Pediatric emergency medicine trisk 0658 0658
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Febrile Young Infant
i
-
Triage ( Critical/Acute)
<
MD /CRNP/RN Assessment
and Bedside Procedure
IV access
CBC enhanced UA
Blood/urine culture
Bedside glucose as needed
LP tray at bedside
.
H&P
Additional Diagnostic Tests
All Infants 0- 28 Days
All III Infants 0- 56 Days
Perform LP
Antimicrobials
Admit
Infant 29-56 Days
with or without Bronchiolitis
Review Low Risk Criteria, including CBC and enhanced UA ( without CSF)
i
• HIGH RISK
Perform LP
Antimicrobials
Admit
Antimicrobial Therapy
(Meningitic doses are used Initially)
0-21 days
22-28 days
29-56 days
Low Risk for Bacterial Meningitis
29-56 days old
Full term ( >37 weeks, gestation)
No prolonged NiCU stay
No chronic medical problems
No systemic antibiotics within 72 hours
Well appearing and easily consolable
No Infections on examination
Blood:
WBC £5.000 and <15.000
Band to neutrophil ratio <0.2
( Bands/bands + neutrophils)
Enhanced UA:
WBC <10/HPF
Negative Gram stain
Chest x -ray (If obtained):
No infiltrate
Amplcillin/cefotaxime/acyclovlr
Ample!Illn/cefotaxime
Cefotaxime
1
Needs Admission
for Bronchiolitis
No antimicrobials
Admit
LOW RISK
No antimicrobials
Discharge
Assure NP follow -up call
* lf data is incomplete (e.g., urine or
blood could not be obtained), consider
patient High Risk
Additional Considerations:
Add
III patient
Vancomycin CSF WBC >8 w/abnormal glucose or protein
Gram- positive organism on Gram stain
Call ID
Gram- negative organism on Gram stain
Imlpenem and amikacin
HSV
Stan acyclovir for Infants <21 days OR for infants
22-40 days with £1 of the following:
III appearing
Abnormal neurologic status, seizures
Testing/
Treatment
Vesicular rash
Hepatitis
Mother known to have primary HSV Infection at delivery
FIGURE 31.2 Algorithm for the evaluation of the febrile young infant.
Special consideration has been given to the evaluation of the febrile young
infant with signs and symptoms suggestive of bronchiolitis. Several studies have
shown that bacteremia is unlikely in the face of a clinical diagnosis of
bronchiolitis. In the well-appearing child with bronchiolitis who is to be treated as
an outpatient, the risk of meningitis or occult bacteremia is exceedingly low.
