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Pediatrics – Fever in a Neonate, Fever in a Child: By Hosanna Au M.D.

November 10, 2019

Fever is a common feature of many disease
processes. It is an elevation in body temperature mediated by the hypothalamus as a physiologic
response to an insult. In children, fever most commonly results from infectious, inflammatory,
or malignant processes. By far, the most common cause of fever in children is infection. Although there are various locations where
a child’s temperature can be measured, in neonates and young children, a rectal measurement
is most definitive, whereas an oral temperature is best in older children. A fever is generally
defined as any temperature ≥38ºC (100.4ºF) using oral or rectal thermometers. Contrary to popular belief, fever in itself
is not harmful, but rather signals caretakers and physicians to search for an underlying
process that can be harmful. The goal in evaluating a febrile infant or child is to identify the
underlying cause of the fever. Infants and children with the following features
are at a high risk for developing serious bacterial or viral infections (such as meningitis
or bacteremia) or serious viral infection and warrant a full septic workup: Ill-appearing infant or child, regardless
of age.1,2 Fever in all neonates younger than 28 days
regardless of clinical appearance.1,2 Any neonate with findings suggesting HSV infection
upon examination (e.g. mucocutaneous vesicles, seizures, or focal neurologic findings), especially
those with maternal risk factors for vertical transmission.1,2
Infants up to 3 months of age with clinical and/or laboratory factors that are high risk
for serious bacterial infections.1,2 Strongly consider a full septic workup in
unimmunized infants.1,2 A full septic workup includes a complete blood
count with differential, blood cultures and sensitivity, urinalysis, urine culture and
sensitivity, cerebrospinal fluid analysis and cerebrospinal fluid culture and sensitivity
or viral studies. Other investigations may be required depending on the clinical presentation
such as a throat culture, chest x-ray if there are respiratory symptoms or stool microbiological
studies if gastrointestinal symptoms are present. The main reason for treating a fever is to
reduce discomfort in the child. Children should wear light-weight clothing and drink lots
of fluids. Medications such as acetaminophen or ibuprofen will help keep the child comfortable
and reduce any associated pain. Caregivers should be notified not to use aspirin because
of its association with Reye’s syndrome. It is important to determine the cause of
the fever and treat the underlying condition. In the case of infection, management may include
empiric broad spectrum antibiotics or antivirals, or narrow spectrum antimicrobials to target
a specific infection.

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