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Pediatric vitals signs

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Temperature

 

<!--<h1> Temperature </h1>--> <strong>The Newborn</strong><br><br> The temperature of the newborn is normally the same as that of the mother. Infants, particularly newborns, are prone to hypothermia. The high ratio of body surface area to body mass causes 4 times more heat loss by radiation and evaporation than in the adult. A contributing factor is the sparse insulation against heat loss from the developing keratinization of skin and subcutaneous fascia. Babies do not shiver. Instead they respond by secreting catecholamines which constrict vessels and mobilize brown fat. <br> The mobilization of brown fat, which contains mitochondria that hydrolyze and oxidize free fatty acids for energy, increases the metabolic rate by twofold or more. Impaired tissue perfusion from the cold may result in metabolic acidosis, shock and cardiac arrest. The incubator or overhead heater maintains the infant at a temperature of 97.7-98.6 F(36.5-37C). <br><br> <strong>Pediatric Temperature</strong><br><br> Pediatric temperatures fluctuate, but generally parallel adult readings. For a quick-screening in the newborn and infant, a heat sensitive strip containing liquid crystals that change color as the temperature changes may be applied to the forehead and a readout recorded. However, these are often inaccurate. A recent temporal artery thermometer which measures forehead temperatures showed inconsistent results in the birth to 12-year-old group. In the neonate, because of the unique distribution of body fat, the axillary temperature is sometimes used. The thermometer should remain in place for at least 5 minutes. <br> <strong>Rectal temperatures </strong>should be routinely done on infants and small children. The infant or small child is positioned on his back and the thighs and knees are flexed while he is held, or prone on the mother s lap with hips flexed. The probe is inserted 1 inch for children and 1/2 inch for infants. Use of the tympanic thermometer is controversial in the period up to 3 months. The probe must make a tight seal for accuracy. Unfortunately, since the auditory canal is small and current probe sizes fairly large, inappropriate caution by the user creates inconsistent and thus unreliable results. <br><br> <strong>Fever</strong><br><br> In the early pediatric age group, the potential exists with fever and a high white count for a severe infection to be present. During the first few months of life, the immune system is developing and the infant is protected from infection by antibodies from the mother (maternal antibodies passive immunity). <br> Passive immunity fails occasionally. Infants less than three months of age with core (rectal) temperatures of 101.3F/38.5C have twenty times more risk of serious infection than do older children (pediatric fever is defined as a rectal temperature of 100.4F/38C). If a source for the fever is found, the infant or child is treated appropriately. If no source is found (fever without a source FWS), the workup proceeds for serious bacterial infection (SBI), such as sepsis/meningitis. <br> In the neonate (0-28 days), a temperature of 100.4F (38C) mandates hospitalization and a workup for SBI: CBC, blood culture, urine culture, lumbar puncture, chest x-ray.  Early onset sepsis (0-5 days after birth) is usually caused by maternal transmission. Signs and symptoms may be entirely absent, or may include poor feeding, lethargy, respiratory problems, vomiting, tachycardia and hypothermia (more common than fever). <br><strong>Treatment: </strong> admission and antibiotic therapy such as IV cefotaxime (Claforan) 50mg/kg q 6h. <br><br> Infants in the<strong> 1 to 3 month age group </strong>with FWS and high risk criteria such as a temperature of 100.4F (38C), a white blood count of 15,000 with bands or toxic signs such as seizure, a weak, shrill or continuous cry, a bulging fontanelle, lethargy, a hemorrhagic rash or paradoxical irritability (picking up and comforting a child usually stops crying in paradoxical irritability, since the movement causes meningeal irritation and pain, picking up induces crying) require a workup for sepsis/meningitis (neonates may also exhibit some of the above characteristics). <br> <strong>Treatment: </strong> A blood culture, urine culture and lumbar puncture are obtained and IV antibiotics are administered, such as ceftriaxone (Rocephin) 50 mg/kg IV q 12h. <br><br> Children in the<strong> 3 to 24 month age group </strong>with FWS are less likely to have life-threatening illnesses than the 0 to 3 month group. A temperature of >102.2F (39C) requires a CBC, UA and chest x-ray. <br> <strong>Treatment: </strong>Toxic children are admitted for septic workup and parenteral antibiotics. Nontoxic children with temperatures <102.2F (39C) may be sent home: if the WBC count is >15,000, a culture is done and ceftriaxone (Rocephin) 50mg/ kg IM is administered. Outpatient antibiotics are prescribed as appropriate for otitis media (i.e., amoxicillin 40mg/kg/day TID or erythromycin/sulfisoxazole 50mg/kg/day TID for 10 days, pneumonia (i.e., amoxicillin 40mg/kg/ day TID for 10 days or azithromycin 10mg/kg initially, then 5mg/kg/day for four days) or UTI (ie., trimethroprim-sulfamethoxazole 8mg/kg/day BID for seven days). <br><br> <strong>Febrile seizures</strong> occur in the five month to five year age group (most under age two). They usually do not occur at extremely high temperatures, but rather at core temperatures of about 102F (38.9C), are usually of benign etiology and often have a genetic component. In the average case, the seizure is generalized, lasts less than 5-10 minutes (often less than one minute) and behavior returns to normal in less than an hour. A source for the fever is sought (i.e., upper respiratory infection, otitis media, pneumonia, urinary tract infection). <br> <strong>Treatment: </strong> if a source is found, the patient is treated for that condition. If none is found, the patient is treated for FWS described above. In the under-one-year age group, a lumbar puncture is sometimes performed for a first time seizure and treatment is based upon the result. In the older child, a CBC and blood culture are performed, the patient receives appropriate antibiotic therapy, and is sent home with close follow-up.

 


 
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