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Fever In The Neonate 2003

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Dang Thanh Tuan
Dang Thanh Tuan
Health & Medicine
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Fever in the Neonate June 2003
QOD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Learning Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object]
What is a Fever? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Who is a Neonate? ,[object Object],[object Object],[object Object],[object Object]
Why Worry about these Infants? ,[object Object],[object Object],[object Object],[object Object],SBI = bacterial meningitis, bacteremia, septic arthritis, osteomyelitis, UTI, bacterial enteritis, pneumonia
Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why the Higher Risk? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
So…What Do We Do? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],Well-Appearance DOES NOT rule out SBI
Deciding on Management ,[object Object],[object Object],[object Object],[object Object],More widely accepted Rochester Criteria No source for fever Previously healthy Full term No prior or current Abx Nontoxic WBC 5,000-15,000 <1,500 bands UA <10 WBC/HPF Stool <5 WBC/HPF (if diarrhea) Philadelphia Criteria Observation Score WBC<15,000 Band:Seg <0.2 UA <10 WBC/HPF CSF analysis <8 WBC Normal CXR Boston Criteria WBC<20,000 UA <10 WBC/HPF CSF analysis < 10WBC Normal CXR All criteria missed diagnosis of SBI in <1 month olds
Well-Established Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1-3 Month Olds – Tougher Decision ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bad Bugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],GBBS and E. coli account for 50-70% of all neonatal infections
Antibiotic Regimen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
The Daily QUIZ Continues!! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oh, No! There’s More!! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
QOD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],GBBS Higher risk in older infants Accounts for 5% of neonatal infections GBBS and E. coli account for 50-70%% of all neonatal infections
Summer is Finally Here! Enjoy!!

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Fever In The Neonate 2003

Editor's Notes

  1. 38 = 2 SD&gt;mean temp for infants &lt;3mo old
  2. If fitting these criteria – then infant considered Low Risk for SBI
  3. Ampicillin Covers Listeria Gentamicin Fine prior to d/c, ie in NICU or NBN, but misses community acquired H. flu Ceftriaxone Great coverage for GBBS, E. coli, H. flu ? Biliary Sludging in the &lt;6 week old Cefotaxime Use in place of Ceftriaxone until 6 weeks