Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.
Division of Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.
JAMA Pediatr. 2016 Aug 1;170(8):794-800. doi: 10.1001/jamapediatrics.2016.0596.
Management of febrile children is an intrinsic aspect of pediatric practice. Febrile children account for 15% of emergency department visits and outcomes range from the presence of serious bacterial infection to benign self-limited illness.
Studies from 1979 to 2015 examining febrile infants and children were included in this review. Management of febrile infants younger than 90 days has evolved considerably in the last 30 years. Increased rates of Escherichia coli urinary tract infections, increasing resistance to ampicillin, and advances in viral diagnostics have had an effect on the approach to caring for these patients. Widespread vaccination with conjugate vaccines against Haemophilus influenzae and Streptococcus pneumoniae has virtually eliminated the concern for bacterial infections in children aged 3 to 36 months. Urinary tract infections still remain a concern in febrile infants of all ages.
Advances over the last 30 years allow for more precise risk stratification for infants at high risk of serious bacterial infection. With appropriate testing at the initial visit, much of the diagnostic testing and empirical treatment can be avoided for infants younger than 90 days. In the vaccinated child aged 3 to 36 months, the only bacterial infection of concern is urinary tract infection.
儿童发热的管理是儿科实践的固有组成部分。发热儿童占急诊就诊的 15%，其结果范围从存在严重细菌感染到良性自限性疾病。
本综述纳入了 1979 年至 2015 年期间研究发热婴儿和儿童的研究。在过去的 30 年中，对 90 天以下发热婴儿的管理已经发生了很大的变化。大肠杆菌尿路感染的发生率增加，对氨苄西林的耐药性增加，以及病毒诊断技术的进步，都对这些患者的护理方法产生了影响。广泛使用针对流感嗜血杆菌和肺炎链球菌的结合疫苗，实际上消除了对 3 至 36 个月儿童细菌感染的担忧。尿路感染仍然是所有年龄段发热婴儿的一个关注点。
过去 30 年来的进展使得对有严重细菌感染高风险的婴儿进行更精确的风险分层成为可能。在初始就诊时进行适当的检测，可以避免对 90 天以下婴儿进行大部分诊断性检测和经验性治疗。在接种疫苗的 3 至 36 个月儿童中，唯一需要关注的细菌感染是尿路感染。
