Fever without source in infants and young children: dilemma in diagnosis and management

BACKGROUND There is controversy surrounding the management of young children who have a fever without a source (FWS). Several strategies have been designed with the purpose of managing children with FWS. AIMS To assess the applicability of a standardized guideline for children up to 36 months of age with FWS. SETTING Pediatric emergency unit, Al-Adan Hospital, Kuwait City, Kuwait, from May 2011 to October 2011. DESIGN Prospective, cross-sectional study. METHODS AND MATERIALS The study involved children with FWS up to 36 months of age. The guideline classifies the risk of serious bacterial infection (SBI) according to the age of the child, the presence or absence of toxemia, clinical presentation, and laboratory screening tests. RESULTS A total of 481 children were included in the present study, but only 385 cases completed the study; 3.9% of patients had toxemia at the initial evaluation. We found 26 children with SBI (6.8%); 12 patients with SBI did not present with toxemia. In all, 40.4% of studied newborns were diagnosed as having a urinary tract infection, and 42.7% of patients as self-limited probable viral etiology. Of the 109 young infants without toxemia, 53.2% were classified as being at high risk of SBI. Of the 163 toddlers without toxemia, 72.4% were treated with antibiotics; 48.4% of patients received therapeutic treatment and 25.8% received empirical treatment. CONCLUSION The guideline followed in our pediatric emergency unit seemed to be appropriate in following up with these children using simple laboratory tests. The most frequent SBI in this sample was urinary tract infection.