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Master Thesis

Prise en charge ambulatoire de la fièvre chez les nourrissons de moins de 3 mois

Abstract : Introduction : Fever is a frequent reason for consultation among infants less than 3 months old. This group is typically considered the most at risk for severe and invasive bacterial infections. A check-up comprising at least urine and blood tests is recommended. The only previous study conducted exclusively in outpatient settings showed a somewhat chaotic compliance with the recommendations. Objective : The main purpose of this study was the descriptive analysis of general physicians and liberal paediatricians professional practices in Brittany. The secondary objectives was to estimate the rate at which infants were sent to the paediatric emergency through a clinical case study ; the rate at which complementary tests were prescribed ; and lastly a comparative analysis in sub-groups. Equipment and methods : This was an observational epidemiological survey, meant to be descriptive and cross-cutting, conducted by means of an anonymous self-questionnaire developed on the Lime Survey platform and disseminated via e-mail to general physicians, SOS Médecins, and liberal paediatricians throughout Brittany. It was made up of 3 parts : general characteristics, consultation practices and clinical cases. The data was analyzed on the R Commander software in a descriptive manner (average, median, standard deviation, frequency) as well as comparative (Chi2 test, Fisher, Student and Anova). Results : 294 fully filled in questionnaires were analyzed. 92.7% of the participants declared to always send febrile infants less than one month old the the paediatric emergency, 66.3% for infants between 1 and 2 months old and 30.6% between 2 and 3 months old. 80.1% of the participants would send to the emergency room the 24-day-old infant from the first clinical case, versus 89.1% for the 2-month-old infant from the second clinical case. Besides the age of the infant, the clinic, and especially the conservation of a general state and the presence of a clinical warning sign were important factors in taking the decision to redirect to the emergency room or to opt for outpatient care. 56.1% of the practitioners declared to have never demanded any complementary tests in city laboratories if the febrile infant was less than 3 months old. Urinalysis was most commonly asked for (42.5%), in front of the CRP and CBC. The prescription -or lack thereof- of a complementary check-up in case of outpatient care was directly connected to the presence -or lack thereof- of clinical warning sign. Conclusion : The majority of the practitioners from our study redirect the febrile infants less than 3 months old to the paediatric emergency. The infants in outpatient care do not always benefit from a complementary check-up, which goes against the recommendations. Bearing in mind the apparent difficulties to conduct complementary check-ups in city laboratories, redirecting to the emergency room to conduct the initial check-up and a short oversight seems to be a good compromise for now.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03239460
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Submitted on : Thursday, May 27, 2021 - 2:50:14 PM
Last modification on : Tuesday, November 30, 2021 - 3:45:20 AM

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  • HAL Id : dumas-03239460, version 1

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Azalaïs Guilloit. Prise en charge ambulatoire de la fièvre chez les nourrissons de moins de 3 mois. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03239460⟩

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