Fever and Hypothermia in Newborns

Yıl 2018, Cilt: 10 Sayı: 4, 0 - 0, 25.07.2018

Ebru Yalın İmamoğlu

Öz

Abstract

Fever in the neonatal period is defined as a body temperature above 38 C. Althoughthe exact mechanisms are unknown, fever results from a dispruption of complex relationsbetween heat production and heat loss. Many infectious or non-infectious causes may leadto fever. Most common infectious agents are viruses. Bacterial agents include E coli andother gram negative pathogens. All newborns who have fever should be admitted to thehospital and evaluated for infections even if they look well.  Evaluation of procalcitoninand CRP is better in diagnosing serious bacterial infections in the first 36-72 hours of life. Leukocyte count is insufficient to diagnose an infection. In newborn infants, a body temperature of 36.,0 – 36,4 is known as mild hypothermia (cold stress), 32,0 – 35,9 C is known as moderate hypothermia and below 32 C is diagnosed as severe hypothermia. Risk of hypothermia is larger in preterminfants. If not treated, hypothermia may result in whole bodycoldness, loss of activity and suck, and weak cry. Differential diagnoses include hypoglycemia, hypothalamic and autonomic dysfunction, infections, endocrine and metabolic di-seases, central nervous system depression and decreased caloric intake. A hypothermic infant should be warmed as soonas possible, but not too quickly.

Anahtar Kelimeler

Fever, hypothermia

Yenidoğanda Ateş ve Hipotermiye Yaklaşım

Öz

Öz

Yenidoğanda rektal olarak ölçülen vücut sıcaklığının 38ºC ve üzerinde olması ateşolarak tanımlanır. Mekanizması tam belli olmamakla beraber, ateşin, ısı üretimi ve tüketimi arasındaki kompleks ilişkilerdeki bozukluktan kaynaklandığı düşünülmektedir.Yenidoğanda enfeksiyonlar veya enfeksiyon dışı birçok neden ateşe neden olabilir. Bu yaş grubunda ateşin en sık nedeni, viral enfeksiyonlardır. Bakteriyel patojenlerden ise,başta Escherichia coli olmak üzere diğer gram negatif patojenler  en sık etkenlerdir. Ateşi olan tüm yenidoğanlar, genel durumları iyi olsa bile, hastaneye yatırılmalı ve enfeksiyon açısından değerlendirilmelidir. Ciddi bakteriyel enfeksiyon tanısını koymada (ilk72 saatten sonra) CRP ve prokalsitoninin birlikte gönderilmesi daha değerlidir. Lökosit sayısının tek başına enfeksiyonu belirlemedeki duyarlılığı düşüktür. Yenidoğan bebeklerde, vücut sıcaklığının 36,0-36,4ºC arasında olması hafif hipotermi (soğuk stresi),32,0-35,9ºC arasında olması orta derecede hipotermi ve 32ºC altında olması ise ciddi hipotermi olarak tanımlanır. Preterm yenidoğanlarda hipotermi riski term yenidoğanlara göre daha da fazladır. Hipotermiye müdahale edilmezse tüm vücutta soğukluk, emmede/aktivitede azalma ve zayıf ağlama ortaya çıkar. Hipoglisemi, hipotalamik/oto-nomik santral patolojiler, enfeksiyonlar, endokrin/metabolik hastalıklar, santral sinir sisteminde depresyon ve kalori alımında azalma hipotermi ayırıcı tanısında düşünülmelidir. Hipotermisi olan yenidoğan bebek, mümkün olan en kısa sürede ancak çok hızlı olmadan ısıtılmalıdır.

Anahtar Kelimeler

Ateş, hipotermi, enfeksiyon

Kaynakça

• Kaynaklar 1.Callanan D. Detecting fever in young infants: reliability of per-ceived, pacifier, and temporal artery temperatures in infantsyounger than 3 months of age. Pediatr Emerg Care.2003;19(4):240-3. 2.Hooker EA, Smith SW, Miles T, King L. Subjective assessmentof fever by parents: comparison with measurement by noncon-tact tympanic thermometer and calibrated rectal glass mer-cury thermometer. Ann Emerg Med. 1996;28(3):313-7. 3.Fever without a focus, Nelson textbook of pediatrics, 20th edi-tion, part 18, chapter 177, p 1280, 2016. 4.Taking a rectal temperature, Basic infant care, p 58-59, Ca-ring for your baby and young child, Oxford UniversityPress, 1997. 5.Fever, chapter 6, p 56, Evidence-based pediatric infectiousdiseases, BMJI boks, 2007. 6.Neonatal fever, chapter 30, p 364-365, Avery’s Diseases ofthe Newborn E-book, 9th edition, 2012. 7.The thermal environment of the intensive care nursery, chap-ter 36, p 505, Fanaroff&Martin`s Neonatal Perinatal Medi-cine, Diseases of the Fetus and Infant, 10th edition, 2015. 8.Caviness AC, Demmler GJ, Almendarez Y, Selwyn BJ. The pre-valence of neonatal herpes simplex virus infection comparedwith serious bacterial illness in hospitalized neonates. J Pe-diatr. 2008;153(2):164-9. 9.Byington CL, Enriquez FR, Hoff C, Tuohy R, Taggart EW, Hill-yard DR, Carroll KC, Christenson JC. Serious bacterial in-fections in febrile infants 1 to 90 days old with and withoutviral infections. Pediatrics. 2004;113(6):1662-6. 10.Blaschke AJ, Korgenski EK, Wilkes J, Presson AP, Thorell EA,Pavia AT, Knackstedt ED, Reynolds C, Schunk JE, Daly JA,Byington CL. Rhinovirus in Febrile Infants and Risk of Bac-terial Infection. Pediatrics. 2018;141(2). 11.Febrile infant (younger than 90 days of age): outpatient eva-luation, UpToDate, 2018. 12.Biondi E, Evans R, Mischler M, Bendel-Stenzel M, Horstmann S,Lee V, Aldag J, Gigliotti F. Epidemiology of bacteremia in feb-rile infants in the United States. Pediatrics. 2013;132(6):990-6. 13.Leazer R, Perkins AM, Shomaker K, Fine B. A Meta-analy-sis of the Rates of Listeria monocytogenes and Enterococcusin Febrile Infants. Hosp Pediatr. 2016;6(4):187-95. 14.Greenhow TL, Hung YY, Herz AM, Losada E, Pantell RH. Thechanging epidemiology of serious bacterial infections in yo-ung infants. Pediatr Infect Dis J. 2014;33(6):595-9. 15.Cruz AT, Mahajan P, Bonsu BK, Bennett JE, Levine DA, Al-pern ER, Nigrovic LE, Atabaki SM, Cohen DM, VanBuren JM,Ramilo O, Kuppermann N; Febrile Infant Working Group ofthe Pediatric Emergency Care Applied Research Network. Ac-curacy of Complete Blood Cell Counts to Identify Febrile In-fants 60 Days or Younger With Invasive Bacterial Infections.JAMA Pediatr. 2017;171(11):e172927. 16.Bonadio W, Maida G. Urinary tract infection in outpatient feb-rile infants younger than 30 days of age: a 10-year evaluati-on. Pediatr Infect Dis J. 2014;33(4):342-4. 17.Hoberman A, Wald ER, Reynolds EA, Penchansky L, Char-ron M. Is urine culture necessary to rule out urinary tract in-fection in young febrile children? Pediatr Infect Dis J.1996;15(4):304-9. 18.Bruno E, Pillus D, Cheng D, Vilke G, Pokrajac N. During theEmergency Department Evaluation of a Well-AppearingNeonate with Fever, Should Empiric Acyclovir Be Initiated?J Emerg Med. 2018;54(2):261-265. 19.Rittichier KR, Bryan PA, Bassett KE, Taggart EW, EnriquezFR, Hillyard DR, Byington CL. Diagnosis and outcomes of en-terovirus infections in young infants. Pediatr Infect Dis J.2005;24(6):546-50. 20.World Health Organization. Thermal protection of the new-born: A practical guide. World Health Organization: ReportNo: WHO/RHT/MSM/97.2, 2013. 21.Temperature regulation, section 1, part 7, page 65-70, Neo-natology: Managements, Procedures, On-Call Problems,Diseases, and Drugs, 7th edition, 2013. 22.Lunze K, Bloom DE, Jamison DT, Hamer DH. The global bur-den of neonatal hypothermia: systematic review of a majorchallenge for newborn survival. BMC Med. 2013;11:24. 23.Hypothermia in children: Clinical manifestations and diag-nosis-UpToDate-2018. 24.Kurulama ve hipoterminin önlenmesi, Sağlıklı yenidoğandadoğum salonu uygulamaları, Türk Neonatoloji Derneği, Do-ğum salonu yönetimi rehberi, 2016.