viral illness?

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butterfl2005

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hi all. had a 3 week old male today with 2 day hx of snotty nose, vomitted X 3 this past week(unassociated with feedings), 4-5 wet diapers/day, diarrhea 2-3x/day for 2 days, no fever, is irritable, taking feedings as usual. brother has viral uri. on pe: no positive findings except irritability and a snotty nose.well-hydrated. I diagnosed this as a viral syndrome and told mom to watch for signs of dehydration and to bring him to the ER if fever >102 or if he stops feeding. Would anyone have done anything different? those little ones < 6 months are so unpredictable, status can change so quickly and they can present with pretty benign findings. ANy thoughts?

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butterfl2005 said:
hi all. had a 3 week old male today with 2 day hx of snotty nose, vomitted X 3 this past week(unassociated with feedings), 4-5 wet diapers/day, diarrhea 2-3x/day for 2 days, no fever, is irritable, taking feedings as usual. brother has viral uri. on pe: no positive findings except irritability and a snotty nose.well-hydrated. I diagnosed this as a viral syndrome and told mom to watch for signs of dehydration and to bring him to the ER if fever >102 or if he stops feeding. Would anyone have done anything different? those little ones < 6 months are so unpredictable, status can change so quickly and they can present with pretty benign findings. ANy thoughts?

Probably viral. I would have set my fever threshold lower. If a 3 week old has fever they need to be seen.
 
Have parents do some bulb suctioning before feedings. And I'd lower my fever threshold to 100.5. Another thing, is the child consolable? Or is he constantly fussy? Some would recommend doing a sepsis workup on an inconsolably fussy newborn. How was the baby's hydration status? 4-5 wet dipaers in a 24 hour period is kinda pushing it.
 
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T max > 100.4 (38) or any acute change in status (tachypnea, lethargy, and especially a big reduction in feeding (and sleeping through feeds)) in a kid under 8 weeks and id bring them back for a s w/u asap. Make sure they know the clinic number.

Other than that, bulb suctioning. They dont even need to buy the store bought stuff, they can mix their own saline and it lasts 24 hours.
 
Would anyone have done anything different?

What did you write on the chart as discharge diagnosis ?

What was the follow up plan (in addition to: go to the ED if your kid goes downhill)?
 
butterfl2005 said:
hi all. had a 3 week old male today with 2 day hx of snotty nose, vomitted X 3 this past week(unassociated with feedings), 4-5 wet diapers/day, diarrhea 2-3x/day for 2 days, no fever, is irritable, taking feedings as usual. brother has viral uri. on pe: no positive findings except irritability and a snotty nose.well-hydrated. I diagnosed this as a viral syndrome and told mom to watch for signs of dehydration and to bring him to the ER if fever >102 or if he stops feeding. Would anyone have done anything different? those little ones < 6 months are so unpredictable, status can change so quickly and they can present with pretty benign findings. ANy thoughts?

A few thoughts......
*Given the current literature you really can't justify anything less than a sepsis workup in a 3 week old with T 100.4 or above (therefore that should have been one of your return criteria)
*Irritability is always a red flag in this age group...I'm presuming this child consoled with mom (and or you) but if they are truly irritable they need further workup (sepsis w/u, head CT, etc)
*Sadly besides infection, non-accidental trauma fits quite well with this scenario (especially if they are really irritable). There was a study in the EM literature now probably at least 5 years ago that retrospectively looked at the presenting complaints/ working diagnoses/ admission diagnoses of children with post-mortem evidence of non-accidental trauma. Viral Syndrome/Gastroenteritis were very high on that list.
*Your infant's urine output appears on the low side for this age group (but again I'm presuming since you sent this child out that 4-5 wet diapers is the norm for this child, they weren't tachycardic, they were well perfused, and without other evidence of clinical dehydration. I'm also presuming emesis was nonbloody, nonbilious, nonprojectile and diarrhea non bloody) Educating mom about what to look for with signs of dehydration will be important here.
 
hi guys
i agree with all of above posts. but i think its difficult to advise without seeing baby. as at this age rather then history...i find observing child for some time reveals more.
1. you said diarrhoea 2-3 times......now is it really diarrhoea.......what about normal pattern of baby
2. may be with sepsis these kids may not show fever but hypothermia or normothermia
3. when you say irritable.....you must find out the cause rather then presuming it...like if its stuffy nose.......clean with saline..remove congestion...then see still child is irritable or not
4.feeding usual meaning what...........sometimes i have seen irritable n septic child in initial stages suck vigorously just to get relief......these kids will stay irritable after feeding....others will not
5. with experience we can make out something from look....offcolor...sick look
6. rather then fever i think i will be worried about child getting lethargic...


lot of small points like this but ya..looks like a viral fever......mostly...but where i have done my residency.......we see lot of sepsis so i think i m overcautious.......
 
The original post is over a month old. I wonder how the kid turned out.
 
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