Potentially Serious Infections - Paediatrics

Potentially Serious Infections

·        When is a child really sick?

·         Factors which are not on their own discriminating between mild and severe: 

· Temperature: spikes easily

o   Pulse: variable, eg ­­ if crying 

o   Blood pressure: hard to measure, and if shocked is still maintained till very late. As soon as they have any hypotension they‟re the same as an adult with no recordable BP

·         Factors from history which discriminate:

o   Intake:

§  Refusal to feed Þ more severe

§  Refusal to take solids but still taking liquids Þ not so bad

o   Losses:

§  Vomiting:

·         Frequency and amount: if vomiting their whole feed then bad (vs a small spill) 

·         Colour: Bile is bad. Yellow (from gallbladder), green (after bile has been in the stomach) or orange. Due to obstruction or ­­ sympathetic discharge, eg due to pain (not necessarily abdominal – could be a torted testicle) 

§  Decreased urine output (wet nappies < 4 per day)

§  Diarrhoeal losses

·         Dysuria and pale extremities may be the only warning signs before they crash

·        Sepsis:  leads to systemic inflammatory response syndrome (SIRS).  Also get it in major trauma,

·        pancreatitis, etc. Mass release of cytokines. (Cf bacteraemia: bugs in blood but no major systemic reaction)

·        Sepsis + focus (pneumonia, kidneys, joints/bones):

o   Neonate: Gp B Strep (S agalactiae), E Coli, S aureus 

o   Infant/older child: S Pneumoniae, N Meningitidis, S aureus (complication of skin infections), S pyogenes, [HIB]

·        Meningitis: infection of CSF via choroid plexus

·        Neonate: Group B Strep, E Coli, Listeria