ED Rounds – Dec 2018
Objectives
- Discuss the risk of serious bacterial infection (SBI) in the neonate or young infant (<90d) with fever
- Review current suggestions for the work up, management, disposition, and follow up in the care of neonates and young infants with fever
- Discuss the role of decision tools (ex: Rochester, Boston, Philadelphia) to aid in decision making for the well-appearing infant with fever
Introduction
- •The febrile neonate (<28d) and young infant (<90d) are commonly encountered in the emergency dept.
- Many will have a self limited, viral illness
- A small but significant proportion (up to 15%1 in some series) will have a serious bacterial infection (SBI)
- How to best assess and manage such infants has long been a matter of debate.
Definitions
- Neonate: 0 to 28d
- Young Infant <90d
- Fever = rectal temp >/= 38.0C
- Serious bacterial infections (SBI) include:
- Bacterial meningitis, bacteremia, UTI, pneumonia
- Some series: enteritis, cellulitis, abscess, osteomyelitis, septic joint
- Invasive Bacterial Infect (IBI)
- Bacterial meningitis and bacteremia
Common Pathogens
- In neonates < 28d, most common pathogens are:
- E. coli
- Group B streptococcus
- S. pnuemoniae
- S. aureus
- L. monocytogenes
- Also:
- Herpes simplex virus
- Respiratory syncytial virus
- Enterovirus
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