Paul McCarthy | PubMed Health

PubMed2005

Fever without apparent source on clinical examination.

PURPOSE: This review discusses recent literature that has focused on the epidemiology, clinical and laboratory evaluation and treatment of episodes of acute illnesses associated with fever and also of prolonged episodes of fever in children. RECENT FINDINGS: Articles addressed the epidemiology of invasive pneumococcal disease in children in other countries that have not yet initiated vaccination with the conjugated pneumococcal vaccine. From the United States there was a report of the decreased occurrence of invasive pneumococcal disease in patients being provided primary care who had been vaccinated with conjugated pneumococcal vaccine. Another report outlined the experience at children's hospitals with invasive pneumococcal disease in the years pre- and post-introduction of pneumococcal vaccine. One of the studies found that there was a slight increase in pneumococcal disease caused by non-vaccine serotypes. Another group of articles focused on serious bacterial infections in infants with fever who are positive for respiratory syncytial virus (RSV). All studies found a significant occurrence of urinary tract infections in these patients. One report found that bacteremia may occur in such patients if less than 28 days of age. Finally articles from Turkey, Thailand, and Italy give excellent discussions about the range of diagnoses and key clinical findings that may be seen in children with prolonged fever. SUMMARY: In the review period, there was a particular emphasis on invasive disease caused by S. pneumoniae and the impact of vaccination with conjugated pneumococcal vaccine, on the occurrence of serious bacterial infection in febrile infants with RSV infections, and on the broad spectrum of diagnoses in children with prolonged fever in varying geographic locales.

Bacteremia↗

PubMed2003

Prediction of resource use during acute pediatric illnesses.

BACKGROUND: Significant resources are used for acute illnesses in children. Identifying predictors of resource use can focus interventions to reduce this use. OBJECTIVE: To determine the relative effects of maternal, infant, social milieu, and demographic characteristics, the mother-child interaction, and perception of illness severity on the use of resources during acute illnesses in children. DESIGN: At the 2-week and 6-, 15-, and 24-month well-child care visits of a cohort of mother-infant dyads, the mother-well-child interaction was assessed by using the Biringen Emotional Availability Scales, and data were gathered regarding maternal depression and sense of competence, infant temperament, maternal social support, the home environment, and demographic characteristics. At each of the cohort's 1983 ill-child care visits during 30 months of follow-up, the mother-ill-child interaction was assessed by using the Emotional Availability Scales, and mothers and pediatricians independently assessed illness severity using the Acute Illness Observation Scales. Resources used during the illnesses-over-the-counter and prescription medications, tests, hospitalizations, follow-up visits, and the emergency department-were assessed. SETTING: A hospital primary care center and an urban and a suburban private practice. Patients Between February 1, 1995, and March 30, 1998, a consecutive sample of 380 dyads were asked to enroll at the 2-week well-child care visit; 316 (83.2%) consented, and complete data were available for analysis of 243 dyads. MAIN OUTCOME MEASURES: A path analytic framework using a structural equation model assessed the presence and strength of predictive relationships between demographic, maternal, infant, and social milieu data, the Biringen Emotional Availability Scales, and the Acute Illness Observation Scales and the main outcome measure, resource use. RESULTS: Three variables predicted greater mean resource use during each acute illness episode: a less optimal mother-child interaction (beta = -.53), lower scores for parenting sense of competence (beta = -.26), and greater perception of illness severity by mothers (beta =.33). By using the coefficient of determination (R2), these 3 predictors account for 55% of the reliable variance in resource use during acute illnesses. CONCLUSION: The quality of the mother-child interaction, maternal sense of competence, and maternal assessment of severity of the illness are major predictors of resource use during acute pediatric illnesses, and should be important foci of interventions to reduce resource use.

Acute Disease↗