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The Sick Infant: Five Deadly Misconceptions

The Sick Infant: Five Deadly Misconceptions. Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009. Case 1. 6 month female with fever to 103.6. Misconception. Immunizations have eliminated the need to perform any laboratory studies on febrile infants!.

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The Sick Infant: Five Deadly Misconceptions

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  1. The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009

  2. Case 1 • 6 month female with fever to 103.6

  3. Misconception Immunizations have eliminated the need to perform any laboratory studies on febrile infants!

  4. Febrile Infant Protocol

  5. Febrile Infant Immunization Status?

  6. Case 2 • 4 month male with 1 day history of high fever and lethargy

  7. Misconception • Kids are just small adults! • Kids are a totally different species!

  8. Sepsis • What’s different?

  9. Sepsis • What’s similar?

  10. Case 3 • 3 month female • 3 days of fever, cough, rash, conjunctivitis

  11. Misconception Kids will read the textbook prior to presenting with a myriad of signs and symptoms!!

  12. Kawasaki Disease • Five or more days of fever

  13. Kawasaki Disease • 4 out of 5 • Conjunctivitis • Rash • Extremity changes • Cervical adenopathy • Mucositis

  14. Incomplete (“Atypical”) Kawasaki Disease • Lack sufficient clinical signs to fulfill the classic criteria

  15. Prevalence Incomplete (“Atypical”) KawasakiDisease • Age • Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals…Pediatrics 2004; 114: 1708-1733.

  16. Coronary artery abnormalities Incomplete (“Atypical”) KawasakiDisease • Age • Genizi J, Miron D, Spiegel R, Fink D, Horowitz Y. Kawasaki Disease in Very Young Infants: High Prevalence of Atypical Presentation and Coronary Arteritis. Clin Pediatr 2003; 42: 263-267.

  17. Case 4 • 8-day old female with poor feeding, fever, and grunting respirations

  18. Misconception The sick neonate has been adequately treated with antibiotics alone

  19. Neonatal HSV

  20. Neonatal HSV

  21. Neonatal HSV The Prevalence of Neonatal Herpes Simplex Virus Infection Compared with Serious Bacterial Illness in Hospitalized Neonates Caviness AC, Demmler GJ, Almendarez Y, Selwyn BJ. J Pediatr 2008;153:164-9

  22. When should we start empiric acyclovir treatment in sick neonates? Clear index of suspicion for HSV Skin vesicles Seizures Elevated hepatic transaminases Neonatal HSV

  23. When should we start empiric acyclovir treatment in sick neonates? Sepsis-like picture Respiratory distress Hypothermia Lethargy Appears more ill than would be expected Neonatal HSV

  24. When should we start empiric acyclovir treatment in sick neonates? CSF pleocytosis Mononuclear cell predominance Neonatal HSV

  25. When should we start empiric acyclovir treatment in sick neonates? Age < 21 days and fever? Neonatal HSV

  26. Case 5 • 9 month male presents following a generalized seizure…noted to have fever to 103.4

  27. Misconception • You don’t have to do a spinal tap anymore! • You always have to do a spinal tap!

  28. Febrile Seizure and Meningitis • What is the risk of meningitis in patients with a febrile seizure?

  29. Febrile Seizure and Meningitis • Indications for a spinal tap

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