I recently saw a 14 week old neonate with a reported temperature of 101 F.
Seen a few days earlier in a community pediatrician's office, she had a
documented office temperature of 101 F. A blood culture was drawn and no
antibiotic was given.
She was sent home with reassurances and return precautions. She was advised to
come to the emergency department for evaluation, because the lab reported a
positive culture on the 3rd day.
In the ED, she had a normal rectal temp, but the night before had several
emesis. Mom did not report tactile temps at home during the interval, but did
not monitor diligently with a thermometer.
While a full septic workup including LP was in progress, I spoke with the
pediatrician, who reported the documented fever, that the neonate "looked
well", and that no LP was done. He stated that community pediatricians (in his
experience), as in his practice, will:
"get a CBC and blood culture"
"send the neonate home"
"if the patient looks good"
"and the lab results are ok"
The justification for this practice was his citation of a study in Boston
recently in the last year or so. I was unable to locate this citation, and am
seeking this reference and any commentary.
Joseph Kim, MD
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