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Newborn fever and lumbar puncture

D Lagae, V Rigo, J-M Senterre, M Kalenga, J Piérart
Enterovirus (EV) may cause a broad spectrum of clinical syndromes and even cause a sepsis-like picture. Although they are responsible for high morbidity and mortality rates, viral testing does not appear in the algorithms for the evaluation of neonatal infections. During the month of June 2013, we identified 3 cases of EV meningitis in our unit of neonatology. All three infants had fever during the first week of life and their clinical examination revealed an irritability. The EV infection was detected by Real-Time Polymerase Chain Reaction (RT-PCR) EV on the cerebrospinal fluid (CSF)...
February 2016: Revue Médicale de Liège
Andréanne Benidir, Rodrick Lim, Marina Salvadori, Gurinder Sangha, Naveen Poonai
OBJECTIVE: The aim of this study was to assess current attitudes and approaches to the febrile neonate in terms of diagnostic investigations and empiric treatment of suspected herpes simplex virus (HSV) infection. METHODS: Between March 2010 and November 2010, a survey describing a hypothetical case of a febrile neonate presenting to the ED without clear signs of an HSV infection was sent to tertiary care pediatric emergency physicians across Canada. Participants were asked multiple choice and open-ended questions to obtain information about their choice of investigations, empiric treatment, and impression of the likelihood of HSV in the case...
March 2013: Pediatric Emergency Care
Jennifer L Hamilton, Sony P John
Febrile illness in children younger than 36 months is common and has potentially serious consequences. With the widespread use of immunizations against Streptococcus pneumoniae and Haemophilus influenzae type b, the epidemiology of bacterial infections causing fever has changed. Although an extensive diagnostic evaluation is still recommended for neonates, lumbar puncture and chest radiography are no longer recommended for older children with fever but no other indications. With an increase in the incidence of urinary tract infections in children, urine testing is important in those with unexplained fever...
February 15, 2013: American Family Physician
Katryn Paquette, Matthew P Cheng, David McGillivray, Christina Lam, Caroline Quach
OBJECTIVES: Guidelines for the management of febrile infants aged 30 to 90 days presenting to the emergency department (ED) suggest that a lumbar puncture (LP) should be performed routinely if a positive urinalysis is found during initial investigations. The aim of our study was to assess the necessity of routine LPs in infants aged 30 to 90 days presenting to the ED for a fever without source but are found to have a positive urine analysis. METHODS: We retrospectively reviewed the records of all infants aged 30 to 90 days, presenting to the Montreal Children's Hospital ED from October 2001 to August 2005 who underwent an LP for bacterial culture, in addition to urinalysis and blood and urine cultures...
November 2011: Pediatric Emergency Care
Michael K Mwaniki, Alison W Talbert, Patricia Njuguna, Mike English, Eugene Were, Brett S Lowe, Charles R Newton, James A Berkley
BACKGROUND: Meningitis is notoriously difficult to diagnose in infancy because its clinical features are non-specific. World Health Organization (WHO) guidelines suggest several indicative signs, based on limited data. We aimed to identify indicators of bacterial meningitis in young infants in Kenya, and compared their performance to the WHO guidelines. We also examined the feasibility of developing a scoring system for meningitis. METHODS: We studied all admissions aged < 60 days to Kilifi District Hospital, 2001 through 2005...
November 1, 2011: BMC Infectious Diseases
David Schnadower, Nathan Kuppermann, Charles G Macias, Stephen B Freedman, Marc N Baskin, Paul Ishimine, Camille Scribner, Pamela Okada, Heather Beach, Blake Bulloch, Dewesh Agrawal, Mary Saunders, Donna M Sutherland, Mercedes M Blackstone, Amit Sarnaik, Julie McManemy, Alison Brent, Jonathan Bennett, Jennifer M Plymale, Patrick Solari, Deborah J Mann, Peter S Dayan
OBJECTIVES: To determine the prevalence of and to identify risk factors for sterile cerebrospinal fluid (CSF) pleocytosis in a large sample of febrile young infants with urinary tract infections (UTIs) and to describe the clinical courses of those patients. DESIGN: Secondary analysis of a multicenter retrospective review. SETTING: Emergency departments of 20 North American hospitals. Patients Infants aged 29 to 60 days with temperatures of 38...
July 2011: Archives of Pediatrics & Adolescent Medicine
Tina T Chu, Jesse Groh, Andrea T Cruz
BACKGROUND: Pertussis has been increasing in frequency and can cause protean manifestation in infants, often resulting in extensive laboratory evaluation. METHODS: We examined the prevalence of cerebrospinal fluid (CSF) anomalies in infants with pertussis and parapertussis over a 5-year period. RESULTS: In total, 239 of 1489 children (16.1%) had a positive PCR for pertussis or parapertussis. Eighty-three percent were infants; the mean age of the 39 years who received a lumbar puncture (LP) was 43 days...
August 2011: Clinical Chemistry and Laboratory Medicine: CCLM
Sara L Chadwick, John W Wilson, James E Levin, Judith M Martin
UNLABELLED: BACKGROUND This study describes differences in the values of cerebrospinal fluid (CSF) white blood cell (WBC), glucose, and protein counts in infants less than 60 days of age with fever who were not proven to have viral or bacterial meningitis. METHODS: Three independent retrospective medical record reviews were conducted using a population of infants less than 60 days of age who presented to the Emergency Department with fever. Full-term infants were included if a lumbar puncture was performed within 24 hours of admittance and bacterial or viral meningitis was not identified as the cause of fever...
April 2011: Pediatric Infectious Disease Journal
William Paul Meehan, Eric Fleegler, Richard G Bachur
OBJECTIVES: The objectives of the study were (1) to determine the relative use of strategies for managing the well-appearing febrile infant and (2) to determine clinician adherence to protocol recommendations. METHODS: Members of the American Academy of Pediatrics Section on Emergency Medicine were asked to complete an online, interactive, case-based questionnaire. Infants with a temperature of 38.6°C who were otherwise completely well were presented. Respondents ordered laboratory studies and received results...
December 2010: Pediatric Emergency Care
Maya Dewan, Joseph J Zorc, Richard L Hodinka, Samir S Shah
OBJECTIVE: To determine whether cerebrospinal fluid (CSF) enterovirus polymerase chain reaction (PCR) testing of febrile neonates is associated with a shorter hospital length of stay (LOS). DESIGN: Retrospective cohort study. SETTING: Urban tertiary care children's hospital emergency department. PARTICIPANTS: Febrile infants 56 days or younger evaluated by means of lumbar puncture. MAIN EXPOSURE: Performance of CSF enterovirus PCR testing...
September 2010: Archives of Pediatrics & Adolescent Medicine
Carrie L Byington, Jeremy Kendrick, Xiaoming Sheng
OBJECTIVE: To describe the cerebrospinal fluid (CSF) profiles of febrile infants aged 1 to 90 days with negative bacterial culture test results and negative results for enteroviruses with polymerase chain reaction. STUDY DESIGN: Statistical analysis of a retrospective cohort. RESULTS: CSF profiles from 823 infants with negative test results for infection were analyzed. For 677 infants with atraumatic lumbar punctures (red blood cell [RBC] count < 1000/mm(3)), the mean and median CSF white blood cell (WBC) counts were 4...
January 2011: Journal of Pediatrics
David Pérez Solís, Juan José Díaz Martín, Etelvina Suárez Menéndez
INTRODUCTION: The relation between cellulitis and Group B streptococcus infection in newborns and small infants was first reported during the early 1980s and named cellulitis-adenitis syndrome. We report a case of a neonate with cellulitis-adenitis syndrome in an unusual location (retroauricular). CASE PRESENTATION: A 21-day-old Caucasian female infant was brought to the emergency department with fever, irritability and a decreased appetite. Physical examination revealed erythema and painful, mild swelling in the right retroauricular region...
2009: Journal of Medical Case Reports
Mary Iskander, Alison Kesson, Dominic Dwyer, Laura Rost, Margaret Pym, Han Wang, Mary McCaskill, Robert Booy
OBJECTIVE: Active surveillance to determine influenza disease burden in children admitted to hospital with influenza-like illness (ILI). METHODS: A prospective hospital-based cohort study conducted June-October 2006 in children <5 years hospitalised at The Children's Hospital at Westmead with ILI (fever and respiratory symptoms). Influenza and other viral infections were diagnosed either by antigen detection using immunofluorescence or nucleic acid amplification testing of nasopharyngeal aspirates...
December 2009: Journal of Paediatrics and Child Health
David Lester-Smith, Yvonne A Zurynski, Robert Booy, Marino S Festa, Alison M Kesson, Elizabeth J Elliott
Influenza is usually considered a mild winter-time illness but can be associated with a range of serious complications. We undertook a retrospective medical record review to study the impact of admissions of children with laboratory-confirmed influenza to The Children's Hospital at Westmead, Sydney, during 2007. One hundred and twenty-two children were identified, representing 530 hospital admission days. There was no clearly documented evidence of influenza vaccination for any patient eligible for vaccination...
June 2009: Communicable Diseases Intelligence Quarterly Report
Santiago Mintegi, Javier Benito, Eider Astobiza, Susana Capapé, Borja Gomez, Andere Eguireun
We included 685 consecutive previously healthy well appearing infants younger than 3 months with fever without known source admitted to an Emergency Department without routinely performing lumbar punctures (LP). LP was performed in 198 infants. Of these, 36 (18.1%) showed pleocytosis. Two infants less than 15 days were diagnosed with bacterial meningitis and 47 with aseptic meningitis (6.8%). LP was not performed in 487 infants. Of these, 69 were admitted to ward (46 had urinary tract infection) and 418 were discharged...
June 2010: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Ran D Goldman, Dennis Scolnik, Laurel Chauvin-Kimoff, Ken J Farion, Samina Ali, Tim Lynch, Serge Gouin, Martin H Osmond, David W Johnson, Terry P Klassen
OBJECTIVES: The objectives of this study were to characterize variations in treatment decisions for young febrile infants in pediatric emergency departments across Canada and to document the extent of practice variations among pediatric emergency department practitioners. METHODS: This was a prospective, concurrent, cohort study of consecutive infants up to 90 days of age who presented to 6 pediatric emergency departments in Canada with fever (rectal temperature of >or=38...
August 2009: Pediatrics
Kara L Davis, Samir S Shah, Gary Frank, Stephen C Eppes
BACKGROUND: The polymerase chain reaction (PCR)-based test to detect herpes simplex virus (HSV) genome in cerebrospinal fluid (CSF) has become the test of choice for diagnosing this infection. The utility of this test in young infants undergoing sepsis evaluations is unknown. OBJECTIVES: We sought to identify the factors that prompted physicians to include HSV PCR in their evaluation of young infants undergoing lumbar puncture. In addition, the impact of ordering this test on patient management was assessed...
October 2008: Pediatric Emergency Care
Larry J Baraff
There is considerable variation in the clinical management of infants and children with FWS. Community pediatricians generally do not follow clinical practice guidelines that are taught and used at academic training institutions. These guidelines are presented in Sidebar 1 (see page 677) and Sidebar 2. In general, the guidelines provided that all febrile neonates (>38.0 degrees C) should have a "full sepsis evaluation", including lumbar puncture, and be admitted for parenteral antibiotic therapy. Non-toxic appearing infants 29-90 days of age with FWS >38...
October 2008: Pediatric Annals
Manuel Díaz A, Yamilka Viel R, Bárbara Acosta B, Daniel Claver I
UNLABELLED: Lumbar puncture to detect bacterial meningitis is a recommended screening procedure to be performed in febrile newborn infants at admission to hospital. OBJECTIVE: To evaluate the usefulness of this procedure performed at admission and eventually, in a second look if clinically justified. PATIENTS AND METHOD: There were studied 1,841 febrile newborns consulting at the Emergency Department from January 1992 to December 2000 without source...
June 2008: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
Tarannum M Lateef, Tammy N Tsuchida, Taeun Chang, Jami Johnson, William D Gaillard, Karin B Nelson
No established guidelines address the need for lumbar puncture in fever-free infants younger than 6 months of age with a first seizure. We analyzed cerebrospinal fluid results in infants and found that lumbar puncture adds little diagnostic value to the evaluation of young, well-appearing infants presenting with possible new-onset seizures.
July 2008: Journal of Pediatrics
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