Fever Flashcards
(17 cards)
What is the definition of fever in an infant <90days old?
Rectal temp >38°C
- alternatively can use axilary or skin for frequent monitoring but if <36.5°C or >37.5°C → confirm with core temperature
What are 3 common causes of fever in the newborn?
1) Overwrapping/↑ambient temp
- maternal fever due to epidural analgesia,
- warm environment at home/warm radiant warmer inpatient
- temperature probe dislodgement
2) Dehydration
3) Infection
How does fever caused by overwrapping/increased ambient temperature present?
1) Appears well
2) Well perfused with warm extremities (peripheral vasodilation)
3) ±Extended posture to facilitate heat loss
4) Usually self-limited after correcting heat source <1hr
What are 2 RFs for infant fevers due to “dehydration?
1) 1st born, inexperienced mother
2) Breastfeeding difficulties
How does dehydration fever in the newborn present?
1) 2-3days of life
2) Hungry baby, exhausted mother
3) ↓stool output (eg. lack of or only meconium beyond 3-5days)
4) Concentrated and small urine volume (pink/orange staining of diapers ie. urate crystals)
5) Excessive WL (>10% birth weight)
6) Low breast milk supply/engorged breasts
What are 4 complications of dehydration due to inadequate milk intake?
1) HyperNa (depletional)
2) Hyperbilirubinemia (↓caloric intake → ↑enterohepatic circulation)
3) Hypoglycemia
4) Sepsis (must do LP)
5) Cerebral venous thrombosis, renal vein thrombosis (hypercoagulability)
6) Seizures
How is dehydration fever managed?
1) Formula supplementation/ expressed breast milk (100-150ml/kg/day)
2) IV fluids (if hyperNa/ hyperbilirubinemia)
3) Monitor vitals and electrolytes to avoid over-correction
What is the most important thing to rule out in a febrile baby?
Invasive bacterial infection
What kind of fever is most concerning for an infectious fever in a baby?
Fever >1hr
True or false: A baby without fever is unlikely to have a serious infection.
False:
eg. early-onset sepsis (<3days of age) → shock + hypothermia
What are the 3 most common types of bacterial infections in febrile neonates?
1) UTI (16-28%)
2) Bacteremia/sepsis (1-5%)
3) Meningitis (0.3-3%)
What are the 4 common causative organisms for infective community-acquired fever in neonate?
Bacteria
1) GBS
2) E. coli
3) Klebsiella Pneumoniae
4) H. Influenza
Virus/Chlamydial
5) RSV/other respi viruses
6) Chlamydia Trachomatis
7) Enterovirus
8) HSV
What are the Ix for a suspected infective fever in a neonate?
1) Urine dipstick and microscopy
2) Urine culture (catheter sample)
3) Full blood count and C-reactive protein
4) Blood culture
5) Lumbar puncture - CSF culture and other Ix
6) Viral tests, if history and clinical features are
suggestive (e.g., HSV, enterovirus)
How should a suspected invasive bacterial infection in neonate be managed?
1) Empirical ABs (eg. IV ampillicin + gentamicin)
- until guided by cultures eg. bloods, urine, CSF
- until 48hrs negative cultures and well neonates
2) IV acyclovir if HSV (mother has HSV/blisters; DIVC; meningitis/seizures; vesicular rash)
3) Hydration: oral feeding/IV fluids
In a baby with excessive WL (>10%) due to breastfeeding difficulties, which electrolyte abnormality is most likely present?
Hypernatremia
True or false: Bulging of the fontanelles contraindicates an LP for a suspected intracranial infection.
False.
Incomplete closure of the fontanelles allowed for greater tolerance for ↑ICP without risk of herniation/coning.
If anything, it should warrant an immediate LP!
What is the most common cause of viral LRTI in children?
RSV
