EVALUATION OF THE INFANT WITH FEVER WITHOUT SOURCE: AN EVIDENCE BASED APPROACH
Section snippets
DEFINITIONS
FWS is understood to mean fever with no apparent focus of infection after a careful history and physical examination have been performed. Occult bacteremia (OB) is the presence of a pathogenic bacterial species in the blood culture from a child not suspected of having a bacterial infection based on history, physical examination, and screening laboratory tests, including chest x-ray, lumbar puncture, and urinalysis. Serious bacterial illness (SBI) generally has included bacteremia, bacterial
METHODS
MEDLINE databases from 1966 to 1997 were searched using the category * fever (*meaning “explode” fever) modified to include English language articles, limited to age groups neonates up to and including children 2 to 5 years old. Additional searches were performed using other categories (e.g., * bacteremia, urinalysis, and spinal puncture) similarly modified to ensure completeness as needed. Articles were selected with preference given to clinical trials or cohort studies dealing with the
GENERAL EPIDEMIOLOGY
Physician visits for fever are very common in the first few years of life. In one family practice–based series,128 21% of office visits for infants under the age of 6 months involved a temperature over 37.8°C. In other series, the incidence of pediatric clinic visits for fever was reported as ranging from 6.5% of patients having temperatures over 38°C75 to 12%,27 to as high as 33% of sick visits, with 19% having temperatures ≥39.4°C.154, 170 In a review of all children presenting to an urban
History
Evaluation of the febrile infant should begin with a detailed history relevant to infectious diseases in children, including a history of the present illness that considers birth history and maternal infection risks, recent immunizations, sick contacts, travel and immigration (e.g., recent immigration from a malaria-endemic region), recent serious illness, level of activity, “fussiness” or irritability, feeding habits, vomiting, bowel habits (e.g., diarrhea), an assessment of hydration status
CONCLUSIONS AND RECOMMENDATIONS
No single aspect of the history and physical examination of the febrile infant will reliably identify an infant at increased risk for SBI; however, the combination of a “low-risk” history, “well” appearance, and certain normal laboratory test results can reliably identify most infants who do not have SBI. This assertion has several ramifications for both current and future practice. Routine hospitalization with empiric antibiotic therapy in all febrile infants has a significant risk of
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Urinary tract infections in children: EAU/ESPU guidelines
2015, European UrologyCitation Excerpt :This includes questions on primary (first) or secondary (recurring) infection, febrile or nonfebrile UTIs; malformations of the urinary tract (eg, pre- or postnatal ultrasound [US] screening), previous operations, drinking, and voiding habits; family history; whether there is constipation or the presence of lower urinary tract symptoms; and sexual history in adolescents. Fever may be the only symptom of UTI, especially in young children [14,26–30]. Newborns with pyelonephritis or urosepsis can present with nonspecific symptoms (failure to thrive, jaundice, vomiting, hyperexcitability, lethargy, hypothermia, and sometimes without fever) [31,32].
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Address reprint requests to Michael Slater, MD, Division of Emergency Medicine, Northwestern University Medical School, 216 East Superior Avenue, Suite 100, Chicago, IL 60611