A Newborn with Fever

2/26/2008

I recently evaluated a six and a half week old baby girl with a fever of 102 degrees Fahrenheit. The baby has an older sibling who had a viral illness several days prior. The baby was feeding well and behaving appropriately in between fever spikes.

The baby was referred to the emergency department of a local hospital for a workup for infection. This workup included a clinical blood count (CBC), blood culture, urine culture and lumbar puncture (spinal tap). The initial labs were all normal including the rapid antigen test for bacteria on the spinal fluid. The baby was given an injection of antibiotics and discharged home. I saw the baby the following morning. The baby continued to have a low grade fever but was feeding beautifully and looking much improved. I gave the baby a second antibiotic injection and followed up the cultures taken in the hospital the previous day. All cultures were negative at 48 and 72 hours.

This case depicts the difficult dilemma faced by pediatricians and parents when a baby has a fever. Years back, all fevers in newborns resulted in hospitalization and work up for infection. Today pediatricians have developed clinical protocols that allow babies of this age that look reasonably well to be treated as an outpatient not requiring hospitalization. The decision to give antibiotics at the time of evaluation depends on the baby’s age, the lab results and a number of other criteria. Most importantly the reliability of the family comes into the decision process. If the family is reliable and comfortable recognizing a worsening situation, then the baby can be treated and monitored at home. Once the cultures are confirmed negative the ordeal is over. The reason for giving an antibiotic in this scenario has more to do with the baby’s young age and the risk of a bacterial process going on. Because this baby is breastfed, I suggested mom take a daily probiotic for several weeks to assist the baby in repopulating the gut with healthy intestinal flora.

      

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