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Evaluation of Fever in Infants and Young Children

Evaluation of Fever in Infants and Young Children. Jennifer L. Hamilton, MD, PhD, FAAFP, Drexel University College of Medicine Sony P. John, MD, Chester County Hospital. Fever. In children less then 36 months of age has the potential for serious consequences. Urine Testing. Important!

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Evaluation of Fever in Infants and Young Children

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  1. Evaluation of Fever in Infants and Young Children Jennifer L. Hamilton, MD, PhD, FAAFP, Drexel University College of Medicine Sony P. John, MD, Chester County Hospital

  2. Fever • In children less then 36 months of age has the potential for serious consequences

  3. Urine Testing • Important! • Higher incidences of Urinary Tract Infections are occuring in children • UTI’s are the most common source of infection in children less than 3 months old • UTI’s are the second most common source of infection in children 3-36 months old (pneumonia is the first)

  4. Signs of serious bacterial infections • Cyanosis • Poor peripheral circulation • Petechial rash • Inconsolability

  5. Define a fever • A clinically significant fever in children younger than 36 months old is a rectal temperature of 100.4 F or greater • Axillary, tympanic and temporal artery measurements have been shown to be unreliable.

  6. Neonates (up to 28 days old) • When parents report a clinically significant fever they may have a serious bacterial infection, even if they do not have a fever at the time of their initial medical evaluation

  7. Teething • Teething is rarely associated with a fever of more than 100.4 F

  8. History and Physical • The history and physical exam cannot identify all children with serious bacterial infection • Judicious use of imaging and laboratory testing is valuable

  9. U Bags • Urine cultures taken from a urinary bag have an 85% false positive rate

  10. Labs • WBC counts and absolute neutrophil counts have been used to identify serious bacterial infection, including occult bacteremia

  11. Current Guidelines • Complete blood count with differential and blood cultures for infants 3 months or younger with a fever

  12. Diarrhea • In neonates and young infants, diarrhea with a fever suggest a systemic illness • Stool culture and fecal WBC counts are recommended

  13. Lumbar Puncture • LP’s are recommended for all febrile neonates • Infants and children WITH clinical signs of meningitis should also have an LP

  14. Flu • Children who test positive for influenza are unlikely to have a coexistent serious bacterial infection • They still have significant risk for UTI • Patients who test positive for influenza do not need more invasive testing

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