Avaliação clínica de crianças de 0 a 36 meses com febre sem sinais localizatórios / Clinical evaluation of children from 0 to 36 months with fever without source

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

Introduction: Fever without localizing signs is defined as the presence of fever of up to 7 days duration, without identifying the cause after history and physical examination. Most of these children presented self-limited acute infectious disease or is in the prodromal phase of a benign infectious disease. Few have serious bacterial infection: occult bacteremia, occult pneumonia, urinary tract infection, bacterial meningitis, septic arthritis, osteomyelitis or cellulitis. Although fever is a common complaint in emergency departments, the approach to febrile children remains controversial. Objectives: To evaluate the applicability of a standardized guideline for the management of children up to 36 months of age with fever without localizing signs and examine the risk factors for serious bacterial infection in these children. Methods: Prospective study involving children up to 36 months of age with fever without localizing signs treated at the emergency department of Hospital Universitário, Universidade de São Paulo, Brazil, from June 2006 to May 2007. The children were treated according to the guideline that classifies the risk of serious bacterial infection according to the presence or absence of toxemia, age and temperature. The laboratory screening was based on risk assessment (blood test, blood culture, urine sediment, urine culture and, if necessary, chest radiograph, cerebrospinal fluid and stool culture). Risk factors for severe bacterial infection were studied: sex, age, presence of toxemia, temperature, total number of leukocytes, total number of neutrophils and total number of young neutrophils. Results: We studied 215 children, 111 (51.6%) females. The mean age was 11.85 months (SD ± 8.91). Toxemia was found in 20 children, and 195 were well-appearing. Among the children from 3 to 36 months without toxemia, 95 had axillary temperature >39ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was serious bacterial infectious. Among the serious bacterial infections, we identified 16 urinary infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no therapy, and 86 received antibiotics at some point. Empirical antibiotic treatment was maintained for an average of 72 hours. The temperature >39°C, the total number of leukocytes >15.000/mm3 and >20.000/mm3 and the total number of neutrophils >10,000/mm3 were statistically significant (p<0,05) in univariate analysis of the factors used for risk stratification for serious bacterial infection. In multivariate analysis only the total number of neutrophils >10.000/mm3 was statistically significant. Conclusion: The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. Most of the children had spontaneous resolution of fever. All serious bacterial infections were identified, and the urinary tract infection was the most common. Among the risk factors studied the total number of neutrophils >10.000/mm3 was statistically significant with serious bacterial infection in both, univariate and multivariate analysis.

ASSUNTO(S)

febre sem sinais localizatórios fever without source bacteremia fever febre bacteremia guideline infection children protocolo criança infecção

ACESSO AO ARTIGO

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