-- [ From: Martin Herman * EMC.Ver #2.5.1 ] --
This is a very touchy area. A baby with a fever actually presents
frequently to my emergency room as well as to the pediatricians officies
. What I do is evaluate the child and obtain as complete a history as I
can. IF there is a clear cut viral syndrome in the child, ie runny nose,
watery eyes, coughing , sneezing and hacky cough, I might do nothing.
Same is true for the kid with diarrhea that is well hydrated. This is
especially true for the kids whose family members have had colds in the
recent past or who are still sick when I see the baby.
Now for the babies who has a fver and no clear cut viral syndrome or
focal explanation of the fever, I will do a complete sepsis work up. If
there is a focus, I treat that. Only exception , is the babe with an
Otitis media. Why exclude OM as a treatable source_ Good question.. My
response to house staff is that the ears are so tough to be sure about,
especially in the neonate that Ido not take a chance on making that
call. The tympaninc membrane in the very young may look thick and white
just from a maturational delay , so how can one be sure that a thick
white drum is a sign of OM?
I believe if you reread the work on febrile neonates, you will find some
support for the position I advocate. Think about how many times we have
performed a swu on a febrile kid,how many yield anything? Usually there
is some marker, though subtle that will substantiate the work up.
Irritability, poor feeding, lethargy , looking sick, etc.
I do not work up every infant who has a fever. I try to be selective.
Good luck with your search for the true path..
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