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Fever 0-3 months What should be done?

Fever 0-3 months What should be done?. Donna Moro-Sutherland, MD Pediatric Emergency Medicine Physician WakeMed Health & Hospitals. Antibiotic Choices. Ampicillin: 100 mg/kg/dose Gentamicin: 2.5 mg/kg/dose Cefotaxime: 100 mg/kg/dose Ceftriaxone: 100 mg/kg/dose

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Fever 0-3 months What should be done?

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  1. Fever 0-3 monthsWhat should be done? Donna Moro-Sutherland, MD Pediatric Emergency Medicine Physician WakeMed Health & Hospitals

  2. Antibiotic Choices • Ampicillin: 100 mg/kg/dose • Gentamicin: 2.5 mg/kg/dose • Cefotaxime: 100 mg/kg/dose • Ceftriaxone: 100 mg/kg/dose • Not recommended for neonates who have jaundice • Vancomycin: 10-15 mg/kg/dose

  3. Empiric Antibiotic Protocols:Rule out sepsis (ROS) • 0-28 days: • Ampicillin and gentamycin • 29-60 days: • Ampicillin and cefotaxime/ceftriaxone • 60+ days • Cefotaxime or Ceftriaxone

  4. Empiric Antibiotic Protocols • Meningitis < 1 month: • Ampicillin + Gentamicin • Meningitis > 1 month: • Vancomycin + Cefotaxime • add Gent if GNR

  5. Neonatal Herpes Simplex • Acyclovir: 20 mg/kg for HSV

  6. What are the laboratory tests used to determine low risk? • CBC 5-15,000/mm3 • ABC < 1500 or B/N ratio < 0.2 • UA < 10 WBC/hpf • Stool < 5 WBC/hpf • CSF < 8 WBC Blood, urine and CSF cultures

  7. Temp > 38.00C and age 0-3 months Age < 28 days or Toxic appearance No Yes CBC with diff BC UA, UC CSF studies CXR & stool if indicated Consider HSV studies IV antibiotics Admission Baseline High Risk Yes No

  8. 29 days- < 2 months 2- 3 months Option 1 Option 2 CBC with diff BC UA, UC CXR & stool if indicated CBC with diff BC UA, UC +CSF studies* (Understand most will get LP upfront) CXR & stool if indicated CSF studies IV Antibiotics Hospital admission Abnormal lab or xray Yes

  9. 29 days- < 2 months 2- 3 months Option 1 Option 2 CBC with diff BC UA, UC +CSF studies (Understand most will get LP upfront) CXR & stool if indicated CBC with diff BC UA, UC CXR & stool if indicated CSF studies IV Antibiotics Hospital admission Abnormal lab or xray Yes No No Follow up assured in 24h Adequate social situation Parent and PMD agree to outpatient approach Consider Ceftriaxone but only if LP is performed Yes Discharge

  10. 2-3 months Option 1 Option 3 Option 2 CBC with diff BC UA, UC CSF studies CXR & stool if indicated CBC with diff BC UA, UC UA, UC

  11. What if the infant has RSV?....

  12. < 28 days 29 days - 2 months RSV+ RSV+ Option 2 Option 1 CBC with diff BC UA, UC CSF studies CXR Stool if indicated IV antibiotics Admission CBC with diff BC UA, UC UA, UC Rarely done!

  13. 29 days - 2 months RSV+ Option 2 Option 1 CBC with diff BC UA, UC UA, UC CBC with diff BC CSF studies CXR IV antibiotics Admission Abnormal labs Yes

  14. What do we know… • 0-28 days with fever • Risk too great for SBI • 29-90 days • Low risk groups can be identified • Presence of RSV, influenza and other recognizable viral illnesses is associated with a decreased incidence of SBI, but not absence of SBI

  15. What else do we know… • 0-28 days with fever • Sepsis work up • Consider Viral testing • Admission and antibiotics • 29-59 days • Sepsis work up (CSF cultures may be omitted in a select population) • If Viral testing done: • If high risk: admit and treat with antibiotics • If low risk: admit/observe vs discharge and follow up

  16. Finally…. • 60-89 days • More mature, immunologically and socially • Most fever caused by viral illness • Incidence of SBI lower • No consensus for evaluation of fever without a source • UA with urine culture in all…. • CBC with BC

  17. Empiric Antibiotic Protocols:Rule out sepsis (ROS) • 0-28 days: • Ampicillin and gentamycin • 29-60 days: • Ampicillin and cefotaxime/ceftriaxone • 60+ days • Cefotaxime or Ceftriaxone

  18. Empiric Antibiotic Protocols • Meningitis < 1 month: • Ampicillin + Gentamicin • Meningitis > 1 month: • Vancomycin + Cefotaxime • add Gent if GNR

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