Evaluation and Management of Fever in Infancy文档.pptVIP

* Based on the risk of SBI due to age, gender, and immunization status, this slide summarizes which infants need to be further evaluated in the setting of fever without a source 1. All patients 60 days should be evaluated for all 3. Some use 6 weeks as a cut-off to evaluate for meningitis. 2. The risk for meningitis, however, is very low after 60 days. 3. Therefore, only those with an abnormal CBC or UA should receive further evaluation for meningitis since antibiotics will be administered in that case. Also, there is a higher risk of concurrent meningitis in the setting of bacteremia, but meningitis is quite rare in the setting of UTI alone 4. After 3 months, a urine dip is a faster, cheaper, and nearly accurate way to evaluate for UTI. But because UA nor urine dips are normal in 1/5 of UTIs, a urine culture should ALWAYS be sent 5. CBCs and cx should still be sent in this age group since they have not received 3 HiB and PCV-7 vaccines yet 6. Only ill appearing patients with symptoms concerning for meningitis need an LP at this age. The same is true in older age groups as well. 7. Once boys are circumcised and are over 6 months of age, their risk for UTI is very low. Some stop screening uncircumcised boys at 9 months while others stop at 12 months. 8. But the risk remains in girls until 24 months, so they should be evaluated until this age 9. Only those patients who have not received HiBx3 and PCV-7 x3 should get CBC and blood cx done 10. After 24 months, no febrile child without a source requires empiric testing. After this age, testing should only be done on patients in whom there is clinical suspicion * Though the findings from the 3 studies help identify some patients at low risk for SBI, other studies since then have also helped identify additional low risk patients One such study done in 1999 by David Greenes and Marvin Harper at Children’s Hospital Boston demonstrated that infants 3 months with a recongizable viral syndrome have a very low r