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Evaluation and Management of the Febrile Young Infant in the Emergency Department (Infectious Disease CME)
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Evaluation and Management of the Febrile Young Infant in the Emergency Department (Infectious Disease CME) - $49.00

Publication Date: July 2019 (Volume 16, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 7/01/2022.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits, subject to your state and institutional approval.

Authors

Lauren Palladino, MD
Chief Resident, Department of Pediatrics, Yale School of Medicine, New Haven, CT
 
Christopher Woll, MD
Fellow, Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT
 
Paul L. Aronson, MD, MHS
Associate Professor of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT

Peer Reviewers

Jeffrey R. Avner, MD, FAAP
Chairman, Department of Pediatrics, Professor of Clinical Pediatrics, Maimonides Children’s Hospital of Brooklyn, Brooklyn, NY
 
Jessica S. Williams, MD
Pediatric Emergency Medicine Faculty, Assistant Professor, UT Southwestern, Children’s Health Plano, Plano, TX

Abstract

Among young infants presenting with fever, untreated serious bacterial infections can have severe outcomes, so a full sepsis workup is often recommended but may not be necessary. This issue reviews the use of novel diagnostic tools such as procalcitonin, C-reactive protein, and RNA biosignatures as well as new risk stratification tools such as the Step-by-Step approach and the Pediatric Emergency Care Applied Research Network prediction rule to determine which febrile young infants require a full sepsis workup and to guide the management of these patients in the emergency department. The most recent literature assessing the risk of concomitant bacterial meningitis with urinary tract infections and the role for viral testing, specifically herpes simplex virus and enterovirus, are also reviewed.

Excerpt From This Issue

A 20-day-old boy presents to the ED in August for evaluation of a rectal temperature of 38˚C (100.4˚F). The baby was born by spontaneous vaginal delivery at 39 weeks’ gestational age. The mother’s prenatal labs were normal, including negative screening for group B Streptococcus. The patient felt warm to the parents today but has otherwise been asymptomatic. The baby has been eating 3 ounces every 4 hours and making an appropriate amount of wet diapers. The physical examination is normal, including a flat anterior fontanel and good hydration. When you explain to the mother that the baby will need to undergo the full sepsis workup, including lumbar puncture, she starts asking you questions: Is all of that testing necessary? Since her baby appears well other than the fever, what is the probability that he has a serious infection? Can other infections besides bacterial infections cause a fever, and does the baby need testing to identify those infections? After the testing is completed, will the baby need to be admitted to the hospital?

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 the 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?

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