Monday, December 31, 2012

Treatment of the Newborn with Fever

I'm highlighting some blog posts this week that I did for Erin MacPherson's Christian Mama's Guide last year. Some of you may not know but I am a real live pediatric ER RN. As always, these posts are meant to be educational and do not replace a doctor's visit if your child is ill.

Erin has a WICKED sense of humor and is releasing a series of books this spring so I hope you'll keep an eye out for them.


Question:  Is it really a bad idea to take a newborn out in public? What will really happen if he/she gets sick?

Jordyn Says:
 

I can remember when my youngest was born and was just a few days old when my in-laws came by to visit. My father-in-law was horribly ill with bronchitis, coughing and hacking at the doorway. I held the baby up for them to see from a distance and kindly asked them to go on their way. They could come back around when he was well.

Here’s the issue: An infant less than two months (some doctors will say three months) that presents with a fever of 100.4 or greater generally gets a septic work-up. The concern is that an infant’s immune system hasn’t quite revved up yet and it can become easily overwhelmed by infection. Therefore, we approach this age infant very cautiously to prevent this from happening.

A septic work-up entails gathering specimens from the most likely places that would become infected. This includes placing an IV to get blood for a blood culture and blood counts, doing a urine cath (placing a small plastic tube into the bladder) for urine and doing a spinal tap (lumbar puncture) to collect cerebrospinal fluid (CSF) which is the fluid that bathes the brain.

Infants are generally admitted into the hospital for 24-48 hours at a minimum on IV antibiotics until their cultures are negative. If their cultures are positive, then they would stay longer to get a full course of antibiotics.

This is not always done but is your “worst case scenario” for ER management. There are some situations that may alter the physician’s medical approach. One may be that we can prove the infant has another source for the fever like an ear infection or RSV (in fall and winter). We generally look for these first. If another source cannot be found, then generally, these other tests are performed.

Unfortunately, a small percentage of infants do die from sepsis. This is why we are very cautious. 
As you can see, these are very invasive procedures and this is why I personally encourage minimal public contact when the infant is under two months.

If you choose to take your new baby in public, here are a few guidelines:

1. Use good hand washing. Before anyone touches the baby, they should wash their hands with soap and water. If water is unavailable, then use antiseptic hand gel.

2. If you develop a cold (runny nose, cough) wear a medical mask around the infant. These can be picked up at stores that have a pharmacy.

3. Keep sick siblings away from the newborn.

4. Encourage younger siblings to kiss the baby’s feet or the back of their head.

5. Immunize.

6. Well newborns need to stay out of the ER! A common scenario is for the whole family to show up with a sick older sibling and bring the new baby. This should only happen if that’s your only option. Otherwise, keep the newborn at home with a responsible adult. There isn’t a way to fully decontaminate the ER waiting room. It’s likely the baby will pick something up during the ER visit of the other sibling.
 



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