Risk Stratification and Management of the Febrile Young Child

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Key points

  • Febrile neonates require blood, urine, and cerebrospinal fluid cultures, empiric antibiotic therapy, and hospital admission.

  • Febrile young infants can be classified as high or low risk for serious bacterial infections. High-risk patients require antibiotic therapy and hospital admission, but most low-risk infants can be discharged home.

  • Some febrile older infants and toddlers require testing to identify clinically occult bacterial infections, but most of these children can be discharged home.

History and physical examination

Fever may have infectious or noninfectious causes,15 but most febrile children who present to the emergency department (ED) have fevers arising from infections. Although there are fluctuations in the normal body temperature, fever in young children is generally accepted as a temperature of 38.0°C (100.4°F) or higher. Rectal thermometry is the method thought to most closely represent core temperature in the ambulatory setting and is more accurate than oral, axillary, tympanic membrane, and

Neonates: Birth to 28 Days Old

Neonates are at a particularly high risk for SBI. Most febrile neonates presenting to the ED are diagnosed as having nonspecific viral illnesses, but approximately 12% to 28% of all febrile neonates presenting to a pediatric emergency department have SBIs.53, 54, 55 The most common bacterial infections in this are group are UTIs and occult bacteremia,53, 55 and these infections are typically caused by more virulent bacteria such as group B Streptococcus, Escherichia coli, and Listeria

Febrile young children 2 months of age and older

A temperature of 38.0°C defines a fever and is the usual threshold at which diagnostic testing is initiated in the young infant. However, in febrile children 2 months of age and older, 39.0°C is commonly used as the temperature for initiating further evaluation (some studies restrict this group to include infants 3 months of age and older), This higher temperature cutoff is used largely because, in the era before universal vaccination with the pneumococcal conjugate vaccine, there was some

Summary

Fever is a common presenting complaint in children who seek ED care. Most of these children have benign viral infections that cause their febrile illnesses, and most of these children recover fully with only supportive care. However, a small percentage of these patients have serious underlying (typically bacterial) causes of fever and require antibiotic therapy and hospital admission. The challenge for the emergency physician is to categorize patients into groups that are at high risk and low

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    • Temporal artery and axillary thermometry comparison with rectal thermometry in children presenting to the ED

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      Fever, defined as core body temperature equal to or > 38.0 °C (100.4 °F), is one of the most common pediatric emergency medicine complaints [1,2]. The accuracy of temperature measurement is paramount given invasive testing and treatment of children will be based off the measured value [3]. Rectal thermometry is the recommended noninvasive method of obtaining temperatures in children younger than 3 years of age [4,5].

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