Febrile Infant
o
38 C
o
100.4 F
(rectal)
Bacteremia (3%)
Meningitis (<1%)
Other causes
Bacterial gastroenteritis
Gonococcal
keratoconjunctivitis
Omphalitis
Osteomyelitis
Peritonitis
Pneumonia
Septic joint
28 days
IV access
LP + CSF studies
Glucose if needed
Lumbar puncture
LP success rate increases with early stylet removal and use of lidocaine
CSF
d
o
o
Bl
Lumbar puncture
CSF Analysis
Tube 1 Culture and Gram stain
Labs
Blood
WBC 5,000 or 15,000
Bands >1,500
Band:Neutrophil <0.2
Bands/Bands + Neutros
Urine
<10 WBC/hpf
CSF
0-28d - WBC <19/L
Gram stain
No infections on exam
LP
HSV?
Labs
HSV PCR in CSF and blood
Empiric Acyclovir
Strongly consider for ALL infants 21 days
and for infants 22 to 40 days with 1 of the
following:
Ill Appearing
Vesicular rash
Hepatitis
Antimicrobials
0-21d Ampicillin/Cefotaxime +/- Acyclovir
22-28d Ampicillin/Cefotaxime
Additional Considerations
Add Vancomycin if
Ill Appearing
CSF
What about?
Procalcitonin and CRP
do not improve confidence
to completely rule out SBI
at this time
Disposition
All babies under 28 days are admitted on empiric antibiotics
for 36 hours
You can get blood, urine and CSF on a baby 29-60 days and
D/C home if normal - but NO antibiotics!
Disposition
Babies discharged home must have PMD follow up within 24
hours
Bronchiolitis
URI Symptoms
Rhinitis
LRTI Symptoms
Tachypnea
Cough
Wheezing
Crackles
Nasal flaring
RSV #1
Suctioning
Albuterol
Oxygen
Racemic epi
Hypertonic saline
Corticosteroids
CPT
Antibiotics (duh)
Respiratory rate 70
O2 sat <95%
Discharge Criteria
RR generally <70
Reliable caretaker
Resources
AAP Clinical practice guideline
Fussy Baby
Your goals
Perform a
thorough
H&P
Try to get
the baby to
stop crying
Head
Neuro exam mental status (must know development!)
Eyes
Corneal abrasion
Ears
AOM
Retained FB
Mouth
Stomatitis
Thrush
Chest
Rib fractures
SVT
Abdomen
UTI
Mass
Hepatomegaly
Intussusception
Appendicitis
Bowel Perforation
Hirschsprung Disease
GU
Testicular/Ovarian torsion
Incarcerated hernia
Anal fissure
Extremities
Hair tourniquet
Fractures
Septic joint
Skin
Cellulitis
Eczema
Toxidromes
Colic
10-26% of infants
nd
2
week of life
Peaks around
th
6 week
Should resolve by
Diagnosis of exclusion!
th
16
of life
week of life
Bottom line
If you and/or caregiver can calm the baby in the ED
and
H&P is normal the baby is probably fine
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