Fever <4 months
Prereading
| AAP Neonatal Sepsis Article |
| CHQ Fever Guideline |
Additional Reading :
PEM Playbook : The Undifferentiated Sick Neonate
Workbook Questions
Case 1
A 6-week-old girl is bought into emergency with her parents as she had a fever at home measured at 38.1 degrees. She has also been quite unsettled today and doesn’t seem to be latching to the breast as normal.
The temperature is recorded in ED as 38.4, HR 164, RR 40, CRT 2-3 seconds. The baby’s skin appearance is shown below.
PEM Playbook : The Undifferentiated Sick Neonate
Workbook Questions
Case 1
A 6-week-old girl is bought into emergency with her parents as she had a fever at home measured at 38.1 degrees. She has also been quite unsettled today and doesn’t seem to be latching to the breast as normal.
- What further history would you like to know about this child, the pregnancy and delivery?
- What features on history and exam are suggestive of a serious illness in a neonate?
- How would you measure the temperature in a neonate? What gives you the most accurate recording?
The temperature is recorded in ED as 38.4, HR 164, RR 40, CRT 2-3 seconds. The baby’s skin appearance is shown below.
- Comment on the image above
- What investigations does this baby require? And how are you going to perform them? What will you write on the request form?
- You have performed a full septic screen and decide to start antibiotics, which antibiotics will you choose and what are the doses?
- When will you use acyclovir and what dose would you use?
The LP results are back and shown below
- WCC 470 x 106/L (<106/L)
- RCC 0
- Protein 1.6 g/L (0.2-0.2g/L)
- Glucose 1.4mmol/L (>2.5mmol/L)
- What is your interpretation of the results?
- What organisms are you concerned about in the child under 2 months old?