medigraphic.com
Órgano Oficial del Hospital Angeles Health System

2018, Número 3

<< Anterior Siguiente >>

Acta Med 2018; 16 (3)


Identificación de los factores de bajo riesgo en el lactante pequeño con fiebre sin foco evidente

Guzmán CB, Cullen BPJ

Idioma: Español
Referencias bibliográficas: 29
Paginas: 219-225
Archivo PDF: 282.68 Kb.


RESUMEN

La fiebre en niños menores de tres meses que no tiene un foco evidente puede ser parte de una infección bacteriana seria o invasiva con riesgo de consecuencias graves de no darse pronta atención. Esta revisión pretende explorar las definiciones de fiebre e infecciones invasivas, las características clínicas y paraclínicas, así como los protocolos que dieron origen a los criterios de bajo riesgo que pueden usarse para evitar tratamientos excesivos o subestimaciones peligrosas. Los tres elementos más importantes de bajo riesgo son: el cuadro clínico en donde la ausencia de apariencia tóxica es esencial, un examen general de orina normal y biomarcadores sanguíneos normales, específicamente leucocitos y proteína C reactiva, pero sobre todo procalcitonina.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Kline MW, Lorin MI. Fever without source. In: McMillan JA, De Angelis CD. Oski’s Pediatrics. 4th ed. Lippincott W&W. Philadelpphia PA. 2006. pp. 842-844.

  2. Black S. Acute fever without a focus. In: Rudolph A, Rudolph C, Lister G, First L, Gershon A. Rudolph’s Pediatrics. 22nd ed. McGraw Hill Medical, Philadelphia PA. 2011.

  3. Pantell RH, Newman TB, Bernzweig J, Bergman DA, Takayama JI, Segal M et al. Management and outcomes of care of fever in early infancy. JAMA. 2004; 291 (10): 1203-1212.

  4. Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC et al. American college of critical care medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017; 45 (6): 1061-1093.

  5. Ishimine P. Fever without source in children 0 to 36 months of age. Pediatr Clin North Am. 2006; 53 (2): 167-194.

  6. Dagan R, Powell KR, Hall CB, Menegus MA. Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis. J Pediatr. 1985; 107 (6): 855-860.

  7. Byington CL, Enriquez FR, Hoff C, Tuohy R, Taggart EW, Hillyard DR et al. Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. Pediatrics. 2004; 113 (6): 1662-1666.

  8. Greenhow TL, Hung YY, Herz AM, Losada E, Pantell RH. The changing epidemiology of serious bacterial infections in young infants. Pediatr Infect Dis J. 2014; 33 (6): 595-599.

  9. Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D. European Research Network on Recognising Serious Infection investigators. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review. Lancet. 2010; 375 (9717): 834-845.

  10. Nelson KG. An index of severity for acute pediatric illness. Am J Public Health. 1980; 70 (8): 804-807.

  11. McCarthy PL, Sharpe MR, Spiesel SZ, Dolan TF, Forsyth BW, DeWitt TG et al. Observation scales to identify serious illness in febrile children. Pediatrics. 1982; 70 (5): 802-809.

  12. Bang A, Chaturvedi P. Yale observation scale for prediction of bacteremia in febrile children. Indian J Pediatrics. 2009; 76 (6): 599-604.

  13. Dieckmann RA, Brownstein D, Gausche-Hill M. The pediatric assessment triangle. Pediatr Emerg Care. 2010; 26 (4): 312-315.

  14. Biondi EA, Byington CL. Evaluation and management of febrile well-appearing young infants. Infect Dis Clin North Am. 2015; 29 (3): 575-585.

  15. Thompson D, Pepys MB, Wood SP. The physiological structure of human C-reactive protein and its complex with phosphocholine. Structure. 1999; 7 (2): 169-177.

  16. Andreola B, Bressan S, Callergo S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C reactive protein as diagnostic marker of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J. 2007; 26 (8): 672-677.

  17. Gendrel D, Raymond J, Coste J, Moulin F, Lorrot M, Guérin S et al. Comparison of procalcitonin with C reactive protein, interleukin 6 and interferón – alpha for differentiation of bacterial vs viral infections. Pediatr Infect Dis J. 1999; 18 (10): 875-881.

  18. Jaskiewicz JA, McCarthy CA, Richardson AC, White KC, Fisher DJ, Powell KR et al. Febrile infants at low risk for serious bacterial infection – an appraisal of the Rochester criteria and implications for management. Pediatrics. 1994; 94 (3): 360-396.

  19. Baker MD, Bell LM, Avner JR. Outpatient management without antibiotics of fever in selected infants. N Engl J Med. 1993; 329 (20): 1437-1441.

  20. Baskin MN, O’Rourke EJ, Fleisher GR. Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone. J Pediatr. 1992; 120 (1): 22-27.

  21. Baraff LJ, Shriger DL, Bass JW, Fleisher GR, Klein JO, McCraken GH Jr. et al. Practice guideline for the management of infants and children. Pediatrics. 1993; 92 (1): 48-62.

  22. Bachur RG, Harper MB. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics. 2001; 108 (2): 311-316.

  23. Lacour AG, Zamora SA, Gervaix A. A score identifying serious bacterial infections in children with fever without source. Pediatr Infect Dis J. 2008; 27 (7): 654-656.

  24. Mintegi S, Bressan S, Gómez B, Da Dalt L, Blázquez D, Olaciregui I et al. Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection. Emerg Med J. 2014; 31 (e1): e19-e24.

  25. Gómez B, Mintegi S, Bressan S et al. Validation of the “step by step” approach in the management of young febrile infants. Pediatrics. 2016; 138: e20154381.

  26. Martínez E, Mintegi S, Vilar B, Martínez MJ, López A, Catediano E, Gómez B. Prevalence and predictors of bacterial meningitis in young infants with fever without a source. Pediatr Infect Dis J. 2015; 34 (5): 494-498.

  27. Olaciregui I, Hernández U, Muñoz JA, Emparanza JI, Landa JJ. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child. 2009; 94 (7): 501-505.

  28. Milcent K, Faesch S, Gras-Le Guen C, Dubos F, Poulalhon C, Badier I et al. Use of procalcitonin assay to predict serious bacterial infection in young febrile infants. JAMA Pediatr. 2015; 170 (1): 62-65.

  29. England JT, Del Vecchio MT, Aronoff SC. Use of serum procalcitonin in evaluation of febrile infants: a meta-analysis of 2,317 patients. J Emerg Med. 2014; 47 (6): 682-688.




2020     |     www.medigraphic.com