Fever without Source in Children: Six Years Experience of a Children’s Hospital

Abstract

Objective: Fever without an apparent source (FWS) in 1-36 months is challenging. An extensive evaluation is carried out, and there is a need to simplify the management of infants with FWS. In this paper, we aimed to review the follow up of the infants with FWS.

Methods: The data of 127 children admitted to the pediatric unit were analysed for six years. The age ranged from 1 to 36 months. Demographics, symptoms, history, laboratory tests, cerebrospinal fluid analysis and cultures, blood and urinalysis and cultures, chest X-rays and abdominal/transfontanel ultrasound, treatment modalities, length of stay and the requirement for pediatric intensive care unit were collected.

Results: Most of the patients were (65.4%) boys. Mean age was ≈3,2 months and fever was present for ≈1.9 days. Dehydration and signs of shock were highly significant concerning severe bacterial infections (SBIs). Two patients were diagnosed as meningitis. A chest X-ray was performed at 112 of the patients whom 17.9% had mild paracardiac infiltration. Abdominal ultrasound was performed in 18.9% of the patients, of whom 8.7% had findings related to UTI. Regarding our results, WBC value >15000x10^3/µL and CRP level > 9 mg/L could be taken as a measure to predict SBIs. However, the MPV level was not significant.

Conclusion: Approach to febrile children is still a challenge for a pediatrician although the prevalence of SBIs was low in children with FWS. In addition, WBC and CRP are valuable and informative to identify SBI, while MPV does not. The findings obtained in this review suggest that pediatricians must sufficiently focus on UTI, which is the most common cause of SBI.