Clinical Pediatric Emergency Medicine
Volume 9, Issue 4 , Pages 221-227 , December 2008

Fever in the Toddler-Aged Child: Old Concerns Replaced With New Ones

  • Prashant Mahajan, MD, MPH, MBA

      Affiliations

    • Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, 3901 Beaubien, Detroit, MI, USA
    • ,
  • Rachel Stanley, MD, MHSA

      Affiliations

    • Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
    • Corresponding Author InformationReprint requests and correspondence: Rachel Stanley, MD, MHSA, Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI.

References 

  1. McCaig LF, Nawar EN. National hospital ambulatory medical care survey: 2004 emergency department summary. Adv Data. 2006;23:1–29
  2. Baraff LJ, Bass JW, Fleisher GR, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Ann Emerg Med. 1993;22:1198–1210
  3. Lee GM, Fleisher GR, Harper MB. Management of febrile children in the age of the conjugate pneumococcal vaccine: a cost-effectiveness analysis. Pediatrics. 2001;108:835–844
  4. Kupperman N. The evaluation of young febrile children for occult bacteremia—time to revaluate our approach. Arch Pediatr Adolesc Med. 2002;156:855–857
  5. Centers for Disease Control and Prevention (CDC) . Invasive pneumococcal disease in children 5 years after conjugate vaccine introduction—eight states, 1998-2005. MMWR Morb Mortal Wkly Rep. 2008;57:144–148
  6. Byington CL, Samore MH, Stoddard GJ, et al. Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the intermountain west: emergence of nonvaccine serogroups. Clin Infect Dis. 2005;41:21–29
  7. McGee L. The coming of age of niche vaccines? Effect of vaccines on resistance profiles in Streptococcus pneumoniae. Curr Opin Microbiol. 2007;10:473–478
  8. Steenhof AP, Shah SS, Ratner AJ, et al. Emergence of vaccine-related pneumococcal serotypes as a cause of bacteremia. Clin Infect Dis. 2006;42:907–914
  9. Trophy DE, Ray CG. Occult pneumococcal bacteremia. Am J Dis Child. 1970;119:12–17
  10. Jaffe DM, Tanz RR, Davis AT, et al. Antibiotic administration to treat possible occult bacteremia in febrile children. N Engl J Med. 1987;317:1175–1180
  11. Bass JW, Steele RW, Witler RR, et al. Antimicrobial treatment of occult bacteremia: a multicenter cooperative study. Pediatr Infect Dis J. 1993;12:466–473
  12. Centers for Disease Control and Prevention . Progress towards elimination of Haemophilus influenzae type b disease among infants and children—United States. 1987-1995. MMWR Morb Mortal Wkly Rep. 1996;45:901–906
  13. Lee GM, Harper MB. Risk of bacteremia for febrile young children in the post–Haemophilus influenzae type b era. Arch Pediatr Adolesc Med. 1998;152:624–628
  14. Alpern ER, Alessandrini EA, McGowan KL, et al. Occult bacteremia from a pediatric emergency department: current prevalence, time to detection, and outcome. Pediatrics. 2000;106:505–511
  15. Myers C, Gervaix A. Streptococcus pneumoniae bacteraemia in children. Int J Antimicrob Agents. 2007;30(Suppl 1):S24–S28
  16. Advisory Committee on Immunization Practices . Preventing pneumococcal disease among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2000;49(RR-9):1–35
  17. Kuppermann N, Fleisher G, Jaffe D. Predictors of occult pneumococcal bacteremia in young febrile children. Ann Emerg Med. 1998;31:679–687
  18. Harper MB, Bachur R, Fleisher GR. Effect of antibiotic therapy on the outcome of outpatients with unsuspected bacteremia. Pediatr Infect Dis J. 1995;14:760–767
  19. Kuppermann N, Malley R, Inkelis SH, et al. Clinical and hematologic features do not reliably identify children with unsuspected meningococcal disease. Pediatrics. 1999;103:E20
  20. Finkelstein JA, Christiansen CL, Platt R. Fever in pediatric primary care: occurrence, management, and outcomes. Pediatrics. 2000;105(1 Pt 3):260–266
  21. Black S, Shinefield H, Fireman B, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J. 2000;19:187–195
  22. Black S, Shinefield H, Baxter R, et al. Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugate vaccine in Northern California Kaiser Permanente. Pediatr Infect Dis J. 2004;23:485–489
  23. Stoll ML, Rubin LG. Incidence of occult bacteremia among highly febrile young children in the era of the pneumococcal conjugate vaccine. Arch Pediatr Adolesc Med. 2004;158:671–675
  24. Herz AM, Greenhow TL, Alcantara J, et al. Changing epidemiology of outpatient bacteremia in 3- to 36-month–old children after the introduction of the heptavalent-conjugated pneumococcal vaccine. Pediatr Infect Dis J. 2006;25:293–300
  25. Sard B, Bailey MC, Vinci R. An analysis of pediatric blood cultures in the postpneumococcal conjugate vaccine era in a community hospital emergency department. Pediatr Emerg Care. 2006;22:295–300
  26. Carstairs KL, Tanen DA, Johnson AS, et al. Pneumococcal bacteremia in febrile infants presenting to the emergency department before and after the introduction of the heptavalent pneumococcal vaccine. Ann Emerg Med. 2007;49:772–777
  27. Klein J. Management of the febrile child without a focus of infection in the era of universal pneumococcal immunization. Pediatr Infect Dis J. 2002;21:584–588
  28. ACEP Clinical Policies Committee and the Clinical Policies Committee and the Clinical Policies Subcommittee on Pediatric Fever . Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med. 2003;42:530–545
  29. Bachur R, Perry H, Harper MB. Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. 1999;33:166–173
  30. Zhou F, Kyaw MH, Shefer A, et al. Health care utilization for pneumonia in young children after routine pneumococcal conjugate vaccine use in the United States. Arch Pediatr Adolesc Med. 2007;161:1162–1168
  31. Murphy CG, van de Pol AC, Harper MB, et al. Clinical predictors of occult pneumonia in the febrile child. Acad Emerg Med. 2007;14:243–249
  32. Tsai CJ, Griffin MR, Pekka Nuorti J, et al. Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States. Clin Infect Dis. 2008;46:1664–1672
  33. Shaikh N, Morone NE, Lopez J, et al. Does this child have a urinary tract infection?. JAMA. 2007;298:2895–2904
  34. Baraff LJ. Management of fever without source in infants and children. Ann Emerg Med. 2000;36:602–614
  35. Gabriel ME, Aiuto L, Kohn N, et al. Management of febrile children in the conjugate pneumococcal vaccine era. Clin Pediatr (Phila). 2004;43:75–82
  36. Nigrovic LE, Malley R. Evaluation of the febrile child 3 to 36 months old in the era of pneumococcal conjugate vaccine: focus on occult bacteremia. Clin Pediatr Emerg Med. 2004;5:13–19
  37. Cincinnati Children's Hospital Medical Center . Evidence based clinical practice guideline for fever of uncertain source in children in 2 to 36 months of age. Cincinnati (Oh): Cincinnati Children's Hospital Medical Center; 2003;Oct 27. Available at: www.guideline.govAccessed on 06/18/08
  38. Kaplan SL, Mason EO, Wald ER, et al. Decrease of invasive pneumococcal infections in children among 8 children's hospitals in the United States after the introduction of the 7-valent pneumococcal conjugate vaccine. Pediatrics. 2004;113(3 Pt 1):443–449
  39. Singleton RJ, Hennessy TW, Bulkow LR, et al. Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA. 2007;297:1784–1792
  40. Gonzalez BE, Hulten KG, Lamberth L, et al. and the U.S. Pediatric Multicenter Pneumococcal Surveillance Group. Streptococcus pneumoniae serogroups 15 and 33: an increasing cause of pneumococcal infections in children in the United States after the introduction of the pneumococcal 7-valent conjugate vaccine. Pediatr Infect Dis J. 2006;25:301–305
  41. Long S. Capsules, clones, and curious events: pneumococcus under fire from polysaccharide conjugate vaccine. Clin Infect Dis. 2005;41:30–34
  42. Schultz KD, Fan LL, Pinsky J, et al. The changing face of pleural empyemas in children: epidemiology and management. Pediatrics. 2004;113:1735–1740
  43. Tan TQ, Mason EO, Wald ER, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae. Pediatrics. 2002;110(1 Pt 1):1–6
  44. Hsiao AL, Baker MD. Fever in the new millennium: a review of recent studies of markers of serious bacterial infection in febrile children. Curr Opin Pediatr. 2005;17:56–61
  45. Zaidi E, Bachur R, Harper M. Non-typhi Salmonella bacteremia in children. Pediatr Infect Dis J. 1999;181:1073–1077
  46. Cummings CA, Relman DA. Genomics and microbiology. Microbial forensics: “cross-examining pathogens”. Science. 2002;296:1976–1979
  47. Relman DA. The human body as microbial observatory. Nat Genet. 2002;30:131–133
  48. Thuler LC, Jenicek M, Turgeon JP, et al. Impact of a false positive blood culture result on the management of febrile children. Pediatr Infect Dis J. 1997;16:846–851
  49. Yamamoto LG. Revising the decision analysis for febrile children at risk for occult bacteremia in a future era of widespread pneumococcal immunization. Clin Pediatr (Phila). 2001;40:583–594
  50. Sharma V, Dowd MD, Slaughter AJ, et al. Effect of rapid diagnosis of influenza virus type A on the emergency department management of febrile infants and toddlers. Arch Pediatr Adolesc Med. 2002;156:41–43
  51. Bonner AB, Monroe KW, Talley LI, et al. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics. 2003;112:363–367
  52. Smitherman HF, Caviness AC, Macias CG. Retrospective review of serious bacterial infections in infants who are 0 to 36 months and have influenza A infection. Pediatrics. 2005;115:710–718

PII: S1522-8401(08)00067-0

doi: 10.1016/j.cpem.2008.09.003

Clinical Pediatric Emergency Medicine
Volume 9, Issue 4 , Pages 221-227 , December 2008

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