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2. A PPROACH TO A CHILD WITH FEVER

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5. D EFINITION Fever : elevated body temperature due to change in hypothalamic set point Hyperthermia : elevated body temperature due to environmental heat, dehydration, overclothing, excessive internal heat production 12/3/1389 5

6. N ORMAL BODY TEMPERATURE Rectal : 38.3 ⁰ С, most sensitive, infants Oral : 37.8 ⁰ С, sensitive, > 5 yr Axillary : 37.2 ⁰ С, less sensitive, 1-5 yr 12/3/1389 6

7. I NDICATIONS OF TREATMENT OF FEVER High fever( > 39 ⁰C) Chronic cardiopulmonary disorders Chronic metabolic disorders Neurologic disorders Risk of febrile convulsion 12/3/1389 7

8. C ONTROL OF FEVER Acetaminophen Ibuprofen Combined acetaminophen and ibuprofen No aspirin No diclofenac Na No corticosteroid External cooling : in hyperthermia, very young infants, severe liver disease, neurologic disorder 12/3/1389 8

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11. TABLE 2 Criteria for Identifying Febrile Infants at Low Risk for Serious Bacterial Infection Infant appears generally well Infant has been previously healthy: Born at term (>=37 weeks of gestation) No perinatal antimicrobial therapy No treatment for unexplained hyperbilirubinemia No previous antimicrobial therapy No previous hospitalization No chronic or underlying illness Not hospitalized longer than mother Infant has no evidence of skin, soft tissue, bone, joint or ear infection Infant has these laboratory values: White blood cell count of 5,000 to 15,000 per mm 3 (5 to 15 3 10 9 per L) Absolute band cell count of ¾1,500 per mm 3 (¾1.5 3 10 9 per L) Ten or fewer white blood cells per high-power field on microscopic examination of urine Five or fewer white blood cells per high-power field on microscopic examination of stool in infant with diarrhea 12/3/1389 11

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15. Main questions in febrile child Comments Predisposing condition Pharyngeal dyscoordination( aspiration pneumonia); CHD( endocarditis); immune deficiency( neutropenia, cycle cell disease); CF( pneumonia); CSF shunt( shunt infection); recent head trauma( meningitis); post operation( atelectasis) Common sources of infection Mostly upper respiratory tract infections, gastroenteritis, nonspecific viral infections …. Serious bacterial infections Age <1 mo: all admit 1-3 mo: admit if high risk 3- 36 mo: 4% risk of bacteremia in well appearing > 36 mo: low risk of SBI Toxicity Admission in hospital, empiric AB for sepsis/meningitis 12/3/1389 15