eMedicine Specialties > Emergency Medicine > Pediatric

Fever in the Neonate and Young Child: Follow-up

Author: Stella C Wong, DO, Assistant Professor, Department of Emergency Medicine, Emory University School of Medicine
Coauthor(s): Richard J Scarfone, MD, Associate Professor, Department of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician and Director of Emergency Preparedness, Division of Emergency Medicine, The Children's Hospital of Philadelphia; Fred Henretig, MD, Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital
Contributor Information and Disclosures

Updated: Aug 6, 2009

Follow-up

Further Inpatient Care

  • All neonates aged 0-30 days and toxic-appearing children should be hospitalized for antibiotic treatments.
  • Antibiotic treatment should not be discontinued until all culture results show no bacterial growth after 48 hours.

Further Outpatient Care

  • Major factors in outpatient care are reliability of caretakers, close follow-up with primary care physicians, and an ED protocol for notification if cultures are positive.
  • Children who have a positive CSF culture should return to the hospital for IV antibiotics and admission.
  • Primary care physicians or ED physicians should notify caretakers if a child has a positive blood culture. The child must be reevaluated.
  • Primary care physicians or ED physicians should notify caretakers if a child has a positive urine culture.
    • The child can be treated on an outpatient basis with close follow-up if he or she continues to appear well.
    • The child should return either to the ED or to the primary care physician's office if his or her clinical presentation worsens after discharge.

Inpatient & Outpatient Medications

See Medication for details.

Transfer

  • If the treating facility is not a pediatric facility, transfer the patient to a pediatric facility as needed after his or her condition is stabilized and the initial workup and treatments are administered in ED.

Deterrence/Prevention

Provide education to parents regarding the signs or symptoms of a serious bacterial infection, the importance of following the recommended immunization schedule and seeking immediate medical attention if a child should present any signs or symptoms of a serious bacterial infection. 

Complications

  • Serious bacterial infection
  • Septic shock
  • Organ damage from hypoperfusion or untreated infections
  • Long-term adverse effects later in life
  • Death

Prognosis

  • The prognosis depends on the patient's age, the severity of the disease, the duration of the disease, the time from when the patient seeks medical care to treatment, the patient's medical history, and other factors.

Patient Education

  • A child's immunizations should be kept up to date.
  • The importance of fever, especially during the first 3 months of an infant’s life, should be emphasized.
  • The importance of close follow-up should be communicated.
  • Caretakers might ask their health care providers for educational materials or resources, and providers should be prepared to respond.
  • For excellent patient education resources, visit eMedicine's Blood and Lymphatic System Center. Also, see eMedicine's patient education article Sepsis (Blood Infection).

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize/suspect occult bacteremia, serious bacterial infection (SBI), and/or sepsis
  • Failure to properly workup or treat fever or unknown source (FUS)
  • Failure to transfer/admit a child to the hospital for further testing and treatment when it is indicated
  • Failure to administer antibiotics and/or antiviral when it is indicated
  • Failure to ask about a child's immunization status
  • Failure to consult a pediatrician when it is indicated

Special Concerns

  • Immunocompromised patients
  • Lack of reliable caretakers or safe home environment
  • Lack of reliable outpatient follow-up
  • History of abuse or neglect
  • Immunizations are not up to date for age
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Michael H Goodyear, DO, Stuart A Friedman, DO, and Mary Beth Crawford, MD, to the development and writing of this article.

Dr. Wong would like to thank Kevin Osterhoudt, MD, from the Children's Hospital of Philadelphia for his assistance in recruiting coauthors for this article.



More on Fever in the Neonate and Young Child

Overview: Fever in the Neonate and Young Child
Differential Diagnoses & Workup: Fever in the Neonate and Young Child
Treatment & Medication: Fever in the Neonate and Young Child
Follow-up: Fever in the Neonate and Young Child
Multimedia: Fever in the Neonate and Young Child
References
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Further Reading

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Keywords

fever in babies, fever in young children, febrile infants and young children, serious bacterial infection, SBI, heptavalent pneumococcal conjugate vaccine (PCV7), children in the emergency department, bacteremia, sepsis, UTI, urinary tract infection, pneumonia, meningitis 

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Contributor Information and Disclosures

Author

Stella C Wong, DO, Assistant Professor, Department of Emergency Medicine, Emory University School of Medicine
Stella C Wong, DO is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, American College of Osteopathic Emergency Physicians, American Osteopathic Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Richard J Scarfone, MD, Associate Professor, Department of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician and Director of Emergency Preparedness, Division of Emergency Medicine, The Children's Hospital of Philadelphia
Richard J Scarfone, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Fred Henretig, MD, Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital
Disclosure: Nothing to disclose.

Medical Editor

Kirsten A Bechtel, MD, Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital
Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, 
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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