’s breathing is difficult

-Child is drooling

-Convulsion has occurred

-Child acts or looks “very sick”

24 hours

These children should be seen within how many hours?

-Child is 3-6 months

-Fever exceeds 104

-Burning or pain with urination

-Fever has been present for more than 24 hours without an obvious cause or identified site of infection

-Fever has subsided for more than 24 hours and then returned

-Fever has been present > 72 H