Fever and Sepsis

Fever (Xable.112.:6) is most commonly due to acute infections. Fever is present when an infant's rectal temperature is 100.4°F or greater, as reportedly measured by a caretaker, or 38°C or more, as measured by a health care professional. The risk of infection rises with the height of fever, especially in infants over 4 weeks of age. The risk is about 3 percent with fever above 39.4°C, 6 percent with fever over 40°C, 13 percent with over 40.5°C, and 26 percent with fever over 41.1°C.

Recognizing neonatal bacterial sepsis early is a difficult task. Neonates have about twice the risk of serious bacterial infection as do infants 4 to 8 weeks of age. Neonatal sepsis tends to appear as either an "early-onset" or a "late-onset" syndrome, but some cases are difficult to classify. Early-onset disease is seen in first few days of life, tends to be fulminant, and is usually associated with maternal or perinatal risk factors, such as maternal fever, prolonged rupture of membranes, and fetal distress. On the other hand, late-onset disease usually occurs after 1 week of age, tends to develop more gradually, and is less likely to be associated with risk factors. Septic shock and neutropenia are more common with early-onset syndrome, and meningitis is more common in late-onset disease.

Clinical signs of either type of sepsis are not specific (Table 112-7). Septic infants may exhibit any of a variety of symptoms, including lethargy, poor feeding, vomiting, temperature instability (hypothermia more often than hyperthermia), unexplained apnea, respiratory distress, seizures (with or without meningitis), cyanosis, tachycardia, bleeding diathesis, and hypotension.

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  • VELI-PEKKA
    Is fever and sepsis emergency?
    7 years ago

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