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R-Baby Introductory Presentation
 

R-Baby Introductory Presentation

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  • Smaller and lighter Bolder bigger Audio 1 Opposites
  • Credits slide Audio 1
  • Epi across top BIGGER Audio 2
  • Audio 3 Occult bacteremia: definition Complications: SBI List complications Last 5 seconds use the motion
  • Decreasing wellness of appearance  Increasing height of fever bottom Bottom: all febrile children presenting to ED Change diagram Audio 4 under clinical : All febrile infants presenting to the ED (cap) No temp wbc Increasing fever Decreasing well appearance Arrow on bottom
  • Audio 5
  • Audio 6 Sarah’s portion
  • Smaller Audio 7 Baby on bottom-middle Say it = flash it High prevalence of Sepsis/SBI; 5-17% Flash in immunocomprimised Cant limit infections Apperance and exam unreliable
  • Audio 8 Low risk criteria included Moving baby with infection but not too sick
  • Summary page Audio 9 Summary: groups 1 and 2 On top of each other And low risk criteria
  • Audio 10
  • Summary of group 1 2 3 Audio 11 SUMMARY 3 groups on top
  • Audio 12 Introduction to guidelines for older infants 1)Moving baby no infection Bullet: community acquired pathogens: Sarah motion More flash in
  • Audio 13 At 1:25 Height of fever and duration of fever AS SAID
  • Audio 14 Patients at risk for UTI: Circumcised less than 6 mo Uncircum less than 1 yo Girls less than 2 yo Previous h/o UTI
  • All 5 groups Audio 15 Evidence Based Guideline for fever in infants

R-Baby Introductory Presentation R-Baby Introductory Presentation Presentation Transcript

  • An Evidence - Based Guideline EVALUATION AND MANAGEMENT of FEVER IN INFANTS
  • The following presentation is part of an educational program for physicians produced by the Division of Pediatric Emergency Medicine of the Morgan-Stanley Children’s Hospital of Columbia University Medical Center. Supported by a grant from the r-baby Foundation.
  • EPIDEMIOLOGY OF SEVERE SEPSIS IN CHILDREN IN THE U.S. > 42,000 Cases 50% < 1 Year Old 50% No PMH 10% Mortality
  • Reducing Infant Mortality From Sepsis ED Prevention Strategy: Bacteremia : The presence of bacteria in the blood of a well-appearing infant Complications of Bacteremia: Serious Bacterial Infections (SBI) Sepsis DIC Shock / Multiple organ failure Death Serious focal infections Bacteremia  SBI ✖
  • Clinical Dilemma All Febrile Infants Presenting to ED
  • Evidence Based Guideline Fever In Infants GOALS Primary : Identify infants at risk for Bacteremia/SBI Secondary : Standardized, Evidence-Based Practice Reduce Unnecessary Testing Decreased ED LOS
  • BUILDING THE GUIDELINE TOGETHER
  • GROUP I (0-28 Days) High Prevalence of SBI/Sepsis (5-17%) Immunocompromised Can’t Limit Infections Appearance and Exam Unreliable Group Age Fever Cutoff Evaluation Disposition I 0-28 Days ≥ 100.4 Full Sepsis Workup (Include LP) Admit
  • GROUP II (29-60 Days) LOW RISK CRITERIA History: Previously healthy Normal behavior and feeding Reliable caretaker / phone access Exam: Well appearing Normal vitals & exam Labs: Blood: WBC ≥ 5,000 and < 15,000 B:N < 0.2 Urine: < 10 WBC/HPF CSF: < 8 WBC/HPF Group Age Cutoff Fever Cutoff Evaluation Disposition II 29-60 Days ≥ 100.4 Full Sepsis Workup Admit Vs. Discharge
  • SUMMARY: GROUPS I AND II Group Age Fever Cutoff Evaluation Disposition I 0-28 Days ≥ 100.4 Full Sepsis Workup (Include LP) Admit II 29-60 Days ≥ 100.4 Full Sepsis Workup Admit Vs. Discharge
  • GROUP III (61-90 Days) 61-90 Days Baby In Transition from Immunodeficient to Immunocompetent Fever Cutoff 100.4 Admit for Focal Infections (LIKE YOUNGER INFANTS) No L-P Unless Clinically Indicated Patients Can Be Discharged (LIKE OLDER INFANTS) Group Age Cutoff Fever Cutoff Evaluation Disposition III 61-90 Days ≥ 100.4 Bacteremia Workup (Blood and Urine) Admit Focal Infection Discharge All Other Patients
  • SUMMARY: GROUPS I, II AND III II 29-60 Days ≥ 100.4 Full Sepsis Workup Admit Vs. Discharge Group Age Fever Cutoff Evaluation Disposition I 0-28 Days ≥ 100.4 Full Sepsis Workup (Include LP) Admit III 61-90 Days ≥ 100.4 Bacteremia Workup (Blood and Urine) Admit Focal Infection Discharge All Other Patients
  • INTRODUCTION TO GUIDELINES FOR OLDER INFANTS
    • Lower Risk for SBI
    Blood AND Urine Testing High fevers only ONLY Urine Testing Fever lasting ≥ 4 Days  Reliable Exam
  • GROUP IV: 3-6 Months History: BOTH height and duration of fever Group Age Cutoff Fever Cutoff Evaluation Disposition IV 3-6 Months ≥ 102.2 Bacteremia Workup (Blood and Urine Only) Discharge Fever < 102.2 Lasting ≥ 4 Days Urine Only
  • GROUP V: ≥ 6 Months Blood Testing Temp ≥ 105 OR ≥ 102.2 for 4 days Urine Testing Only if at risk for UTI or any fever x4 days Group Age Cutoff Fever Cutoff Evaluation Disposition V ≥ 6 Months + Immunized + Good Flu ≥ 105 Blood – All Urine – If Indicated Discharge ≥ 102.2 for 4 Days Fever ≤ 102.2 For 4 Days Urine Only: If Indicated Patients at Risk for UTI Circumcised < 6 Months Uncircumcised < 1 Year Old Girls < 2 Years Old Previous H/O UTI
  • Group Age Fever Cutoff Evaluation Disposition I 0-28 Days ≥ 100.4 Full Sepsis Workup (Include LP) Admit II 29-60 Days ≥ 100.4 Full Sepsis Workup Admit Vs. Discharge III 61-90 Days ≥ 100.4 Bacteremia Workup (Blood and Urine) Admit Focal Infection Discharge All Other Patients IV 3-6 Months ≥ 102.2 Bacteremia Workup (Blood and Urine Only) Discharge Fever < 102.2 Lasting ≥ 4 Says Urine Only V ≥ 6 Months + Immunized + Good Flu ≥ 105 Blood – All Urine – If Indicated Discharge ≥ 102.2 for 4 Days Fever ≤ 102.2 For 4 Days Urine Only: If Indicated