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Baby fever
Last reviewed: 23.04.2024
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Normal temperature varies with different people and during the day. Fever - rectal temperature equal to or greater than 38.0 ° C. The significance of fever is determined by clinical symptoms; Some Non-Severe disease can cause high fever, while some serious diseases are only minor. temperature, fever.
Fever is caused by the action of exogenous (microbial, viral) pyrogens, which, by acting on tissue or blood macrophages, stimulate their release of secondary (endogenous) pyrogens. Interleukin-1 (IL-1) and tumor necrosis factor (TNF) are believed to be the main endogenous pyrogens. Leukocyte interferon (a) is of less importance.
Fever has 3 stages: incrementi (increase), fastigii (plateau) and incrementi (decrease). Reduced temperature can be critical and lytic. With a rapid drop in high body temperature (minutes, hours), a collapse is possible.
Body temperature can be subfebrile (up to 37.5 ° C), febrile (high - 37.5-38.5 ° C), hyperthermic (hyperpyrexia - above 38.5 ° C).
Fever can be classified according to the duration and severity of individual attacks of fever:
- febrile reaction
- Hyperthermic syndrome (Ombredanna),
- malignant hyperthermia.
The febrile reaction suggests the presence of a relatively short episode of an increase in body temperature (from a few minutes to 1-2 hours) and is not accompanied by a significant deterioration in the well-being of the comb. The skin is usually pink, moist. The temperature in some cases (can be high 39-40 ° C), but, as a rule, is easily affected by antipyretic agents. This reaction is called the "pink" or "red" hyperthermia. Heat production prevails in its genesis.
Hyperthermic syndrome is characterized by persistent fever fever, antipyretic drugs, skin paleness (or pallor with acrocyanosis), deterioration of well-being, and sometimes impaired consciousness and behavior (lethargy, agitation).
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Causes of Fever in Children
Most often, acute fever in a child of the first year of life and early age is infectious in nature, mainly acute respiratory viral infections (ARVI) or gastrointestinal infections. Bacterial infections, usually otitis media, pneumonia, urinary tract infections, are less common, but can sometimes be very severe (for example, meningitis). Newborns are susceptible to infections caused by Streptococcus group B, Escherichia coli, Lysteria monocytogenes, virus, simple virus, simple virus, simple virus, simple virus, simple virus, simple virus, simple virus, simple virus, simple herpes virus perinatally.
Children under 2 years old (especially under 3 months) are at risk for the development of cryptogenic bacteremia, that is, the presence of pathogenic bacteria in the blood of a febrile feverish child with no signs of local damage. The most common causative microorganisms are Streptococcus pneumoniae and Haemophylus influenzae ; Vaccination against hemophilic infection is now widespread in the USA and Europe, which has led to less frequent septicemia.
Rarely, among the non-infectious causes of acute fever, heatstroke and poisoning are noted (for example, anticholinergics). Some vaccines (for example, the vaccination for the pertussis vaccine ) can cause a fever every other day or even in 1-2 weeks, causing a vaccine-associated disease (for example, measles) after the vaccination. This fever in children usually lasts from several hours to one day. Teething does not cause fever.
Chronic fever in children may indicate various causes of autoimmune diseases (e.g., juvenile rheumatoid arthritis, non-specific inflammatory bowel disease) to cancer (e.g., leukemia, lymphoma ), as well as chronic infections ( osteomyelitis, IC).
What to do if a child has a fever?
The survey varies by age group and focuses on identifying the source of the infection or the causes of noncommunicable diseases. Acute fever in a child younger than 3 months requires careful examination, regardless of other signs and symptoms, because severe infections (eg, sepsis, meningitis) can occur without other clinical manifestations.
Anamnesis
For children younger than 3 months, history should focus on risk factors for sepsis, including infectious diseases of the mother, prematurity, early surgery, or HIV infection. In older children, the history should focus on the detection of local symptoms and signs, vaccination history, recent infections (including infectious diseases of family members and the caretaker), as well as other risk factors for infection, including invasive medical procedures (eg, catheterization, bypass surgery), as well as conditions that predispose to infections (eg, congenital heart diseases, sickle cell anemia, neoplasms, immunodeficiency). A family history of autoimmune diseases is also important. Despite the fact that there is no direct relationship between the height of the fever and the severity of the cause, the temperature above 39.0 "C is a high risk of having cryptogenic bacteremia in children under 2 years of age.
Inspection
It is extremely important to assess the general condition and appearance of the child. A febrile feverish child with signs of intoxication, especially when the temperature has already decreased, requires careful examination and further observation. In all febrile-febrile children, special attention should be paid to examining the eardrum, pharynx, chest, abdomen, lymph nodes, and skin, checking for meningeal signs. Petechiae or purpura often indicate a severe infection.
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Laboratory and instrumental examination
All febrile febrile children is necessary to analyze the blood to determine the number of white blood cells and leukocyte counts, blood cultures, urinalysis and urine culture. Spinal puncture is required for children under 2 months; There are different opinions about the need for this procedure in children aged 2-3 months. It is advisable to carry out X-ray of chest x-ray, determination of leukocyte count in feces, seeding feces, determination of acute phase indicators (for example, ESR, C-reactive protein, procalcitonin).
Febrile febrile children aged 3 to 24 months with good health can be quite careful observation, conducting laboratory tests are optional. If there are symptoms of a specific infection, appropriate studies should be ordered (for example, chest radiography in the presence of hypoxemia, dyspnea, or wheezing ; analysis and urine culture in the presence of urine with an unpleasant odor). If your child has symptoms of intoxication, but there are no local symptoms, should appoint complete blood count, blood cultures and urine studies and cerebrospinal fluid.
Examination of children older than 2 years is determined by history and examination results; control of blood culture and leukocyte count is not shown.
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Treatment of fever in a child
Symptomatic treatment of fever in children usually includes acetaminophen at a dose of 10-15 mg / kg by mouth or rectally every 4 or 6 hours (do not exceed 5 doses per day) or ibuprofen at 5-10 mg / kg every 6-8 hours.
Treatment of infectious fever with a well-established etiology is aimed at treating the underlying disease. Treatment of fever in a child of unknown genesis depends on the age, anamnesis, and results of laboratory and instrumental examination.
Most experts recommend treating infants up to 28 days in the hospital until the results of laboratory tests are obtained using intravenous forms of broad-spectrum antibiotics. Current guidelines include ceftriaxone (50–70 mg / kg every 24 hours, or 80–100 mg / kg if high cytosis is found in the cerebrospinal fluid) or cefotaxime (50 mg / kg every 6 hours) plus ampicillin, which is effective against listeria and enterococci. Vancomycin (15 mg / kg every 6 hours) is added if it is suggested that the disease may be caused by penicillin-resistant strains of Streptococcus pneumoniae, or acyclovir, in the event that a herpes infection is suspected.
The decision on how deep the examination is required if there is a fever in the child, whether it is necessary to prescribe antibiotics to the child before obtaining the results of seeding, hospitalize him or leave the hospital at home depends on the child’s condition, family responsibility, presence or absence of risk factors for septicemia.