EMS A to Z: Neonatal Fever

Show Notes:

From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn

 

Definition of a neonate: An infant that is < 30 days old (from their expected gestational date), meaning that if they were born 21 days early, you subtract those days from their current age.

 

What are some of the reasons we may see these newborns? 

Fever 

Fussiness

Respiratory symptoms 

BRUE

Vomiting / spitting up 

Rash 

Poor weight gain 

 

When assessing neonates, are there any specific considerations? 

Pediatric assessment triangle

Appearance

Circulation 

Work of breathing 

Vitals: HR, RR, SpO2, Temp

Reference normal vitals for age (don’t let that HR of 150 scare you) 

Glucose 

 

What if you have the following case:  

10-day old female with 1 day of nasal congestion, just developed a fever of 101.4 per parent’s thermometer, calls EMS, says she has a pediatrician appointment tomorrow but isn’t sure if she should wait

There are some other factors that may be good to note:

Sick contacts

Feeding

Urine / stool output

Birth history 

While those (along with the patient’s appearance, vitals, etc.) can be helpful, the bottom line is that any neonate with a fever needs transport to the ED 

 

Why?  

These patients are at a high risk of bacterial infection (10-20%) with associated increased morbidity 

Neonates have poorly developed immune systems that cannot “fight” even simple infections like urinary tract infections as an older child or adult can

They have increased risk that infections will become systemic – spread to the bloodstream or cerebrospinal fluid

In the ED, these kids will get bloodwork, including cultures, lumbar punctures, antibiotics, and admitted to the hospital  

There is some nuance to this with guidelines from the American Academy of Pediatrics, however from the pre-hospital standpoint the idea is simple: these patients need ED eval

https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783/Evaluation-and-Management-of-Well-Appearing 

 

Can they go to their pediatrician’s office? 

These