Infants with a body temperature of more than 38 ° C for more than 2 weeks need emergency medical care. A study by American scientists published in JAMA Pediatrics revealed which simple tests can quickly and painlessly rule out a serious infection.
Why are current diagnostic and treatment methods more harmful than helping children?
High body temperature is always a warning sign for parents. If urinary tract infections, bacteremia, or meningitis are not treated quickly, this can have serious consequences for the baby.
Many outpatient departments for preventive purposes carry out intensive diagnostics and treat children with antibiotics. 9 out of 10 cases showed that these measures are unnecessary because children are not always seriously ill.
The American Society of Pediatricians is looking for ways to prevent over-diagnosis.
Microchips that detect various bacterial genes in the blood are considered the method of the future. They promise quick confidence not only in the presence of infection, but also in the personality of the pathogen and its sensitivity to drugs.
Microchips have not yet been introduced in clinics, and perhaps they are not needed, because there are simpler diagnostic methods. 3 simple tests that modern researchers have discovered help rule out a serious infection.
What 3 simple tests help rule out a serious infection in a child?
American scientists examined 1821 children under 60 days of age who had a fever at a temperature not lower than 38 ° C. Children were located in 1 of 26 emergency departments and were randomly assigned to 2 groups.
The protocol that researchers are presenting consists of 3 simple tests.
First test - This is a urinalysis for a urinary tract infection. If there is a positive result, antibiotic treatment is required.
Second test - determination of neutrophilic granulocytes in the blood picture. An increase to more than 4090 / μl is also a sign of a bacterial infection.
Third test - determination of the level of procalcitonin in the blood. An increase to 1.71 ng / ml or higher also indicates a bacterial infection. In the study, 3 tests were reliable and quickly identified the causes of the baby's disease.
In total, in 3 children the diagnosis of "severe bacterial infection" was missed. One child with bacteremia and 2 children with urinary tract infections were misclassified.
Meningitis has never been missed. In the general group, 170 children (9.3%) had a severe bacterial infection.
Researchers hope that 3 tests, after further testing in an independent group, will prevent unnecessary hospitalization, diagnosis or antibiotic treatment.
How can a parent help a child?
The most common reason for visiting a pediatrician is fever. Approximately 70% of all planned appointments with the local doctor are due to an uncharacteristic increase in body temperature. The occurrence of fever in a child is of great concern to parents, but partly to the attending physicians.
For parents, fever is often not a symptom, but an anxiety disorder. Parents should pay attention to the breathing, skin, behavior and consciousness of the child, and not normalization of body temperature. The use of antipyretic drugs in Russia is no longer recommended for the treatment of fever in healthy children.
Antipyretic drugs can be used in the following cases:
- chronic heart and lung disease;
- acute stroke;
- very high body temperature (≥40 ° C);
- the child consumes very little fluid.
Improving the condition of the child is possible without the use of antipyretic drugs by sufficient fluid intake (50-80 ml / kg body weight). The baby loses approximately 10-15% of the fluid with each increase in temperature by 1 ° C. An increase in baby fluid requirements at 40 ° C is 40% higher than normal.
External cooling with ice baths is useless because it enhances vasoconstriction. As a result, heat production increases, which further increases body temperature.
Not with fever, but with hyperthermia (defined as> 40 ° C), external cooling of the child helps.
With a sharp increase in body temperature in all cases, it is recommended to seek specialist advice. Self-medication sometimes leads to fatal consequences.
