Term
| Pediatric Fever Epidemiology |
|
Definition
• 15% of visits to pediatricians
• Children average 4–6 fevers in first 2
years of life
• Only 1% under 2 months of life
• Most common November to March |
|
|
Term
|
Definition
• Thermoregulatory center of hypothalamus
• Peripheral/central receptors
• Maintain “set point”
• Heat generation vs. heat conservation
• Cytokine/acute phase mediated change
• Host response |
|
|
Term
| Clinical Manifestations of Fever |
|
Definition
• “Hot”
• “Fussy”
• Chills (as set point rises)
• Flush (as set point falls) |
|
|
Term
|
Definition
• 98.6° (37.0°)
-Wunderlich (1868)
-1 million axillary temps in 25,000 adults
• Diurnal variation
• Age, gender, activity, ambient temp
• Children with CNS abnormalities |
|
|
Term
|
Definition
• Esophageal
• Rectal
• Axillary
• Oral
• Temporal
• Tympanic |
|
|
Term
| Fever- So Why Do We Care? |
|
Definition
• Course of illness?
• Severity of cause?
• Height of fever?
• Metabolic demand?
- 10–15 BPM per degree C
- 2–3 breaths per minute per degree C
• Seizure?
• “Brain damage”?
• Look at the patient!! |
|
|
Term
|
Definition
• Virus
• Bacteria
- Many sites
• Autoimmune
disease
• Tumors
• Subdural
hematomas |
|
|
Term
| fever How Long Is Too Long? |
|
Definition
- Any fever
• Unvaccinated
• Neonate (<2 months)
• Neutropenic/immunosuppressed
• Cancer, sickle cell, transplant recipient
- Typically 3–5 days
• “FUO” at 7–9 days |
|
|
Term
|
Definition
• “Mucocutaneous lymph node syndrome”
• Systemic inflammatory reaction, viral
trigger?
• Children under 5 most common
• Mortality near 1% if untreated—coronary
artery aneurysm
- Fever for 5 days and four of the following:
• Bilateral nonsuppurative conjunctivitis
• Mucous membrane changes (red throat, lips,
“strawberry” tongue)
• Extremity changes (edema, erythema, desquamation)
• Rash
• Cervical lymphadenopathy >1.5 cm
- And it’s not something else |
|
|
Term
|
Definition
• Vaccines, immune development, exposure
• Unreliable clinical assessment
• Risk of serious bacterial infection (SBI) 10–12%
- Group B Strep, E coli, Listeria, etc.
- Mostly UTI
- Others: sepsis, meningitis, pneumonia, cellulitis
• Criteria—goal: identify low-risk patients
- Philadelphia, Rochester, Boston |
|
|
Term
|
Definition
-All patients up to 60 days old with temp of 100.4 or
above and well appearing:
• CBC, blood culture, UA, urine culture, LP
- 1–28 days: admit with antibiotics
- 29–60 days—may go home without antibiotics if:
• WBC <15,000 and Bands: Neutrophils <0.2
• UA with <10 WBC/HPF and gram stain neg
• CSF with <8 WBC/mm3 and gram stain neg
• CXR and stool (if performed) negative
- Sensitivity 98%, specificity 42%, PPV 14%, NPV 99.7% |
|
|
Term
|
Definition
- Occult bacteremia: 3% à 0.7%
• Streptococcus pneumococcus, Hemophilus
influenza
- Higher risk for urinary tract infection
• Girls
• Uncircumcised boys
• White
• Fever >39°C |
|
|
Term
|
Definition
• Goal: comfort, reduce metabolic demand
• Hydration
• Adjust environment
• Antipyretics
• Not: cold/alcohol baths (vasoconstriction) |
|
|
Term
|
Definition
- Acetaminophen
• Contraindications: hepatic
• 15 mg/kg every 4 hours
• PO or PR
- Ibuprofen
• >6 months
• Contraindications: renal, bleeding
• 10 mg/kg every 6 hours
- Aspirin
• Contraindications: kids
• Reye syndrome |
|
|
Term
|
Definition
• “Fever phobia”
• Disease versus symptom
• Worry about consequences
• Schools, daycares, grandparents, etc.
• Pressure for antibiotics
• Talk about fever before the child is sick
• Educate about fever as a symptom
• Teach about taking temperatures
(“ballpark” approach)
• Look at the child!
• Acknowledge parent’s concerns |
|
|
