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Hasbro and PEM > Febrile Infant > Flashcards

Febrile Infant Flashcards

1
Q

What is the most accurate way to obtain a temperature?

A

Rectal

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2
Q

Is fever itself dangerous? What good does it do?

A

Not dangerous itself

Recruits WBC’s and slows replication of virus and bacteria

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3
Q

Most fevers in kids are caused by?

A

Viruses

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4
Q

What are the SBI’s we need to rule out in febrile infants?

A

Sepsis, meningitis, PNA, bacteremia, bacterial enteritis, UTI, soft tissue or skin infection

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5
Q

What is the most common SBI in kids?

A

UTI

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6
Q

What are the three main categories for febrile infants?

A

First month or ill-appearing or high risk
Second month and well appearing
Third month and older

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7
Q

What are the features of a high risk patient?

A 
toxic appearance
immune compromise
premature
Hx of NICU stay (exposure to bugs)
comorbidities
Significant infectious exposure
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8
Q

What percent of febrile neonates have an SBI?

A

5–15%

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9
Q

What percent of febrile neonates that appear totally normal have an SBI?

A

about 5%

This is why we admit all kids <29 days old with a fever

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10
Q

What is the management of kids in first month of life, or are toxic appearing or high risk?

A

Labs: CBC, CRP, procalcitonin, blood and urine Cx, UA, LP
IV antibiotics
Admission
Consider CXR, RPP, Stool studies

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11
Q

What are the most common causes of SBI in neonates?

A 
E. coli
GBS
Gram (-) enterococci
Listeria
MRSA
Herpes
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12
Q

Why is Herpes so scary in neonates?

A

Very bad complications
<50% have any skin findings
Can be without fever or hypothermic

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13
Q

If a neonate is positive for a URI, can you stop there in your evaluation and treatment?

A

still 5% risk of SBI and treatment should be the same

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14
Q

What is the abx regimen for neonates/high risk/toxic appearing?

A

Cefotaxime + Ampicillin
Give Vanco if toxic appearing or NICU stay
Acyclovir if concern for herpes (many providers just give it)

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15
Q

Should abx be held until LP is done?

A

Abx are given BEFORE LP if the patient is really sick

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16
Q

When can risk predictive rules be used in kids that are >29 days old?

A

Only if they are well-appearing. If toxic or high risk, they go back into the 0–29d category and are treated aggressively

17
Q

What are low risk features in kids >1 month old?

A

Normal WBC, procal level, and CRP
Negative UA
Low Bands

18
Q

What is the standard workup for febrile kids 1 month old and well-appearing?

A

Labs: CBC, CRP, Procal, UA, blood Cx, Urine Cx
Have low threshold for LP, but it is not for everyone
CXR only if needed

19
Q

When are abx given to kids 29–60d and well-appearing?

A

Abx only if there is a source identified or if CSF culture is pending
Admission if high risk

20
Q

When can febrile kids 29–60days go home?

A

Well-appearing, low risk, good social situation, follow up in 24 hours
Give abx for home if source identified or CSF cultures are pending
They get admitted if any high risk features (abnormal labs of any kind or vital abnormalities)

21
Q

What is the preferred abx regimen for kids 29–60days?

A

Ceftriaxone and vanco

22
Q

What is different about febrile kids >2 months old in regard to initial evaluation?

A

These kids more reliably show signs or symptoms if they actually have a significant infection whereas younger kids do not. A good clinical exam is all that is needed initially, but a UA should be considered as UTI accounts for 90% of bacterial infections.

23
Q

What is the WBC cutoff for UA to be positive?

A

> 10 cells per hpf

24
Q

What causes of meningitis are covered by ampicillin in the neonate?

A

GBS, E. coli, and listeria

25
Q

What is the treatment for E. coli meningitis that is resistant to ampicillin?

A

third gen cephalosporin plus gentamicin

26
Q

What is the best treatment initially for listeria?

A

Ampicillin + gentamicin is better then ampicillin alone but can be transitioned to amp alone after CSF sterility is documented

27
Q

How long after abx administration is LP with CSF culture still likely to be positive?

A

At least 4 hours and maybe up to 8 hours

28
Q

How long are inflammatory changes seen in CSF after abx administration?

A

Up to 24 hours after antibiotics

Hasbro and PEM (8 decks)

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