Pediatric Fever

Dr. Stacey Reynolds - Pediatric Fever

    0-28 days - don't overthink it!  - full work up

    29-90 days - to tap or not to tap? 

     > If low risk 
        - well appearing child full term with normal physical exam without evidence of focal bacteria infection -             then blood cultures, UA (don't trust the dip)
        - if meets low risk criteria - can either choose to not tap & DC w/o antibiotics or tap, 
        - if no pleocytosis, give dose of abx and DC home (if reliable parents)

    3-36 months - does fever exceed 102.5? If not, no further testing is needed!!

         > Does patient have an obvious source of fever?  if so treat.  If not & febrile > 102.5 test

         > UTI
            - Test all with high risk (prior UTI, high grade VUR, renal abnl); uncircumcised male < 1,circumcised male < 6 months, females                 < 2 yrs

         > Bacteremia  
            - If less then 2 prevnar (meaning 2 shots, then 2 weeks after 2nd set of shots) test - CBC,
                blood cultures - if WBC > 15K, ANC >10K, treat with ceftriaxone
            - If > 2 prevnar blood cultures at MD's discretion

            - If hyperpyrexia (temp of 106 or above) blood cultures at MD's discretion
              (based on small study that showed 10% bacteremia in hyperthermic kids - this was pre Prevnar)

         > PNA - CXR only needed if evidence of lower respiratory symptoms, hypoxemia, persistent
            fever, T over 103, WBC > 20K

> Herpes - we overtest! (only 2% of what we send comes back positive

> 60 day old febrile kid with + UA - to tap or not - data is still out

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