Fever in Infants Less than 60 Days
Feb 1 2018 For report of tactile fever
SSM Health
Fever in neonates (age 0 to 28 days) Infant ? 28 days of life ... •Infants with gestational age less than 37 weeks congenital medical.
CHOC
Inclusion Criteria: Previously healthy children 0-90 days of age who have: • Fever 38.0° C or <28 days old. Interventions. • Blood & urine cultures.
Fever Without Source in Infants < 28 Days Care Guidelines For
Obtain an Infectious Disease consult if Acyclovir is to be continued more than 48 hours or if index of suspicion for HSV is high. Afebrile Neonates. Acyclovir
Fever in Neonates & Infants
Neonates (?28 days of age) and young infants (29-60 days of age) with fever account for a significant number of emergency department (ED) visits.
General Best Practice for Immunization; Epidemiology and
about recommended travel vaccines (e.g. yellow fever
Clinical Practice Guidelines for Febrile Infants
Infants with gestational age less than 37 weeks with congenital medical Infants <7 days or >60 days of age
Fever Without a Source Clinical Guideline
While viral infections are the most common cause of fever in young infants neonates less than 28 days have a particularly higher risk of invasive bacterial
Febrile illness - Emergency management in children
Jul 25 2022 Fever is defined as a temperature greater than or equal to 38°C. ... Neonates (age less than 28 days) and children who are not fully ...
Community Acquired Pneumonia (CAP) Complicated
Sep 27 2016 Effusion opacity greater than ¼ but less than ½ of thorax ... consider these CCGs: Infant fever less than 28 days and infant.
[PDF] Fever in Infants Under 28 Days of Age SSM Health
The most common cause of fever is usually a self- limited viral infection but the incidence of serious bacterial infections (SBI) may be higher in infants
[PDF] Fever Without Source in Infants < 28 Days Care Guidelines - CHOC
In general febrile infants < 28 days should be considered at high risk for SBI and thus undergo a full septic work-up hospital admission and empiric
The febrile infant (29 to 90 days of age): Outpatient evaluation
21 fév 2023 · The outpatient evaluation of febrile infants 29 to 90 days old is discussed in this topic For a discussion of the management of febrile
[PDF] The Febrile Neonate and Young Infant
Axillary - least invasive; less accurate Generally 1 0 to 1 8 F lower than rectal temperature Febrile neonate- < 28 days old- risk SBI 10
[PDF] Fever in Neonates & Infants - TREKKca
Neonates (?28 days of age) and young infants (29-60 days of age) with fever Most experts agree that a temperature of ?38 0°C or greater is a fever
[PDF] Fever in Young Infants - TREKKca
Neonates (less than or equal to 28 days of age) and young infants (29-60 days of age) with fever account for a significant number of
[PDF] ANMC Clinical Guideline: Fever in Infants 0-90 days old
Children's Hospital of Philadelphia – Emergency Department Clinical Pathway for Evaluation/Treatment of Febrile Infants Less than 56 Days Old 2019 August
[PDF] The New and Nuanced Ways to Evaluate Fever in Infants Aged less
Fever in Infants Aged less than 60 days ? Beech Burns MD MCR ? Associate Professor of Pediatrics and Emergency Medicine
[PDF] Diagnosis and Management of Febrile Infants (0–3 months
Historically febrile infants less than 3 months of age would undergo a complete evaluation for sepsis including a lumbar puncture and would be admitted to a
[PDF] Febrile illness - Emergency management in children
The management of children with an unexplained fever for greater than one In neonates (age less than 28 days) temperature should be measured using an
What should I do if my 3 week old has a fever?
Call your baby's healthcare provider right away if your baby is younger than 3 months old and has a rectal temperature or forehead (temporal) of 100.4°F (38°C) or higher. This is an emergency. You will need to take your baby to the closest emergency room (ER) for assessment.What is a fever in neonates protocol?
FEVER DEFINITION — We regard a rectal temperature of ?38°C (100.4°F) as fever in infants 29 to 90 days old. Most studies establishing the risk of serious infections in febrile young infants have relied upon rectal temperatures. Thus, they are the standard for detecting fever in infants ?90 days old.21 fév. 2023Why do I have a fever under 3 months?
Fever in an infant who is less than 3 months old is cause for concern. “A fever in this age group can be a sign of a serious bacterial infection that requires urgent medical treatment,” says Dr. Seth Gregory, a Mayo Clinic Health System pediatrician.- The Rochester criteria identify febrile infants ? 60 days of age at low-risk for bacterial infection if they satisfy all of the following criteria: 1) well-appearing 2) born at ? 37 weeks gestation and previously healthy, 3) no source of infection present on exam, 4) peripheral white blood cell (WBC) count 5,000 to
Fever Without Source in Infants < 90 Days
Care Guideline
Inclusion Criteria: Previously healthy children 0-90 days of age who have:Fever 38.0° C or greater
No apparent focus of infection
Require hospitalization for concern for serious bacterial infection (SBI) or not meeting criteria for outpatient managementExclusion Criteria:
PICU status
Assessment
Vital signs
Hemodynamic stability
Signs of sepsis
Determination of risk for SBI
Continuous pulse oximetry if
respiratory distress, hypoxia present or pneumonia issuspectedReassess the appropriateness of Care Guidelines as condition changes and 24 hrs after admission. This guideline is a tool to aid
clinical decision making. It is not a standard of care. The physician should deviate from the guideline when clinical judgment so
indicates. Approved Evidence-Based Medicine Committee5-20-15; Reviewed 7-18-18
Prior versions: 12-16-09, 1-20-10 and 09-18-2013
28 - 90
days old© 2018 Children's Hospital of Orange County
<28 days oldInterventionsBlood & urine cultures
CBC with diff, u/a
Lumbar puncture
CXR if signs of pneumonia
Apnea monitor
Stool Culture if diarrhea plus
blood or mucusAntibiotic Dosing Guidance
Ampicillin
50 mg/kg IV q 12 h
< 7 days, < 2000g > 7 days, < 1200g OR50 mg/kg IV q 8 h
<7 days, > 2000g > 7 days,1200g-2000g > 7 days, > 2000g, non-meningitis OR100 mg/kg IV q 8 h
<7 days any weight, GBS meningitisOR 100 mg/kgIV q 6 h
>7 days any weight, GBS meningitis ANDCefotaxime
50 mg/kg IV q 12 h
< 7 days, < 2000g > 7 days, < 1200g OR50 mg/kg IV q 8 h
<7 days, > 2000g > 7 days, 1200-2000g OR50 mg/kg IV q 6 h
> 7 days, > 2000g, non- meningitis OR75 mg/kg IV q 6 h
>1 month; pneumococcal meningitisInterventions - Option 2
Blood & urine cultures
+/- Lumbar punctureCXR if signs of
pneumoniaObservation: no
antibioticsDoes Patient Meet Low Risk Criteria?Non-toxic appearing
Previously healthy term infant with uncomplicated
nursery stayNo focal bacterial infection apparent on exam
WBC 5-15,000/mm
3 < 1500 bands/mm 3Urinalysis: < 5 WBC/hpf and negative leukocyte
esterase and nitrite Stool with negative blood, negative mucus: < 5 WBC/hpf stool, if doneCSF < 8 WBC/ul and negative Gram stain (if done)
CXR negative (if done)
Interventions - Option 1
Blood & urine cultures
Lumbar puncture
CXR if signs of
pneumonia*Antibiotics
Ceftriaxone 50 mg/kg IV
q 12 hr YesNo * Signs of pneumoniaRespiratory signs (i.e.
abnormal breath sounds, tachypnea)Respiratory symptoms
(i.e. cough)Respiratory distress
SaO2 < 95%Continued on
page 2Interventions
Blood & urine
culturesLumbar puncture
CXR if signs of
pneumoniaAntibiotics
Ceftriaxone 50 mg/
kg IV q 12 hrSuspected bacterial
meningitis requires significant additional managementAntibioticsAmpicillin AND Cefotaxime
Interventions
CBC with diff, u/a
Stool Culture if diarrhea plus
blood or mucusCXR if signs of pneumonia
Consider Lumbar Puncture
Recommendations/Considerations
If planning to treat with antibiotics, would obtain all cultures, including Lumbar Puncture, beforehand. Due to difficulty in evaluation of behavioral state, decreased immune function, potential pathogens, & higher frequency of SBI in infants < 90 days of age, a structured clinical approach is mandated. Serious bacterial infections include bacterial sepsis, pneumonia, meningitis, UTI/pyelonephritis, cellulitis, septic arthritis, osteomyelitis, & bacterial enteritis. Goal of management strategy is to identify those at low risk for SBI & thus reduce the need for either or both hospital admission & antibiotic exposure.Infants < 90 days with an apparent focus of
bacterial infection should, in general, be considered as high risk, i.e., full septic evaluation, hospital admission, & appropriate antibiotics. These patients should not be included in this guideline.In general, febrile infants <28 days should be considered at high risk for SBI & thus undergo a full septic work-up, hospital admission, & empiric antibiotics.
Always consider evaluation and treatment for
possible herpes simplex infection (HSV PCR and intravenous acyclovir) in meningitis or sepsis syndrome especially in infants 0-6 wks (seeStatement on Acyclovir Therapy in Neonates on
next page).Consider viral studies (VRP, rapid viral screen,
CSF/blood PCR, viral culture) in the febrile infant especially during the enteroviral season and respiratory viral season. Keep in mind that a positive viral test does not preclude the possibility of SBI. Criteria for outpatient management include age 28-90 days, non-toxic appearance, meeting low risk
criteria, reliable parents, secure follow-up, & access to timely medical care.Fever Without Source in Infants < 90 Days
Care Guideline
Page 2
Discharge Criteria
Vital signs & clinical status are
stableBacterial cultures are negative
Follow-up care is coordinated
28 - 90 days old
May discharge at 36 hrs if:
Cultures negative
Afebrile
Good follow-up available
Continued Considerations
When meningitis can be
excluded, adjust antibiotics to non-meningitic dosing Adjust antibiotics per culture results, LP results, and clinical statusD/C antibiotics if cultures
negative or VRP/viral study positive and no other high risk criteria metRe-evaluate if worsening signs
& symptomsContinued from
page 1Parent Education
Fever in Infants 0-
90 days old
(locatedPatient in Family
Education on PAWS)
Significant Additional Management for Suspected
Bacterial Meningitis
ICU monitoring
Conservative fluid management
Vancomycin
Electrolyte monitoring
Frequent neuro checks, serial head circumference
References
Fever Without Source in Infants < 90 Days
Care Guideline
Avner JR, Baker, MD. Management of Fever in Infants and Children. Emergency MedicineClinics of North America, Feb 2002, 20(1): 49
-67. Baraff LJ. Management of Infants and Young Children With Fever Without Source. PediatricAnnals, Oct 2008; 37(10) 673
-679. Baraff LJ Management of Fever Without Source in Infants and Children. Annals of EmergencyMedicine, Dec 2000; 36: 602
-614.9/abstract
Biondi EA, Mischler M, et. al. Blood Culture Time to Positivity in Febrile Infants with Bacteremia; Sep 2014. JAMA Pediatrics, 168(9): 844 -849. Byington CL, Enriquez FR, et al. Serious Bacterial Infections in Febrile Infants 1 to 90 days Old With and Without Viral Infections. Pediatrics 2004; 113: 1662 -1666. http:// Kadish HA, Loveridge B, et al. Applying Outpatient Protocols in Febrile Infants 1 -28 Days of Age: Can The Threshold Be Lowered? Clinical Pediatrics 2000, 39: 81 -88. Levine DA, Platt SL, et al. Risk of Serious Bacterial Infection in Young Febrile Infants with Respiratory Syncytial Virus Infections. Pediatrics, Jun 2004; 113: 1728-1734. 7 /18/18 1CHOC Children's Evidence Based Medicine Committee
Statement on Acyclovir Therapy in Neonates
Neonates < 4 weeks with fever:
Parenteral acyclovir (20 mg/kg IV q8hours) should be added empirically to antibiotics for neonates admitted with fever in
the following situations;1. Clinical signs of sepsis, toxic (including hypothermia, apneas, hypotension, other signs of shock)
2. Seizure
3. Maternal HSV
4. Physical exam findings consistent with Herpes simplex involvement (skin, eye, mucous membrane)
5. CSF pleocytosis with negative gram stain and consistent with aseptic meningitis.
Anytime acyclovir therapy is started on neonates one should perform a lumbar puncture and send the cerebrospinal
fluid for HSV PCR.In high risk situations where there is concern for disseminated HSV or SEM disease please send whole blood for HSV
PCR, obtain swabs for HSV viral culture of at least 3 different mucous membrane (i.e. mouth, conjunctiva,
nasopharynx, rectum), and any skin lesions and a panel 18. Obtain an Infectious Disease Consult.Because of the risk of renal toxicity, patients on intravenous acyclovir should receive maintenance IV fluids and have
urine dipped for heme q shift to evaluate for early evidence of nephrotoxicity.In the absence of the above findings, in the neonates admitted with fever, the following scenarios demand specific
attention.1. Traumatic lumbar puncture: attempts to interpret traumatic CSF may lead to serious misdiagnoses. CSF with
RBC > 2000 should be interpreted with caution and should be dealt with on an individual basis.2. Unsuccessful lumbar puncture: same as above; increased LFTs and low platelets would be suggestive of
disseminated HSV. These neonates are addressed above.3. Strongly consider adding acyclovir in the presence of:
a. Decreased platelets b. Increased liver function tests (LFTs), if done c. PneumoniaIn these scenarios when the infant appears more ill than would be expected, the physician's judgment should be used to
determine acyclovir use on a case by case basis.Obtain an Infectious Disease consult if Acyclovir is to be continued more than 48 hours or if index of suspicion for HSV is
high.Afebrile Neonates
Acyclovir should empirically be given to patients admitted with seizure and or physical exam findings consistent with
Herpes simplex involvement (skin, eye, mucous membrane) and/or altered mental status. 2References:
1. Kimberlin DW, Lin CY, Jacobs RF, Powell DA, Frenkel LM, Gruber WC, et al. Natural history of neonatal herpes
simplex virus infections in the acyclovir era. Pediatrics 2001;108:223-9.2. Long S. In defense of empiric acyclovir therapy in certain neonates. J Pediatr 2008:1153:157-8.
3. Caviness AC, Demmier G, Almendarez Y, Selwyn BJ. The prevalence of neonatal herpes simplex virus infection
compared with serious bacterial illness in hospitalized neonates. J Pediatr 2008:153:164-9.4. Whitley R, Arvin A, Prober C, Burchett S, Corey L, Powell D, et al. A controlled trial comparing vidarabine with
acyclovir in neonatal herpes simplex virus infection. Infectious Diseases Collaborative Antiviral Study Group. N
Engl J Med 1991;324:444-9.
5. Kimberlin DW, Lin C-Y, Jacobs RF, et al, and the National Institute of Allergy and Infectious Diseases
Collaborative Antiviral Study Group. Safety and efficacy of high-dose acyclovir in the management of neonatal
herpes simplex virus infections. Pediatrics. 2001;108:230-2386. Kimberlin DW. When should we initiate acyclovir in a neonate? J Pediatrics 2008; 153:155-6.
7. Pinninti SG and Kimberlin DW. Maternal and Neonatal Herpes Simplex Virus Infections. Am J Perinatol
2013;30:113-120.
8. Pinninti SG and Kimberlin DW. Neonatal Herpes Simplex Virus Infections. Pediatr Clin N Am 2013;60:351-365.
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