Fever without a focus in children 0-36 months of age

Abstract

About 20% of fevers in childhood have no apparent cause. A small, but significant number of these children may have a seroius bacterial infection. Fever without a focus of infection is an acute febrile illness with rectal temperature of 38 degrees C or higher in children younger than 36 months, without localizing signs or symptoms. In this article, practical recommendations for medical care of febrile children 0-36 months of age are given, bearing in mind children's age, clinical presentation (toxic manifestations) and risk for serious bacterial infection (sepsis, meningitis, pneumonia, urinary tract infection...). Toxic appearance is a clinical presentation characterized by lethargy, poor perfusion, marked hypo/hyperventilation and cyanosis. All febrile children under 36 months of age, who are appearing toxic, require hospitalization, evaluation for sepsis and administration of empiricial antibiotic therapy. All febrile neonates, however, must be hospitalized; cultures of blood, urine and spinal fluid should be taken and empirical antibiotic therapy administered immediately. Febrile infants, 28 to 90 days of age, need to be evaluated in order to determine whether they are in the low-risk group for serious bacterial infections (Rochester Criteria). Yale Observation Scale is recommended to assess febrile children aged 3-36 months, and the risk of occult bacteriemia. Febrile children, 3-36 months of age who appear well, with temperature of less than 39 degrees C without focus, should be closely followed up without laboratory tests and antibiotics and 2-3 days later reexamined. In febrile children, 3-36 months old, with temperature of 39 degrees C and above, without toxic manifestations, blood culture should be taken and ceftriaxone 50 mg/kg/in a single dose should be given, if leukocyte count is 15000/mm3 or absolute neutrophil count is over 10.000/mm3.