Posted by Robin Wilkinson in: Uncategorized , trackback
A 40-day-old girl presents to the ED in January for evaluation of a rectal temperature of 38˚C (100.4˚F). The history and physical examination are similar to an infant you saw in August, except that she has nasal discharge and a cough. Which risk stratification algorithm should you use for this infant? Would your workup change if a respiratory swab was positive for respiratory syncytial virus?
Although the 40-day-old infant’s signs and symptoms were suggestive of a benign URI, you remembered that several studies demonstrated that infants in this age group (29-56 days) with documented RSV or influenza are still at risk for SBI, especially UTI, though the risk of IBI is lower in this age group compared with infants who have negative RSV or influenza testing. You ordered urine studies, blood culture, CBC, CRP, and PCT, given the non-negligible prevalence of IBI. The urinalysis was normal, the CBC showed a WBC of 10,000/mcL, the CRP was < 20 mg/L, the PCT was < 0.5 ng/mL, and the ANC was < 10,000 cells/mcL. Since the girl’s labs were reassuring and she was well appearing and feeding appropriately with reliable followup, you discharged her home without CSF testing and with close primary care follow-up the next day.
Did you get it right?