Скачать или смотреть Pediatrics – Fever in a Neonate, Fever in a Child: By Hosanna Au M.D.

medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME.

Pediatrics – Fever in a Neonate, Fever in a Child
Whiteboard Animation Transcript
with Hosanna Au, MD
https://medskl.com/module/index/fever...


Fever is a common feature of many disease processes. It is an elevation in body temperature mediated by the hypothalamus as a physiologic response to an insult. In children, fever most commonly results from infectious, inflammatory, or malignant processes. By far, the most common cause of fever in children is infection.

Although there are various locations where a child’s temperature can be measured, in neonates and young children, a rectal measurement is most definitive, whereas an oral temperature is best in older children. A fever is generally defined as any temperature ≥38ºC (100.4ºF) using oral or rectal thermometers.

Contrary to popular belief, fever in itself is not harmful, but rather signals caretakers and physicians to search for an underlying process that can be harmful. The goal in evaluating a febrile infant or child is to identify the underlying cause of the fever.

Infants and children with the following features are at a high risk for developing serious bacterial or viral infections (such as meningitis or bacteremia) or serious viral infection and warrant a full septic workup:

Ill-appearing infant or child, regardless of age.1,2

Fever in all neonates younger than 28 days regardless of clinical appearance.1,2

Any neonate with findings suggesting HSV infection upon examination (e.g. mucocutaneous vesicles, seizures, or focal neurologic findings), especially those with maternal risk factors for vertical transmission.1,2

Infants up to 3 months of age with clinical and/or laboratory factors that are high risk for serious bacterial infections.1,2

Strongly consider a full septic workup in unimmunized infants.1,2

A full septic workup includes a complete blood count with differential, blood cultures and sensitivity, urinalysis, urine culture and sensitivity, cerebrospinal fluid analysis and cerebrospinal fluid culture and sensitivity or viral studies. Other investigations may be required depending on the clinical presentation such as a throat culture, chest x-ray if there are respiratory symptoms or stool microbiological studies if gastrointestinal symptoms are present.

The main reason for treating a fever is to reduce discomfort in the child. Children should wear light-weight clothing and drink lots of fluids. Medications such as acetaminophen or ibuprofen will help keep the child comfortable and reduce any associated pain. Caregivers should be notified not to use aspirin because of its association with Reye’s syndrome.

It is important to determine the cause of the fever and treat the underlying condition. In the case of infection, management may include empiric broad spectrum antibiotics or antivirals, or narrow spectrum antimicrobials to target a specific infection.