FEVER IN INFANTS <3 MONTHS

OF AGE

FEVER IN INFANTS <3 MONTHS OF AGE

Also known as temperature instability

Most febrile illnesses caused by common viral

pathogens

Higher risk = serious bacterial infections

(compared to older infants)

NEONATES
Group B Strep
E. coli
L. Monocytogenes

1-3 MONTHS
S. pneumoniae
H. influenzae
Nontyphoidal Salmonella
N. meningitidis

Bacteremia

E. coli

UTI

S. aureus
S.pneumoniae
Group B strep

Pneumonia

FEVER
Osteomyelitis/
Suppurative
Arthritis
S. aureus
Group B strep

Bacterial
Diarrhoea
Salmonella
Shigella
E. coli

Meningitis
S. pneumoniae
H. Influenzae type B
Group B strep
Meningococcus
HSV
Enteroviruses

Clinical Presentation
Fever
Poor feeding

Management
Viral vs Bacterial Very difficult to differentiate!

Obtain Samples:
Blood
Urine
CSF
Febrile infants < 3 months:
Admit to ward
Empirical antibiotics
Culture results pending

Broad-spectrum Parenteral Antibiotics

1st line: Ampicillin + Gentamicin
2nd line: Cefotaxime

*Choice of antibiotics dependent on pathogens

suspected by localising findings.

Prognosis
Low risk for serious bacterial infection:
-Well appearing febrile infants (1-3months old)
-No identifiable focus
-Certainty of follow-up
* 0.8% Bacteremia
2% Serious localised bacterial infection

Specific Criteria for Low Risk Infants

>1 month old

Well appearing without a focus of infection
No Hx of prematurity
No Hx of prior antimicrobial therapy
WBC count = 5000 15000/ L
Urine = <10 WBCs/ high power field
Stool = <5 WBCs/ high power field (if diarrhoea)
Chest X-ray = normal (if respiratory signs)

Management
As outpatients
No empirical antibiotic treatment
Alt: IM ceftriaxone
Re-evaluation in 24 hours or immediately with
any clinical change
Close follow-up for 72 hours