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Dr. Mulya Rahma Karyanti, SpA(K)Dr. Mulya Rahma Karyanti, SpA(K)

Courtesy of Dr. Alan R. Tumbelaka, SpA(K)Courtesy of Dr. Alan R. Tumbelaka, SpA(K)

Child eath DepartmentChild eath Department

!ni"ersity of #ndonesia!ni"ersity of #ndonesia

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FeverFever

› The most frequent complaint, usuallyThe most frequent complaint, usually

alarms parentsalarms parents

› The clinical manifestations variesThe clinical manifestations varies

› Age : neonatal to adolescentAge : neonatal to adolescent

› Problems if fever with no apparentProblems if fever with no apparent

sourcesource

Mc Cartey PL.Fever. Pediatric in Rieviev 1998

Poerwo Soedarmo S,dkk: Buku Aar !n"ek#i $ Pediatri %ro&i#'())8

Avner *R.Acute Fever.Pediatric in Rieview ())9

+raneto *.Pediatric#,Fever. -tt&:www.med#ca&e.com. ())9

Tolan R$ %&e"er $ithout a &o'us . -tt&:www.med#ca&e.com, ())9

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Fever denitonFever deniton

› Pathophysiological and Clinical termPathophysiological and Clinical term

Pathophysiological termPathophysiological term

› ody temperature increase above normal asody temperature increase above normal asthe result of a coordinated response to athe result of a coordinated response to apathological insult in the thermoregulationpathological insult in the thermoregulationcentrecentre

Clinical termClinical term› !ectal temperature " #$%& 'C A(illary temperature!ectal temperature " #$%& 'C A(illary temperature

" #)%*'C" #)%*'C

› +ral temperature " #)%'C+ral temperature " #)%'C Tympanic membraneTympanic membrane ""#)%'C#)%'C /0Rad-i AS :Pat-o2ene#i# o" Fever'C0inica0 Manua0 o" Fever in C-i0dren. ())9

ard MA: Fever Pat-o2ene#i# and %reatment . Pediatric !n"ectiou# 3i#ea#e#' ())9

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ueter S ,Defrie C*% +athophysioloy The *asis for Disease in Adults and Children-//0

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Guideline Fever Without Source until 3 years of age

Beatriz et al. 2009

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7/25A"ner 1R, MD. A'ute &e"er, +ediatri's #n Re"ie2. //3

The +athoenesis of &e"erThe +athoenesis of &e"er

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ClassClass CommonesCommonest Causet Cause

-sual-sualFeverFever.uration.uration

Fever withFever with/ocali0ing 1igns/ocali0ing 1igns2F3/142F3/14

-!T5-!T5 6 7 wee8 6 7 wee8

Fever withoutFever without

/ocali0ing 1igns/ocali0ing 1igns2F3+/142F3+/14

9iral9iral

5nfection, -T55nfection, -T5

6 7 wee8 6 7 wee8

Fever of -n8ownFever of -n8own+rigin+rigin

2F-+P-+42F-+P-+4

5nfection,;5A5nfection,;5A < 7 wee8 < 7 wee8

F3/1 = of cases F3+/1 F-+ > of casesF3/1 = of cases F3+/1 F-+ > of casesl4Radhi AS %&e"er-Clini'al Manual of &e"er in Children. //3

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Fever with /ocali0ing 1ignFever with /ocali0ing 1ign

?roup?roup .iseases.iseases-pper airway infections-pper airway infections 9iral -T5, A+@, Tonsillitis,9iral -T5, A+@, Tonsillitis,

/aryngitis/aryngitis

PulmonaryPulmonary Pnemonia, ronchiolitisPnemonia, ronchiolitis

?astrointestinal?astrointestinal ?astroenteritis, epatitis,?astroenteritis, epatitis,AppendicitisAppendicitis

CB1CB1 @eningitis, ncephalitis@eningitis, ncephalitis

(antems(antems @easles, Chic8enpo(@easles, Chic8enpo(

CollagenCollagen !heumatoid arthritis, Dawasa8i!heumatoid arthritis, Dawasa8idiseasedisease

BeoplasmaBeoplasma /eu8emia, lymphoma/eu8emia, lymphoma

TropicsTropics Dala a0arDala a0arl4Radhi AS %&e"er-Clini'al Manual of &e"er in Children. //3

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Fever without /ocali0ing 1ignFever without /ocali0ing 1ign

CausesCauses .iseases.iseases5nfection acteriemia 1epsis

@ost viruses 2E,94-T5, @alaria

P-+ 2Persistent Pyre(ia of-n8nown +rigin4

5nfection, Collagen ,Beoplasma

Beoplasma/eu8emia, /ymphoma

Post 9accination .PT,measles

.rug Fever Antibiotics, Cytoto(ic,Antiepileptics

/0Rad-i AS :Fever'C0inica0 Manua0 o" Fever in C-i0dren. ())9

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Principal Causes of Pyre(ia -n8nown +rigin2P-+4

CausesCauses .iseases.iseases5nfection 2 &E)& 4 /ocali0ed 1ystemic

1inusitis ,ndocarditis ,+ccultabscess9 9iral, TC, rucellosis

Collagen .iseases 2G&4 ;5A,1/Beoplasma 2H4 /eu8aemia, /ymphoma%

Beuroblastoma

@iscellaneous 2 HE7&4 .rug Fever

l4Radhi AS %&e"er-Clini'al Manual of &e"er in Children. //3

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FeverFever› @ost are benecial : enhancing infection@ost are benecial : enhancing infection

host response, inhibiting the infectioushost response, inhibiting the infectious

agentsagents

› 1ome are harmful : Beuro, cardioE1ome are harmful : Beuro, cardioErespiratory diseasesrespiratory diseases

› @orbiditymortality due to the underlying@orbiditymortality due to the underlying

diseasedisease

Antipyretic sAntipyretic s (ternal Cooling(ternal Cooling

ParentsParentsI Fever PhobiaI Fever Phobia5orin M#.&e"er and #ts Treatment-6ski7s ssential +ediatri's.//8

l4Radhi AS %Manaement of &e"er -Clini'al Manual of &e"er in Children. //3

+oer2o Soedarmo S dkk %*uku A9ar #nfeksi : +ediatri Tropis-//;

$ard MA % +atient information% &e"er in 'hildren - !pToDate CD4R6M

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@ost commonly used

5deal antipyretics:

› !apid ,Jective in reducing fever

› Available in liquid K suppository form› /ow side eJects , low to(icity when

overdoses

› /ow interaction with other medications, rare

contraindications› 1afe and cost eJective

Choices : Paracetamol and 5buprofen/0Rad-i AS :Mana2ement o" .Fever 'C0inica0 Manua0 o" Fever in C-i0dren. ())9

!#aac# 3. Fever. /vidence 4 Ba#ed Pediatric !n"ectiou# 3i#ea#e#. ())5

Arono"" SC:Fever in !n"ant andtodd0er:'-tt&:emedicine.com.6&dated A2u#tu# ())9

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Physical methods to reduce bodytemperature› ed rest and (ternal cooling

(ternal cooling› 3arm water, Total body surface

cooling

› Tepid water 2#& ' C4 Temp < *& 'C

+ne hour after antipyretic

.uration #& minutes

&isher R> % &e"er and Sho'k Syndrome-Moffet7s +ediatri' #nfe'tious Diseases.//?$ard MA% &e"er +athoenesis and Treatment . +ediatri' #nfe'tious Diseases- //3

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Advice tell them :

› @ild and moderate fever is benecial ,supports the immune system

› To observe the childIs interaction withthe environment

› To prevent dehydration : small,frequent drin8s

› To reduce discomfort with antipyretics

› .onIt overdress ,provide light blan8etswhen children are cold shivering

l4Radhi AS %Manaement of &e"er -Clini'al Manual of &e"er in Children. //3

$ard MA % +atient information% &e"er in 'hildren - !pToDate CD4R6M

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› Antipyretic only if necessary forcomfort 2childparent4

› Try tepid sponging rst

› -se paracetamol or ibuprofen 2not <*$ hrs# days4

5buprofen is not recommended forbabies 6 mo old

#saa's D. &e"er. "iden'e @ *ased +ediatri' #nfe'tious Diseases. //=

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To predict a serious bacterialinfection 2154

The 8ey factors :› The child age

› The height of temperature

› The presence or absence of

infection focus

› The presence or absence oftoxicity


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15 :› @eningitis,acteriemia

1epsis,nteritis,Pnemonia,Pericarditis,+steomyelitis,1e

ptic arthritis,Cellulitis Common bacteria cause of 15 :

› S pneumoniae

› N meningitidis

›

H infuenzae type b› L monocytogenes

› E coli

Tolan R$ %&e"er $ithout a &o'us . http%emedi'ine.'om.!pdated% 1an , //3>ranetto 1$%+ediatri' &e"er. http%emedi'ine.'om.!pdated% 1an , //3

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Beonate 6 G$ days Moung child suggestive -T5 on urinalysis

Appear toxic istory F-+ or Prolonged fever

1uspected 15 Tachypnea, grunting, rash, headaches ,vomiting

18in petechiae 5nfant with fever < *&'C, without focus

First febrile sei0ure -nreliable ,not assured follow up parent

3C < G&%&&&,highC!P

loody diarrhea, abdominal tenderness,drowsiness

l4Radhi AS % Manaement of &e"er -Clini'al Manual of &e"er in Children. //3

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› 1ign of to(icity &E# months febrilechildren 2AC.4

A : Arousal, Alertness, and Activity

: reathing diNculties

C : Color and or Circulation andor Cry . : .ecreased Ouid inta8e, urine output

@ore than one increased ris8 factor forserious illness

(Toxic child : drowsy lethargic or irrita!le pale mottled and tachycardi"


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Antibiotic indications :Antibiotic indications :› 3ith focus of infection suggesting3ith focus of infection suggesting

bacterial diseasebacterial disease› Beonates and ill loo8ing childrenBeonates and ill loo8ing children› Fever < *& 'C ,6 # months , without focusFever < *& 'C ,6 # months , without focus

infectioninfection› 3ithout infection focus, screening test are3ithout infection focus, screening test are

abnormalabnormal

.epend on :.epend on :› 1everity of illness, immuni0ation status ,1everity of illness, immuni0ation status ,

epidemiology of local organismepidemiology of local organism

!#aac# 3. Fever. /vidence 4 Ba#ed Pediatric !n"ectiou# 3i#ea#e#. ())5

/0Rad-i AS :Mana2ement o" .Fever 'C0inica0 Manua0 o" Fever in C-i0dren. ())9

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A? ABT55+T5C1 .+1 mg8g3

&E# mos Amo(AmpicillinPlus

?entamicin

H&

),H

59 hourly

59 daily* mos *yrs

en0ylpenicillin+!Ceftria(one

#&H&%&&&-

H&

59 hourly

595@ daily

+ver * yrs The C+@5BAT5+B

+Fen0ylpenicilinP/-1.iFluclBafcillin+! as A 15B?/A?BT

Cefota(im +!Ceftria(on

#&H&%&&&-H&

H&H&

59 hourly59 houly

59$ hourly595@ daily


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Algorithm for management of the febrile child 6#Algorithm for management of the febrile child 6#

years oldyears old


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Fever is most common complaint, not dangerous andmay be protective.

The most common cause are Infections Fever is caused by the increase of the temperature set

point in the thermoregulatory centre as the result of!"2 stimulation. There are # classi$cations of fever %ntipyretics, "&ternal cooling, and fever'phobia have

to be managed properly aracetamol and Ibuprofen are commonly used

antipyretic (nder certain conditions,febrile children should be

hospitalized and the administration of antibioticconsidered .

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