Chandani Dezure, MD, FAAP

Presenter: Kenneth Roberts, MD

One of PHM16’s most highly attended sessions was about anticipated updated from the American Academy of Pediatrics (AAP) to its guidelines for febrile infants ages 7¬–90 days. The proposed update stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.

The proposed inclusion criteria for infants for this algorithm require an infant to be full-term (37–43 weeks’ gestation), aged 7–90 days, well-appearing, and presenting with a temperature of 38°C. Proposed exclusion criteria include perinatal/prenatal/neonatal maternal fever, infection, or antimicrobial treatment; the presence of any evident infection; being technology-dependent; and the presence of congenital anomalies.

The proposed guideline update will aim to stratify management by ages 7–28 days, 29–60 days, and 61–90 days to provide the most appropriate and directed treatment. It will also include a role for inflammatory markers and allow for a “kinder, gentler” approach, including withholding certain treatments and procedures if infants are at low risk of infection. An active need for observation may be appropriate for certain infants as well.

Key Takeaway

It is likely that the AAP will update its algorithm for the management of well-appearing febrile infants ages 7–28 days, 29–60 days and 60–90 days. It will help standardize care in this population but should not be used as a substitute for clinical judgment. The new guidelines are expected to be published in early 2017.

Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.

Presenter: Kenneth Roberts, MD

One of PHM16’s most highly attended sessions was about anticipated updated from the American Academy of Pediatrics (AAP) to its guidelines for febrile infants ages 7¬–90 days. The proposed update stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.

The proposed inclusion criteria for infants for this algorithm require an infant to be full-term (37–43 weeks’ gestation), aged 7–90 days, well-appearing, and presenting with a temperature of 38°C. Proposed exclusion criteria include perinatal/prenatal/neonatal maternal fever, infection, or antimicrobial treatment; the presence of any evident infection; being technology-dependent; and the presence of congenital anomalies.

The proposed guideline update will aim to stratify management by ages 7–28 days, 29–60 days, and 61–90 days to provide the most appropriate and directed treatment. It will also include a role for inflammatory markers and allow for a “kinder, gentler” approach, including withholding certain treatments and procedures if infants are at low risk of infection. An active need for observation may be appropriate for certain infants as well.

Key Takeaway

It is likely that the AAP will update its algorithm for the management of well-appearing febrile infants ages 7–28 days, 29–60 days and 60–90 days. It will help standardize care in this population but should not be used as a substitute for clinical judgment. The new guidelines are expected to be published in early 2017.

Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.

Presenter: Kenneth Roberts, MD

One of PHM16’s most highly attended sessions was about anticipated updated from the American Academy of Pediatrics (AAP) to its guidelines for febrile infants ages 7¬–90 days. The proposed update stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.

The proposed inclusion criteria for infants for this algorithm require an infant to be full-term (37–43 weeks’ gestation), aged 7–90 days, well-appearing, and presenting with a temperature of 38°C. Proposed exclusion criteria include perinatal/prenatal/neonatal maternal fever, infection, or antimicrobial treatment; the presence of any evident infection; being technology-dependent; and the presence of congenital anomalies.

The proposed guideline update will aim to stratify management by ages 7–28 days, 29–60 days, and 61–90 days to provide the most appropriate and directed treatment. It will also include a role for inflammatory markers and allow for a “kinder, gentler” approach, including withholding certain treatments and procedures if infants are at low risk of infection. An active need for observation may be appropriate for certain infants as well.

Key Takeaway

It is likely that the AAP will update its algorithm for the management of well-appearing febrile infants ages 7–28 days, 29–60 days and 60–90 days. It will help standardize care in this population but should not be used as a substitute for clinical judgment. The new guidelines are expected to be published in early 2017.

Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.

PHM16’s Visual Diagnosis: Signs and Why They Matter session led by Dr. Kenneth Roberts and guest presenters was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses/over-diagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.

Many of the presented cases (such as the Gianotti-Crosti toddler over-diagnosed as eczema herpeticum, a child with pseudochromhidrosis misdiagnosed as a cyanotic disease, the case of phytophotodermatitis mistaken as child abuse, and a teen treated for 2 years for JIA before diagnosis of hypertrophic osteoarthropathy was made) highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.

In other instances, such as Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis is necessary to help guide management and future treatment, including subspecialty evaluation.

Many diseases with visual presentations also have a benign course and require no treatment, and acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.

This session underscores the need for experience and exposure to various signs, not only with rare medical conditions, but also in common illnesses such as Kawasaki and scarlet fever that may present similarly.

Key Takeaway:

Providers should have a high index of suspicion and use visual clues to make the correct diagnosis in order to guide treatment, avoid harm in children, and ensure appropriate utilization of resources.

PHM16’s Visual Diagnosis: Signs and Why They Matter session led by Dr. Kenneth Roberts and guest presenters was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses/over-diagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.

Many of the presented cases (such as the Gianotti-Crosti toddler over-diagnosed as eczema herpeticum, a child with pseudochromhidrosis misdiagnosed as a cyanotic disease, the case of phytophotodermatitis mistaken as child abuse, and a teen treated for 2 years for JIA before diagnosis of hypertrophic osteoarthropathy was made) highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.

In other instances, such as Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis is necessary to help guide management and future treatment, including subspecialty evaluation.

Many diseases with visual presentations also have a benign course and require no treatment, and acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.

This session underscores the need for experience and exposure to various signs, not only with rare medical conditions, but also in common illnesses such as Kawasaki and scarlet fever that may present similarly.

Key Takeaway:

Providers should have a high index of suspicion and use visual clues to make the correct diagnosis in order to guide treatment, avoid harm in children, and ensure appropriate utilization of resources.

PHM16’s Visual Diagnosis: Signs and Why They Matter session led by Dr. Kenneth Roberts and guest presenters was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses/over-diagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.

Many of the presented cases (such as the Gianotti-Crosti toddler over-diagnosed as eczema herpeticum, a child with pseudochromhidrosis misdiagnosed as a cyanotic disease, the case of phytophotodermatitis mistaken as child abuse, and a teen treated for 2 years for JIA before diagnosis of hypertrophic osteoarthropathy was made) highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.

In other instances, such as Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis is necessary to help guide management and future treatment, including subspecialty evaluation.

Many diseases with visual presentations also have a benign course and require no treatment, and acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.

This session underscores the need for experience and exposure to various signs, not only with rare medical conditions, but also in common illnesses such as Kawasaki and scarlet fever that may present similarly.

Key Takeaway:

Providers should have a high index of suspicion and use visual clues to make the correct diagnosis in order to guide treatment, avoid harm in children, and ensure appropriate utilization of resources.

One of PHM16’s most highly-attended sessions was an update on the anticipated AAP guidelines for febrile infants between ages 7-90 days given by Dr. Kenneth Roberts. The goal is to give evidence-based guidelines, not rules, from the most recent literature available. It also stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.

The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37-43 weeks gestation), aged 7-90 days, well-appearing, and presenting with a temperature of 38 degrees Celsius.

Exclusion criteria include perinatal/prenatal/neonatal: maternal fever, infection, or antimicrobial treatment, the presence of any evident infection, being technology-dependent, and the presence of congenital anomalies.

The updated guideline will aim to stratify management by age 7-28 days, 29-60 days, and 61 to 90 days to provide the most appropriate and directed treatment.

It will also include a role for inflammatory markers, and allow for a “kinder, gentler” approach to the management of febrile infants aged 7-90 days including withholding certain treatments and procedures if infants are at low risk of infection. An active, not passive, need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk in this population.

Key Takeaway:

An updated AAP Practice guideline algorithm for the management of well-appearing febrile infants 7-28 days, 29-60 days, and 60-90 days will be coming in the near future that will help standardize care in this population, but should not be used as a substitute for clinical judgment.

One of PHM16’s most highly-attended sessions was an update on the anticipated AAP guidelines for febrile infants between ages 7-90 days given by Dr. Kenneth Roberts. The goal is to give evidence-based guidelines, not rules, from the most recent literature available. It also stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.

The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37-43 weeks gestation), aged 7-90 days, well-appearing, and presenting with a temperature of 38 degrees Celsius.

Exclusion criteria include perinatal/prenatal/neonatal: maternal fever, infection, or antimicrobial treatment, the presence of any evident infection, being technology-dependent, and the presence of congenital anomalies.

The updated guideline will aim to stratify management by age 7-28 days, 29-60 days, and 61 to 90 days to provide the most appropriate and directed treatment.

It will also include a role for inflammatory markers, and allow for a “kinder, gentler” approach to the management of febrile infants aged 7-90 days including withholding certain treatments and procedures if infants are at low risk of infection. An active, not passive, need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk in this population.

Key Takeaway:

An updated AAP Practice guideline algorithm for the management of well-appearing febrile infants 7-28 days, 29-60 days, and 60-90 days will be coming in the near future that will help standardize care in this population, but should not be used as a substitute for clinical judgment.

One of PHM16’s most highly-attended sessions was an update on the anticipated AAP guidelines for febrile infants between ages 7-90 days given by Dr. Kenneth Roberts. The goal is to give evidence-based guidelines, not rules, from the most recent literature available. It also stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.

The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37-43 weeks gestation), aged 7-90 days, well-appearing, and presenting with a temperature of 38 degrees Celsius.

Exclusion criteria include perinatal/prenatal/neonatal: maternal fever, infection, or antimicrobial treatment, the presence of any evident infection, being technology-dependent, and the presence of congenital anomalies.

The updated guideline will aim to stratify management by age 7-28 days, 29-60 days, and 61 to 90 days to provide the most appropriate and directed treatment.

It will also include a role for inflammatory markers, and allow for a “kinder, gentler” approach to the management of febrile infants aged 7-90 days including withholding certain treatments and procedures if infants are at low risk of infection. An active, not passive, need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk in this population.

Key Takeaway:

An updated AAP Practice guideline algorithm for the management of well-appearing febrile infants 7-28 days, 29-60 days, and 60-90 days will be coming in the near future that will help standardize care in this population, but should not be used as a substitute for clinical judgment.