Neonatal fever 新生兒發燒
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Transcript Neonatal fever 新生兒發燒
Neonatal fever
新生兒發燒
General data
Name:黃ㄨ瑩之子
Gender: male / 1-day-old
Hx: 2791668
Ward: PICU-CN02
Admission Date: 2014/10/24
Time of birth: 2014/10/24 22:05
GA: 39 1/7 weeks, BBW: 3458gm
Chief complaint
Fever 38.3℃(Anal temperature) after birth.
Present illness
2014/10/24
13:30
2014/10/24
16:00
2014/10/24
22:05
His mother experienced rupture of
membrane at 13:30
His mother had fever up to 38.7C at 16:00
Ampicillin 2 doses before delivery
The baby was born at 22:05 with gestational
age 39 1/7 weeks via NSD at TSGH OBS.
Mild meconium stain was noted, but no
meconium was seen at vocal cord and
epiglottis.
Floppiness and delay crying.
Apgar score: 1’(7), 5’(9)
Fever, 38.3C
Prenatal history
產婦轉診: 無
產檢醫院: TSGH
Maternal disease: HBV carrier
Tocolysis: None
HBs Ag: Positive, HBe Ag: Positive, VDRL:
Negative
GBS culture: Negative
Rupture of membrane: 9 hrs
Drug: Ampicillin (Dosage before delivery: 2)
NTISS: 15
Birth history
G: 0, P: 0, GA: 39 1/7 weeks, BBW: 3458gm
Delivery: NSD
出生醫院: TSGH
Time of birth: 20141024 22:05
Fetal distress: mild, Meconium stain: mild
Apgar score: 1’(7), 5’(9)
產房急救: O2 support
HEPATITIS B IMMUNOGLOBULIN+
HEPATITIS B Vaccine
Family history
Physical examination
Vital sign: PR: 140 /min RR: 42 /min BT: 38.3 ℃ BW:
3458gm (75th percentile), HC: 33.5cm (50th percentile),
BL: 51cm (75th percentile)
Skin: no petechiae or ecchymosis, no skin rash, no jaundice
HEENT: no pale conjunctiva, no icteric sclera, no stiffness,
no cervical lymphadenopathy, no oral ulcer, no congestion
throat, no congestion of eardrum, bil
Chest: well expansion, clear breathing sound, no chest wall
deformity; no respiratory retraction; no rhonchi, no
wheezing, no rales, no suprasternal retraction, no subcostal
retraction
Physical examination
Heart: regular heart beat, no murmur, no heave or thrill
Abdomen: ovoid in shape, no palpable mass, no
hepatomegaly or splenomegaly, bowel sound increasing,
tympanic percussion sound, no rebounding pain &
tenderness
Extremities: no deformity of the spine or limbs, no joint
stiffness, no clubbing finger
Neurologic: normal Moro reflex, normal rooting reflex,
normal grasp reflex, present Barbinski sign, normal sucking
reflex
10/25 00:23 Lab. data
10/25 00:25 Lab. data
10/25 Chest X-ray
13
10/24 05:00 Maternal Lab. data
Impression
Fever, supect neonatal sepsis
Suspected meconium aspiration syndrome
Plan to do
1.Empiric antibiotic use with Ampolin
(150mg/kg/day) and Gentamicin (4mg/kg/day) to
cover possible pathogen.
2.Adequate fluid supplement and nutrition support
to the patient.
3.Monitor vital signs, RDS and activity closely.
Definition
rectal temperature ≥ 38ºC (100.4ºF)
2. Vaccinations and bundling may affect body
temperature
~~ a fever >38.5ºC (101ºF) should not be
attributed to bundling regardless of the manner taken
1.
Immunity
Immunologic competence improves steadily in the
first 3 months of life
more susceptible to serious bacterial infection
(Pneumococcus and Hemophilus influenza type b)
Etiology-virus
Viral infection : the most common cause
1. vertical transmission
2. family members and hospital personnel
Pathogens
1. Herpes simplex
2. Varicella
3. Enteroviruses
4. Influenza virus
5. Adenoviruses
6. Respiratory syncytial virus
Etiology-bacteria
Serious bacteria infection
1. bacteremia
2. bacterial meningitis
3. bacterial pneumonia
4. skin and soft tissue infections
5. osteomyelitis
6. bacterial gastroenteritis
7. septic arthritis
8. urinary tract infection
Pathogens
1. Escherichia coli (<3 m/o)
2. Group B streptococcus (<3 m/o)
3. Listeria monocytogenes (<1 m/o)
4. others: Staphylococcus aureus, Streptococcus
pneumoniae, Salmonella species, Enterococcus
faecalis, Enterobacter cloacae, Moraxella
catarrhalis, Klebsiella species, and Citrobacter
species
Signs/Symptoms
Temperature
irregularity
Fever
Hypothermia
Tone and Behavior
Poor tone
Weak suck
Shrill cry
Weak cry
Irritability
Skin
Poor perfusion
Cyanosis
Mottling
Pallor
Petechiae
Unexplained
jaundice
Signs/Symptoms
Feeding Problems
Vomiting
Diarrhea
Abdominal
distension
Hypo or
Hyperglycemia
Cardiopulmonary
Tachypnea
Retractions
Tachycardia for age
Bradycardia in first
few days of life
Hypotension for age
Low SpO2
Not doing well !
Evaluation
Higher risk-- WBC
1. serum ≥ 20000/uL
2. CSF ≥ 8-10/uL
3. UA ≥ 10/hpf
4. Stool ≥ 5 WBCs or RBCs
5. infiltration over CXR
Sepsis Work-Up
Blood cultures
Confirms sepsis
Urine cultures
Don’t need in infants <24 hours old because UTIs are
exceedingly rare in this age group
Lumbar puncture
Suspect Meningitis
Others: Tracheal aspirates, tapping for pleural
effusion/ascites, ….etc.
Other studies
CBC/DCs
CRP
CXR
Obtain in infants with respiratory symptoms
Renal ultrasound or VCUG in infants with
accompanying UTI
Maternal Studies
Examination of placenta and fetal membranes for
evidence of chorioamnionitis
Management
Neonates should be considered high risk!
-> a complete sepsis evaluation with hospital
admission are warranted regardless of clinical
picture and laboratory results
Antibiotics
1. ampicillin and gentamicin
2. ampicillin and cefotaxin (meningitis)
3. vancomycin and gentamicin/cefotaxin
(nosocominal infection)
Thanks for your attention!