Upload
happy
View
58
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Approach to a child with fever. Definition. 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. Normal body temperature. - PowerPoint PPT Presentation
Citation preview
12/3/1389
1
APPROACH TO A CHILD WITH FEVER
12/3/1389
3
12/3/1389
4
DEFINITIONFever: 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
NORMAL BODY TEMPERATURERectal : 38.3⁰С , most sensitive,
infantsOral: 37.8⁰С, sensitive, > 5 yrAxillary: 37.2⁰С, less sensitive, 1-5
yr
12/3/1389
6
INDICATIONS OF TREATMENT OF FEVER High fever( > 39⁰C)Chronic cardiopulmonary disordersChronic metabolic disordersNeurologic disordersRisk of febrile convulsion
12/3/1389
7
CONTROL OF FEVERAcetaminophen IbuprofenCombined acetaminophen and ibuprofenNo aspirinNo diclofenac NaNo corticosteroidExternal cooling : in hyperthermia, very
young infants, severe liver disease, neurologic disorder
12/3/1389
8
12/3/1389
9
12/3/1389
10
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 mm3 (5 to 15 3 109 per L) Absolute band cell count of ¾1,500 per mm3 (¾1.5 3 109 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
12/3/1389
12
12/3/1389
13
12/3/1389
14
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 risk3- 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