Febrile Baby: Pathology & Management – Pediatric Infectious Diseases | Lecturio

Febrile Baby: Pathology & Management – Pediatric Infectious Diseases | Lecturio


In this lecture, we’re going to discuss The Febrile Baby. If you’ve done a pediatric rotation and have spent some time in the inpatient setting you’ve probably encountered a baby who is febrile who is admitted for what we call a rule out sepsis, making sure that there is nothing more significant cause of illness. I’m going to try and break that down for you here and make it clear so we can understand how and why we manage the babies the way we do. Okay. A fever in an infant is defined as any temperature above 38 degrees Celsius or 100.4 degrees Fahrenheit. Generally, we think about serious bacterial infection as a bacterial infection of either the meninges, the blood, or the urinary tract. Already we’ve waited into controversy here. Many people do not find that urinary tract infections are actually all that serious and 1% of infants will have bacteria in their urine and no symptoms at all but let’s consider all of this SBI or serious bacterial infection. So there is some controversy about how to manage these patients in the United States and there are schools of thought and I’m going to take you through some of that. Before we even start with serious bacterial infection though, we really need to consider the idea of HSV or herpes simplex virus infection. Do we include these patients in this group or not? Do they present the same or not? Then, after that, we have the question of “What do we do with the children that is age of 4 to 8 weeks?” Typically, in children under 4 weeks, they’re all getting admitted and we’re going to evaluate them all for bacterial infection. After 8 weeks, we usually think of that as a period when children will get urinary tract infections but the risk of meningitis and bacteremia are much lower. Well, what do we do during this 4 to 8-week period? There are generally 3 schools of thought. There’s the Rochester criteria, the Philadelphia criteria and the Boston criteria. I’m optimistic that in the near future we will have a guideline that will try to bring all these together but I want to explain these 3 schools of thoughts for you now. So, in all 3 schools of thought, they agree that urine and blood is indicated in patients who present between 4 and 8 weeks of age. However, in Rochester, they will only get a spinal tap if the CBC is abnormal in a well-appearing febrile infant, whereas in Philadelphia and Boston, the spinal tap is still obtained. In neither Rochester nor Philadelphia is an antibiotic necessarily given to children this age whereas in Boston they presumably and presumptively give a dose of ceftriaxone. However, what’s key is that if preliminary laboratory testing is unremarkable in all 3 programs, patients can be discharged home from the ER if they have good followup rather than admitted to the hospital.

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