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Pediatrics – Fever in a Neonate, Fever in a Child
Whiteboard Animation Transcript
with Hosanna Au, MD
https://medskl.com/module/index/fever-in-a-neonate-fever-in-a-child

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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A fever in an infant must be taken seriously. In this episode, Dr. Sanjay Wazir, Neonatologist, and Pediatrician from Cloudnine Hospitals, Gurugram is answering all your queries regarding fever in newborn. #FeverInNewborn #FeverInChildren

Excerpts:-
Newborn babies may have a fever because they are actually sick or they may have a fever because they may have been over-covered. So, the fever
could be because of the baby or it could be environmental. Now, The first thing is to measure
the baby’s temperature and during that process you can use an axillary temperature or a rectal
thermometer. Anyone you use make sure of one point. Do not add plus one or minus 1 as the
common convention in most homes to add to the axillary temperature. So most cases in baby’s are taken based on axillary temperature. So if the axillary temperature is more than 100 degrees.
look at the hands and feet of the baby.

If the hands and feet are warm then most likely you are over covering the baby and then the best thing is
to uncover the baby. But if the baby’s hand and feet are very cold and especially if the baby does not look very good
then in that case probably the baby has a genuine fever.

Once you have the baby fever you have paracetamol drops. The dose of which is based on the weight.

and for that dose, you should consult your pediatrician or maybe have asked him in the previous visit.
But not more than one or 2 doses you should give for fever. and then it is important if the newborn has a fever you go to the doctor to find out the cause of fever because children may have an infection sepsis that may progress rapidly and you may not get enough chance for them to go back and treat adequately. So it’s important that you give only
1 or 2 doses of crocin or paracetamol and then show to your doctor to decide the future course of .

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