WHat do you do with a infant and fever.

I saw a couple of these when I was rotating in the pediatric ER back in the fall. Here is the scenario. Infant under the age of 2 months comes in with a fever. The fever in a newborn is defined as a temperature of 100.4 or higher. A newborn with a fever gets a full work up. The first time you see this kind of work up it can be a little unsettling. You looking at a infant that does not look that sick but does have a fever above 100.5. You know that it is probably nothing but you have to do a full work up.

A full fever work up for an infant includes basically poking in every nook and cranny to ferret out the source of the fever. This includes a straight catheter and a spinal tap. The parents are freaking out and the healthy looking baby is now traumatized and bleeding from the spine. In the end the infant usually gets admitted. Eventually the source is hopefully found and the treatment is tailored accordingly and if no source is found the infant gets empiric treatment. Why all this torture over a small fever? 

You can't run the risk of missing meningitis in a newborn. Even though the odds are slim, a newborn can't communicate their symptoms the way older children can so you have to assume the worst. Every few years a case is missed and a newborn dies or suffers deafness or other consequences of meningitis. I think that there are roughly 300,000 or more negative spinal taps etc done for every 1 case of meningitis found in newborns. Even if your newborn does not get meningitis, if he / she gets a fever and you go to the hospital the work up will be traumatic and even possibly dangerous (rarely) but it is better safe than sorry. This is why I think newborns should be guarded from any exposure which means no church or other mass gatherings for at least 2 months.

I have had 3 cases this week of fevers in newborns and we did full work ups including spinal taps in each case.