FEVER AFTER CRANIOFACIAL SURGERY IN THE INFANT UNDER 24 MONTHS OF AGE

A retrospective review was undertaken of 126 consecutive craniofacial procedures involving a transcranial component, performed at the Childr en's Medical Center at Dallas, between 1990 and 1994. Standard postope rative axillary temperature measurements were recorded until discharge . Age at surgery of less than 24 months correlated very strongly with a postoperative temperature of greater than 38 degrees C (r = -0.92). The incidence of postoperative fever was high in all age groups, yet t here was still a significant difference between the group younger than 2 years and the group in which surgery was performed after the age of 2 years across all postoperative temperature ranges, from > 38 degree s C to > 39.5 degrees C (p < 0.001, chi-square test). The white blood cell count was elevated above the age-related normal in 67 percent of febrile patients. There was no correlation between type or duration of surgical procedure, length of intensive care or hospital stay, or the need for blood transfusion and the development of a significant posto perative fever. There were minor infectious complications in four pati ents (3 percent), only one of which was a wound problem related to the surgery. All infectious complications were easily identifiable clinic ally. There was no mortality or serious infections. The development of postoperative fever, and an elevated white blood cell count, is to be expected in pediatric patients undergoing craniofacial procedures. Th e routine laboratory investigation of postoperative fever in pediatric craniofacial patients under 2 years of age without procedures involvi ng transgression of the paranasal sinuses is not warranted unless ther e are associated clinical indicators.