Problemi correnti
La febbre alta nel lattante e nel bambino sotto i tre anni
FEVER IN THE FIRST THREE YEARS OF LIFE
STEFANO RUSSIAN, CHRISTINE M. SALVATORE
Clinica Pediatrica dell’Università di Trieste, IRCCS “Burlo Garofolo”
Marzo 1997 - pagg. 171 -175
Abstract
The Authors review the recommendations
on the management of fever in infants and
children below three years of age, and
compare them with the current practice of
primary care paediatricians. Primary care
practictioners indeed appear more confident
on their clinical assessment, in spite of
the results of several studies showing that a
small but significant proportion of cases
with severe bacterial infection can be missed
this way. Based on existing evidence,
the Authors recommend to perform a WBC
count and urinalysis in all infants below 3
months with fever and in all other children
below 2 years of age with fever higher
than 39C°, provided that no other obvious
cause can be identified. A follow-up visit
within 24 hours is also recommended in
these cases.
Classificazione MeSH
Bibliografia
1. Baraff LJ, Bass JW, Fleisher GR, Klein JO
et al: Practice guidelines for the management
of infant and children 0 to 36 months
of age with fever without source. Ann Emerg
Med July, 22, 7, 108-120, 1993.
2. Rabusin M, Ronfani L, Tamburlini G: La febbre nei primi 3 mesi di vita. Medico e Bambino 13, 451, 1994.
3. Dagan R, Sofer S, Phillip M, Shachak E: Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections. J Pediatrics March, 355-360, 1988.
4. Dagan R, Powell KR, Hall CB, Menegus MA: Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis. J Pediatics December, 885-860, 1985.
5. Broner CW, Polk SA, Sherman JM: Febrile infants less than eight weeks old. Prediction of infection. Clin Ped August, vol 29, 8, 438-443, 1990.
6. Baskin MN, O’Rourke EJ, Fleisher GR: Outpatients treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone. J Pediatrics January, 22-27, 1992.
7. Lieu TA, Sanford Schwartz J, Jaffe DM, Fleisher GR: Strategies for diagnosis and treatment of children at risk for occult bacteremia: clinical effectiveness and cost-effectiveness. J Pediatrics January, 21-29, 1991.
8. McCarthy PL: Management of the febrile infants. Pediatrics, 89, 125 -1253, 1992.
9. Bonadio WA, McElroy K, Jacoby PL, Smith D: Relationship of fever magnitude to rate of serious bacterial infections in infants aged 4-8 weeks. Clin Ped August, vol. 30, 8, 478-480, 1991.
10. Baker MD, Bell LM, Avner JR: Outpatients management without antibiotics of fever in selected infants. NEJM November, 11, vol 329, 20, 1437-1441, 1993.
11. Jaskiewicz JA, McCarthy CA, Richardson AC, White KC et al: Febrile infants at low risk for serious bacterial infection - An appraisal of the Rochester Criteria and Implications for Management. Pediatrics September, vol. 94, 3, 390-396, 1994.
12. Crain EF, Bulas D, Bijur PE, Goldman HS: Is a chest radiograph necessary in the evaluation of every febrile infant less than 8 weeks of age? Pediatrics October, vol 88, 4, 821-824, 1991.
13. Patterson RJ, Bisset GS, Kirks DR, Vanness A: Chest radiographs in the evaluation of the febrile infant. Am J Roentgenol October 155, 4, 833-5, 1990.
14. Taylor JA, Del Beccaro M, Done S, Winters W: Establishing clinically relevant standards for tachypnea in febrile children younger than 2 years. Arch Pediatr Adolesc Med March, 149, 3, 283-7, 1995.
15. McCarthy PL, Shape MR, Spiesel SZ, Dolan TF et al:. Observation scales to identify serious illness in febrile children. Pediatrics November, vol 70, 5, 802-809, 1982.
16. McCarthy PL, Jekel JF, Stashwick CA, Spiesel SZ et al: Further definition of history and observation variables in assessing febrile children. Pediatrics May, vol 67, 5, 687- 693, 1981.
17. McCarthy PL, Sznajderman SD, Lustman- Findling K, Baron MA et al: Mothers’ clinical judgment: a randomized trial of the acute illness observation scales. J Pediatrics February 200-206, 1990.
18. Baker MD, Avner JR, Bell LM: Failure of infants observation scales in detecting serious illness in febrile, 4-to 8- week-old infants. Pediatrics June, vol. 85, 6, 1040-1043, 1990.
19. Lieu TA, Baskin MN, Sanford Schwartz J, Fleisher GR: Clinical and cost-effectiveness of outpatient strategies for management of febrile infants. Pediatrics June, vol 89, 6, 1135-1144, 1992.
20. Young PC: The management of febrile infants by primary-care pediatricians in Utah: comparison with published practice guidelines. Pediatrics May, vol 95, 5, 623- 627, 1995.
21. Oppenheim PI, Sotiropoulos G, Baraff LJ: Incorporating patients preferences into practice guidelines: management of children with fever without source. Ann Emerg Med November, 24, 5, 836-841, 1994.
22. Lembo RM, Marchant CD: Acute phase reactants and risk of bacterial meningitis among febrile infants and children. Ann Emerg Med January, 20, 1, 36-39, 1991.
2. Rabusin M, Ronfani L, Tamburlini G: La febbre nei primi 3 mesi di vita. Medico e Bambino 13, 451, 1994.
3. Dagan R, Sofer S, Phillip M, Shachak E: Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections. J Pediatrics March, 355-360, 1988.
4. Dagan R, Powell KR, Hall CB, Menegus MA: Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis. J Pediatics December, 885-860, 1985.
5. Broner CW, Polk SA, Sherman JM: Febrile infants less than eight weeks old. Prediction of infection. Clin Ped August, vol 29, 8, 438-443, 1990.
6. Baskin MN, O’Rourke EJ, Fleisher GR: Outpatients treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone. J Pediatrics January, 22-27, 1992.
7. Lieu TA, Sanford Schwartz J, Jaffe DM, Fleisher GR: Strategies for diagnosis and treatment of children at risk for occult bacteremia: clinical effectiveness and cost-effectiveness. J Pediatrics January, 21-29, 1991.
8. McCarthy PL: Management of the febrile infants. Pediatrics, 89, 125 -1253, 1992.
9. Bonadio WA, McElroy K, Jacoby PL, Smith D: Relationship of fever magnitude to rate of serious bacterial infections in infants aged 4-8 weeks. Clin Ped August, vol. 30, 8, 478-480, 1991.
10. Baker MD, Bell LM, Avner JR: Outpatients management without antibiotics of fever in selected infants. NEJM November, 11, vol 329, 20, 1437-1441, 1993.
11. Jaskiewicz JA, McCarthy CA, Richardson AC, White KC et al: Febrile infants at low risk for serious bacterial infection - An appraisal of the Rochester Criteria and Implications for Management. Pediatrics September, vol. 94, 3, 390-396, 1994.
12. Crain EF, Bulas D, Bijur PE, Goldman HS: Is a chest radiograph necessary in the evaluation of every febrile infant less than 8 weeks of age? Pediatrics October, vol 88, 4, 821-824, 1991.
13. Patterson RJ, Bisset GS, Kirks DR, Vanness A: Chest radiographs in the evaluation of the febrile infant. Am J Roentgenol October 155, 4, 833-5, 1990.
14. Taylor JA, Del Beccaro M, Done S, Winters W: Establishing clinically relevant standards for tachypnea in febrile children younger than 2 years. Arch Pediatr Adolesc Med March, 149, 3, 283-7, 1995.
15. McCarthy PL, Shape MR, Spiesel SZ, Dolan TF et al:. Observation scales to identify serious illness in febrile children. Pediatrics November, vol 70, 5, 802-809, 1982.
16. McCarthy PL, Jekel JF, Stashwick CA, Spiesel SZ et al: Further definition of history and observation variables in assessing febrile children. Pediatrics May, vol 67, 5, 687- 693, 1981.
17. McCarthy PL, Sznajderman SD, Lustman- Findling K, Baron MA et al: Mothers’ clinical judgment: a randomized trial of the acute illness observation scales. J Pediatrics February 200-206, 1990.
18. Baker MD, Avner JR, Bell LM: Failure of infants observation scales in detecting serious illness in febrile, 4-to 8- week-old infants. Pediatrics June, vol. 85, 6, 1040-1043, 1990.
19. Lieu TA, Baskin MN, Sanford Schwartz J, Fleisher GR: Clinical and cost-effectiveness of outpatient strategies for management of febrile infants. Pediatrics June, vol 89, 6, 1135-1144, 1992.
20. Young PC: The management of febrile infants by primary-care pediatricians in Utah: comparison with published practice guidelines. Pediatrics May, vol 95, 5, 623- 627, 1995.
21. Oppenheim PI, Sotiropoulos G, Baraff LJ: Incorporating patients preferences into practice guidelines: management of children with fever without source. Ann Emerg Med November, 24, 5, 836-841, 1994.
22. Lembo RM, Marchant CD: Acute phase reactants and risk of bacterial meningitis among febrile infants and children. Ann Emerg Med January, 20, 1, 36-39, 1991.