First day fever

[Perrotfish]

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Just curious, how old do you guys think a newborn has to be before you start abx for fevers? I have seen doctors who work up every fever even if its 30 seconds after birth and doctors who will just try unwrapping the baby until they're 24 hours old, and a lot in-between.

 

[sliceofbread136]

My thought is what will you end up getting sued for, and delaying care on sepsis etc with a bad outcome I could picture so I would have a tough time not going down the neonatal fever protocol.

I’m still a resident so maybe that will change with more experience

 

[Stitch]

I think it's pretty risky to ignore a temp in a newborn, even under 24 hours old. If they hit 100.5, they get it all. But I'm PICU not NICU, so I may be biased.

 

[BabyDoc86]

In our NICU we use the Kaiser early-onset sepsis risk calculator first. Had a case the other night that I thought we might start Abx but infant was well-appearing, low risk on the calculator, and temp recheck was 37.1 - No Abx, sent back to NBN

 

[mvenus929]

If a baby comes out with a fever, I want to know what mom's temp is... if she also has a fever, baby gets antibiotics. If baby is under a warmer, I'll switch off the warmer and recheck in a little bit. But it's hard to ignore any fever when there is so much that can go wrong.

 

[calvnandhobbs68]

In our NICU we use the Kaiser early-onset sepsis risk calculator first. Had a case the other night that I thought we might start Abx but infant was well-appearing, low risk on the calculator, and temp recheck was 37.1 - No Abx, sent back to NBN

Yeah, we had multiple times in the nursery where a regular uncomplicated baby popped a temp under a warmer or super bundled up. We definitely had some times where we’d get a recheck in an hour and watch to make sure they didn’t act funny. Risk factors definitely lower the threshold for work up and antibiotics although I think there’s also the case for the in between...q4 vitals, CBC, CRP and blood culture and just watch to see what happens if the fever or temp instability doesn’t persist.