Neonatal fever Question

[HIppoCamp]

I recently had a full term 7 wk old male spike a fever to tmax 103F (rectal) about 10-12 hours after receiving his 2 mth shots - Pentacel, prevnar, rota; rec'd tylenol about 1-2 hrs before this fever too for lower temp ~101F. He is otherwise well appearing. Does this patient need a limited work up? Or can we say this is due to vaccines?

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[tantacles]

I recently had a full term 7 wk old male spike a fever to tmax 103F (rectal) about 10-12 hours after receiving his 2 mth shots - Pentacel, prevnar, rota; rec'd tylenol about 1-2 hrs before this fever too for lower temp ~101F. He is otherwise well appearing. Does this patient need a limited work up? Or can we say this is due to vaccines?

As with all things, it depends. But I would probably at the very least get some basic labs, a urine culture, and a blood culture. The timing is, of course, suspicious for being related to vaccines, but a UTI could also quickly progress to bacteremia, sepsis, and meningitis in a patient who is only 7 weeks old. By definition, this patient is also unvaccinated (the ones you just gave haven't been in the system long enough to cause immunity), so all of the nasties could still be there.

I think you can make a case for observation, but I would at least want the limited workup.

Edit: Just wanted to add that while one could make a case for observation with no labwork, I think it would take a very experienced physician, as in one 20-30 years out of residency, to confidently do that even in a well-appearing child with this clinical picture of a fever not responding to acetaminophen. And even then, might still be pretty nervous about it.

 

[HIppoCamp]

As with all things, it depends. But I would probably at the very least get some basic labs, a urine culture, and a blood culture. The timing is, of course, suspicious for being related to vaccines, but a UTI could also quickly progress to bacteremia, sepsis, and meningitis in a patient who is only 7 weeks old. By definition, this patient is also unvaccinated (the ones you just gave haven't been in the system long enough to cause immunity), so all of the nasties could still be there.

I think you can make a case for observation, but I would at least want the limited workup.

Yeah, that's the way I was leaning too - thanks!

Also, sorry about the title, I guess this kid isn't technically a "neonate"

 

[tantacles]

Yeah, that's the way I was leaning too - thanks!

Also, sorry about the title, I guess this kid isn't technically a "neonate"

They fall into the category age-wise where the neonatal guidelines still apply, so I think the characterization was appropriate.