I first learned in my third year of medical school, fever is one of the
most common reasons children end up at the emergency department. The
probable causes sometimes are obvious, like when a peek through the
otoscope shows the red, bulging eardrum of otitis media. But often, the
cause of a child's fever isn't readily apparent.
especially challenging to diagnose young infants with a serious
infection that can overwhelm their immature immune system and even be
fatal. Babies can't tell us how bad they feel, or where their pain is.
They often don't look really sick until they're near the point treatment
could no longer help them. Each year, more than 75,000 children develop
severe sepsis, and almost 7,000 of them will die. That's why infants
with fevers of unknown cause are usually admitted for extensive and
invasive workups to rule out serious infections and sepsis.
first exposure to the management of young infants with fever with an
unknown source came during my third year of medical school. As we headed
to the E.R. to admit yet another baby with fever,
asked my resident if any babies who got septic workups ever actually
had an infection that required treatment. In response, he took me down
the hall to see a 3-year-old patient with a G- tube and tracheostomy who
was profoundly developmentally delayed.
At 2 weeks old, the child had a 101-degree fever but looked well when his mother put him to bed one night. By the next morning. E. Coli
meningitis had devastated him. This gave me a (very) healthy respect
for infants with fever, but my experience still made me think our
approach to ruling out sepsis was overkill. We were catheterizing
babies, doing spinal taps, treating them with broad spectrum
antibiotics, and hospitalizing them for 48 hours, yet only a very few of
them actually turned out to have a serious bacterial infection.