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Fever 0-3 months What should be done? Donna Moro-Sutherland, MD Pediatric Emergency Medicine Physician WakeMed Health & Hospitals.

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Presentation on theme: "Fever 0-3 months What should be done? Donna Moro-Sutherland, MD Pediatric Emergency Medicine Physician WakeMed Health & Hospitals."— Presentation transcript:

1 Fever 0-3 months What should be done? Donna Moro-Sutherland, MD Pediatric Emergency Medicine Physician WakeMed Health & Hospitals

2 Antibiotic Choices Ampicillin: 100 mg/kg/dose Gentamicin: 2.5 mg/kg/dose Cefotaxime: 100 mg/kg/dose Ceftriaxone: 100 mg/kg/dose –Not recommended for neonates who have jaundice Vancomycin: mg/kg/dose

3 Empiric Antibiotic Protocols: Rule out sepsis (ROS) 0-28 days: –Ampicillin and gentamycin days: –Ampicillin and cefotaxime/ceftriaxone 60+ days –Cefotaxime or Ceftriaxone

4 Empiric Antibiotic Protocols Meningitis < 1 month: –Ampicillin + Gentamicin Meningitis > 1 month: –Vancomycin + Cefotaxime –add Gent if GNR

5 Neonatal Herpes Simplex Acyclovir: 20 mg/kg for HSV

6 What are the laboratory tests used to determine low risk? CBC 5-15,000/mm 3 ABC < 1500 or B/N ratio < 0.2 UA < 10 WBC/hpf Stool < 5 WBC/hpf CSF < 8 WBC Blood, urine and CSF cultures

7 Temp > C and age 0-3 months Age < 28 days or Toxic appearance CBC with diff BC UA, UC CSF studies CXR & stool if indicated Consider HSV studies IV antibiotics Admission Yes No Baseline High Risk Yes No

8 29 days- < 2 months 2- 3 months CBC with diff BC UA, UC +CSF studies* ( Understand most will get LP upfront ) CXR & stool if indicated CBC with diff BC UA, UC CXR & stool if indicated Option 1 Option 2 CSF studies IV Antibiotics Hospital admission Abnormal lab or xray Yes

9 29 days- < 2 months 2- 3 months CBC with diff BC UA, UC +CSF studies (Understand most will get LP upfront) CXR & stool if indicated CBC with diff BC UA, UC CXR & stool if indicated Option 1Option 2 CSF studies IV Antibiotics Hospital admission Abnormal lab or xray Yes Follow up assured in 24h Adequate social situation Parent and PMD agree to outpatient approach Consider Ceftriaxone but only if LP is performed No Yes Discharge

10 2-3 months CBC with diff BC UA, UC CSF studies CXR & stool if indicated CBC with diff BC UA, UC Option 1 Option 2 Option 3

11 What if the infant has RSV?....

12 29 days - 2 months< 28 days RSV+ CBC with diff BC UA, UC CSF studies CXR Stool if indicated IV antibiotics Admission RSV+ Option 1 Option 2 UA, UC Rarely done! CBC with diff BC UA, UC

13 29 days - 2 months RSV+ CBC with diff BC CSF studies CXR IV antibiotics Admission Option 1 Option 2 CBC with diff BC UA, UC Abnormal labs Yes

14 What do we know… 0-28 days with fever –Risk too great for SBI days –Low risk groups can be identified –Presence of RSV, influenza and other recognizable viral illnesses is associated with a decreased incidence of SBI, but not absence of SBI

15 What else do we know… 0-28 days with fever –Sepsis work up –Consider Viral testing –Admission and antibiotics days –Sepsis work up (CSF cultures may be omitted in a select population) –If Viral testing done: If high risk: admit and treat with antibiotics If low risk: admit/observe vs discharge and follow up

16 Finally… days –More mature, immunologically and socially –Most fever caused by viral illness –Incidence of SBI lower –No consensus for evaluation of fever without a source UA with urine culture in all…. CBC with BC

17 Empiric Antibiotic Protocols: Rule out sepsis (ROS) 0-28 days: –Ampicillin and gentamycin days: –Ampicillin and cefotaxime/ceftriaxone 60+ days –Cefotaxime or Ceftriaxone

18 Empiric Antibiotic Protocols Meningitis < 1 month: –Ampicillin + Gentamicin Meningitis > 1 month: –Vancomycin + Cefotaxime –add Gent if GNR


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