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Study Notes Pediatrics

Study Notes Pediatrics

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Study Notes Pediatrics
Study Notes Pediatrics

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Published by: MedShare on Apr 01, 2010
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11/06/2015

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* 5mo infant presents with 39ºC fever. Mother states child is less active and has a decreased appetite. On physical
exam, no focus of infection can be found. This is a common dilemma for the pediatrician.
* Definition of fever is temp > 38ºC (100.4ºF) rectally.
* Fever of short duration without localizing signs is short duration. Fever without focus is less than a week in
duration in children less than 36mo of age. Fever of unknown origin, a specific diagnosis meaning fever > 14d in
child and > 21d in adolescent or adult.
* Fever without focus occurs in about 5% of children less than 36mo of age.
* Babies are immuno-naïve. They are at higher risk to develop many infections, septic arthritis, meningitis, sepsis.
* Children under 24mo are at very high risk for infection. Sometimes not very specific signs of symptoms.
* Organisms that may be responsible are group B strep, E. coli, listeria. Others include salmonella, neisseria.
* Most common cause of fever in children (and adults) is viruses.
* Children older than 3mo of age with temps > 38.9 (102) are at risk for fever without a focus (occult bacteremia).
* We can get bacteremia by brushing our teeth, but we clear it easily.
* What should you order on these patients? CBC with differential and smear. May see Döhle bodies on a smear.
* Risk factors for occult bacteremia include age < 24mo, fever > 104, WBC > 15000.
* Order CBC and blood culture first. May toss in urine. Culture any suspicious lesions.
* If child has sickle cell disease, be suspicious for pneumococcal infections.
* Risk factors also include AIDS, immunodeficiencies, sick contacts, toxic clinical appearance and petechia.
* All infants less than a month age with fever and suspicion for infection should be admitted to the hospital and
started on antibiotics. If cultures are negative, then consider stopping antibiotics.
* If less than a month of age, cover group B strep, listeria, E. coli, meaning start ampicillin and 3rd generation
cephalosporin or ampicillin and an aminoglycoside.
* Children > 1mo of age who appear well and have been in good health are unlikely to have serious illness if their
counts are between 5-15000 and absolute band count less than 1500. You may give ceftriaxone (or cefotaxime plus
ampicillin) if they appear well without a source for the fever while waiting for cultures. If they appear ill, admit.
* Third generation cephalosporins to no cover listeria well so ampicillin is given.
* Follow up with a phone call, have the child come back, check cultures.
* 18mo child presents with temperature of 39ºC, the patient is alert and happy. The mother states that the child has
been eating well, has good urine output, and has no evidence of localized infection.
* Most common organism for occult bacteremia is strep pneumonia in this age group.
* Blood culture should be performed whenever you suspect occult bacteremia. Count > 15000 is high risk for having
a positive blood culture.
* Without therapy, occult bacteremia may resolve spontaneously in this age group or lead to localized infection such
as meningitis or septic arthritis.
* Non-toxic patients get empiric therapy with third gen cephalosporin and follow-up.
* Toxic patients should consider spinal tap, start antibiotics, admit.
* If positive blood culture and child looks better, may not need to treat further.

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