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Master Thesis

Évaluation des pratiques de prise en charge de la fièvre chez le nourrisson de moins de 3 mois

Abstract : Introduction: fever is a common reason for pediatric consultations. Management of febrile infants <3 months of age is challenging. The emergency protocol is not completely followed. Objective: to analyze the management of febrile infants from 1 to 3 months at Pediatric Emergency of Bordeaux and to compare the adequacy to the data of literature. Methods: retrospective registry-based cohort study including all the infants between 1 to 3 months with fever who were evaluated in the pediatric emergency department (ED) of Bordeaux from 1 January to 31st of December 2011 and from 1 January to 31st of December 2016. Results: 530 infants were included. 76, 03% of them were hospitalized. The intravenous antibiotics rate was 59, 81% and decreased significantly in 2016. Less blood tests were performed when fever was <12h, temperature was <38,4° and when infants were well-appearing and had no hemodynamic trouble. When a quick CRP test was performed, there were less prescription of urinary tests. We found 25,66% of SBI and 21,69% of them were urinary infections. Three child were admitted to intensive care and no deaths were observed. 13,39% of the infants came back to the ED during the month following their first admission. The nosocomial infection rate was 1,51%. 364 infants were initally diagnosed viral infections, 16 of them were finally diagnosed IBS. No clinical criteria was performant in predicting SBI on this children. Conclusion: management of febril infants is changing and we prescribe less antibiotics. Urine dipstick test seems to be essential in the management of febrils infants. Hospitalisation seems to be necessary on those infants even for a short period but antibiotic could be deleted. A sequential approach to young febrile infants on the basis of urine dipstick first and then laboratory parameters, including protein C reactive and procalcitonin, seemed to be performant in identifying patients at high risk for SBI. In these selected infants unnecessary antibiotics and some hospitalisations can be avoided.
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Master Thesis
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Submitted on : Wednesday, February 21, 2018 - 6:37:23 PM
Last modification on : Saturday, March 3, 2018 - 1:16:05 AM
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Clémence Grimaud. Évaluation des pratiques de prise en charge de la fièvre chez le nourrisson de moins de 3 mois. Médecine humaine et pathologie. 2018. ⟨dumas-01714718⟩



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