• Am J Emerg Med · Jul 2022

    Outcomes of children presenting to the emergency department with fever and bulging fontanelle.

    • Jiriys Shahada, Oren Tavor, Or Segev, Ayelet Rimon, Dennis Scolnik, and Miguel Glatstein.
    • Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children's Hospital, University of Tel Aviv, Israel.
    • Am J Emerg Med. 2022 Jul 1; 57: 153-155.

    BackgroundIn infants aged 3-18 months presenting with a bulging fontanelle and fever it is often necessary to exclude central nervous system infection by performing a lumbar puncture. Several studies have shown that well-appearing infants with normal clinical, laboratory and imaging studies have a benign (non-bacterial) disease. At our institution, we often observe such infants and withhold lumbar puncture.ObjectiveTo determine the clinical characteristics and outcomes of well-appearing, febrile infants with a bulging fontanelle, whether they did or did not undergo lumbar puncture.DesignA retrospective chart review of the medical records of all febrile infants with a bulging fontanelle seen between March 2018 and March 2020 at Dana Children's Hospital. The following data were extracted: age of the patient, gender, previous medical history, general appearance, vomiting, appetite, fever, blood test results and CSF results (when taken), final diagnosis, disposition status, and whether or not the patient returned to our ER. Stats: Descriptive statistics were used to describe the study population.ResultsThe study group included 40 children, 22 males, and 18 females. Their age ranged from 3 to 13 months. Only 8 of the patients in the study group were admitted and 32 were discharged. Only 13 (32.5%) had an LP performed, three of which had elevated levels of WBC in the CSF, two of them had a positive culture. None of the patients who were discharged returned to the ED.ConclusionsOur study, combined with previous works, supports the assumption that management of well-appearing infants with normal medical history who present with fever and bulging fontanelle could be done without a lumbar puncture. Larger and prospective studies are needed to support this observation.Copyright © 2022. Published by Elsevier Inc.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…