12/3/1389 1. A PPROACH TO A CHILD WITH FEVER 12/3/1389 3.

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APPROACH TO A CHILD WITH FEVER

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DEFINITIONFever: elevated body temperature

due to change in hypothalamic set point

Hyperthermia: elevated body temperature due to environmental heat, dehydration, overclothing, excessive internal heat production

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NORMAL BODY TEMPERATURE

Rectal : 38.3⁰С , most sensitive, infants

Oral: 37.8⁰С, sensitive, > 5 yr

Axillary: 37.2⁰С, less sensitive, 1-5 yr

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INDICATIONS OF TREATMENT OF FEVER

High fever( > 39⁰C)Chronic cardiopulmonary disordersChronic metabolic disordersNeurologic disordersRisk of febrile convulsion

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CONTROL OF FEVER

Acetaminophen Ibuprofen Combined acetaminophen and ibuprofen No aspirin No diclofenac Na No corticosteroid External cooling : in hyperthermia, very

young infants, severe liver disease, neurologic disorder

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TABLE 2 Criteria for Identifying Febrile Infants at Low Risk for Serious Bacterial Infection Infant appears generally well Infant has been previously healthy: Born at term (>=37 weeks of gestation) No perinatal antimicrobial therapy No treatment for unexplained hyperbilirubinemia No previous antimicrobial therapy No previous hospitalization No chronic or underlying illness Not hospitalized longer than mother Infant has no evidence of skin, soft tissue, bone, joint or ear infection Infant has these laboratory values: White blood cell count of 5,000 to 15,000 per mm3 (5 to 15 3 109 per L) Absolute band cell count of ¾1,500 per mm3 (¾1.5 3 109 per L) Ten or fewer white blood cells per high-power field on microscopic examination of urine Five or fewer white blood cells per high-power field on microscopic examination of stool in infant with diarrhea

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Main questions in febrile child

Comments

Predisposing condition

Pharyngeal dyscoordination( aspiration pneumonia); CHD( endocarditis); immune deficiency( neutropenia, cycle cell disease); CF( pneumonia); CSF shunt( shunt infection); recent head trauma( meningitis); post operation( atelectasis)

Common sources of infection

Mostly upper respiratory tract infections, gastroenteritis, nonspecific viral infections …. Serious bacterial infections

Age <1 mo: all admit 1-3 mo: admit if high risk3- 36 mo: 4% risk of bacteremia in well appearing > 36 mo: low risk of SBI

Toxicity Admission in hospital, empiric AB for sepsis/meningitis

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