FEVER IN INFANTS WITH NO FOCAL SIGN OF IN FECTION - CRITERIA OF THERAPEUTIC DECISION-MAKING

Fever is one of the most frequent signs seen in children at consultati on, In infants under the age of 3 months, fever is nonspecific and is often the only sign of a potentially severe infection. It has been est imated that two-thirds of the children hospitalized have a viral infec tion and 10% a bacterial infection with risks of complications includi ng meningitis. It must be recalled that 5% of the infants with septica emia due to Haemophilus influenzae b who does not receive an appropria te treatment will develop meningitis or another focal infection. There is agreement on the definition of potentially severe infections: meni ngitis, osteoarthritis, cellulitis or cellulodermitis, urinary infecti on, lung infection and gastroenteritis. Certain authors also include i nner ear infections. In suspected cases, the need for hospitalization can be based on signs of impaired conscienceness and/or muscle tone, a bnormal heart rate, blood pressure or recoloration time, paleness, cya nosis, respiratory distress, signs of dehydration, or abnormal behavio ur. In order to identify infants at low risk, in addition to the physi cal examination, the clinician can rely on essential laboratory tests: white cell count with differential count, blood culture, C-reactive p rotein and/or sedimentation rate with fibrinogen and an urinanalysis. A chest X-ray is required in case of respiratory signs and a culture o f the fecal matter is needed in case of diarrhoea. On the basis of the se findings and the clinical picture, if the criteria of low risk of b acterial infection are fulfilled in an infant under 3 months of age wi th fever, most authors agree that a spinal tap must nevertheless be pe rformed. When these tests lead to the conclusing of low risk, close su rveillance at home is appropriate. If the clinical picture worsens wit hin 24h hospitalization is required.