TY - CHAP M1 - Book, Section TI - The Febrile or Septic-Appearing Neonate A1 - Fein, Daniel M. A1 - Avner, Jeffrey R. A2 - Tenenbein, Milton A2 - Macias, Charles G. A2 - Sharieff, Ghazala Q. A2 - Yamamoto, Loren G. A2 - Schafermeyer, Robert Y1 - 2019 N1 - T2 - Strange and Schafermeyer's Pediatric Emergency Medicine, 5e AB - The risk of serious bacterial illness (SBI) is greatest during the neonatal period, defined as birth to 28 days of life. Some authorities recommend that a child born prematurely should have the degree of immaturity subtracted from the child’s chronological age for this consideration.It is generally accepted that a fever is a temperature of ≥38°C or 100.4°F taken with a rectal thermometer.A neonate who had a documented fever by any method but is afebrile in the emergency department (ED) should be treated as a febrile neonate whether or not antipyretics have been given, as other methods of thermometry tend to underestimate the actual temperature.The most frequent bacterial pathogens in the neonatal period are group B Streptococcus (GBS), Escherichia coli, and Listeria monocytogenes.Hypothermia is a rectal temperature less than 36°C or 96.8°F, and in the neonatal period may actually be a more common presentation than elevated temperature. All neonates with hypothermia should be treated as septic.Causes other than SBI, especially herpes simplex virus (HSV) infection, should be considered and, if suspected, treated expectantly.Noninfectious problems, such as congenital heart disease (CHD), inborn errors of metabolism, and trauma, may present in a similar way and must always be included in the differential diagnosis of the septic-appearing infant.If the child is exhibiting signs of shock, such as tachycardia, mottling, apnea, or prolonged capillary refill time, aggressive fluid resuscitation must be immediate.Antibiotics should be started after cultures have been obtained.If the child is unstable, the lumbar puncture may need to be postponed but should not delay empiric antibiotic therapy. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessemergencymedicine.mhmedical.com/content.aspx?aid=1155167277 ER -