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45 - Work-Up of Newborn Fever

from Part II - Pediatrics

Published online by Cambridge University Press:  15 December 2009

Maureen McCollough
Affiliation:
Associate Professor of Emergency Medicine and Pediatrics, Keck School of Medicine, University of Southern California; Director, Pediatric Emergency Department, Department of Pediatrics; Medical Director, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

INTRODUCTION

The neonate is defined as a newborn infant younger than 4 weeks old, and fever as a temperature greater than 100.4°F or 38°C. Because clinical exam is limited and because of the high risk of serious bacterial infection in this age group, all febrile neonates must be admitted for a sepsis workup and empiric antibiotic therapy.

Neonatal infections are unique, in that transmission of organisms can occur transplacentally during gestation and can present early on or be delayed by months or longer. Vertical transmission can occur in utero or during delivery. The newborn immune system is immature, increasing the susceptibility to infection. Other disease processes such as hyaline membrane disease may complicate infectious presentations. Finally, the presentation of infectious diseases in neonates is variable, often with subtle signs and symptoms.

EPIDEMIOLOGY

Neonates who are less than 2 weeks old who present to the ED have a particularly high incidence of serious illness with 10–33% requiring hospital admission. The most common diagnoses in admitted neonates include respiratory infections, sepsis, dehydration, congenital heart disease, bowel obstruction, hypoglycemia, and seizures.

Group B Streptococcus is the most common bacterial cause of neonatal sepsis in the United States. Listeria monocytogenes, Escherichia coli, Klebsiella, enterococcus, non-group D alpha hemolytic strep, and nontypeable Haemophilus influenzae are other bacterial causes.

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Publisher: Cambridge University Press
Print publication year: 2008

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References

American Academy of Pediatrics, Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006 Oct;118(4):1774–93.CrossRef
Bonsu, B K, Harper, M B. Utility of the peripheral blood white blood cell count for identifying sick young infants who need lumbar puncture. Ann Emerg Med 2003 Feb;41(2):206–14.CrossRefGoogle ScholarPubMed
Gerdes, J S. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin North Am 2004;51:939–59.CrossRefGoogle ScholarPubMed
Griffin, M P, Lake, D E, Moorman, J R. Heart rate characteristics and laboratory tests in neonatal sepsis. Pediatrics 2005;115(4):937–41.CrossRefGoogle ScholarPubMed
Grijalva, C G, Poehling, K A, Edwards, K M, et al. Accuracy and interpretation of rapid influenza tests in children. Pediatrics 2007 Jan;119(1):e6–11.1.CrossRefGoogle ScholarPubMed
Hoppe, J E. Neonatal pertussis. Pediatr Infect Dis J 2000;19:244–7.CrossRefGoogle ScholarPubMed
Hsiao, A L, Chen, L, Baker, M D. Incidence and predictors of serious bacterial infections among 57- to 180-day-old infants. Pediatrics 2006 May;117(5):1695–701.CrossRefGoogle ScholarPubMed
Levine, D A, Platt, S L, Dayan, P S, et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics 2004 Jun;113(6):1728–34.CrossRefGoogle ScholarPubMed
Malk, A, Hui, C P S, Pennie, R A, Kirpalani, H.Beyond the complete blood cell count and C-reactive protein. Arch Pediatr Adolesc Med 2003;57:511–6.CrossRefGoogle Scholar
Poland, R, Watterberg, K.Sepsis in the newborn. Pediatr Rev 1993;14(7):262–3.CrossRefGoogle ScholarPubMed
Sadow, K B, Derr, R, Teach, S J. Bacterial infections in infants 60 days and younger. Arch Pediatr Adolesc Med 1999;153:611–4.CrossRefGoogle ScholarPubMed
Scarfone, R J. Controversies in the treatment of bronchiolitis. Curr Opin Pediatr 2005 Feb;17(1):62–6.CrossRefGoogle ScholarPubMed
Smitherman, H F, Caviness, A C, Macias, C G. Retrospective review of serious bacterial infections in infants who are 0 to 36 months of age and have influenza A infection. Pediatrics 2005 Mar;115(3):710–8.CrossRefGoogle Scholar
Tipple, M A, Beem, M O, Saxon, E M. Clinical characteristics of the afebrile pneumonia associated with Chlamydia trachomatis infection in infants less than 6 months of age. Pediatrics 1979;63:192–7.Google ScholarPubMed
Willwerth, B M, Harper, M B, Greenes, D S. Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. Ann Emerg Med 2006 Oct;48(4):441–7.CrossRefGoogle ScholarPubMed
American College of Emergency Physicians (ACEP) Pediatric Committee. Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med 2003 Oct;42(4):530–45.CrossRef
American Heart Association (AHA). 2005 guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric advanced life support. Pediatrics 2006 May;117(5):e1005–28.CrossRef
Millar, K R, Gloor, J E, Wellington, N, Joubert, G.Early neonatal presentations to the pediatric emergency department. Pediatr Emerg Care 2000;16:145–52.CrossRefGoogle ScholarPubMed

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  • Work-Up of Newborn Fever
    • By Maureen McCollough, Associate Professor of Emergency Medicine and Pediatrics, Keck School of Medicine, University of Southern California; Director, Pediatric Emergency Department, Department of Pediatrics; Medical Director, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.046
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  • Work-Up of Newborn Fever
    • By Maureen McCollough, Associate Professor of Emergency Medicine and Pediatrics, Keck School of Medicine, University of Southern California; Director, Pediatric Emergency Department, Department of Pediatrics; Medical Director, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.046
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Work-Up of Newborn Fever
    • By Maureen McCollough, Associate Professor of Emergency Medicine and Pediatrics, Keck School of Medicine, University of Southern California; Director, Pediatric Emergency Department, Department of Pediatrics; Medical Director, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.046
Available formats
×