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Valenzise M, D’Amico F, La Barbera G, Cassone CM, Patafi S, Lombardo F, Aversa T, Wasniewska MG, Salzano G, Morace C. Retrospective Analysis of Fever in Pediatric Age: Our Experience over the Last 5 Years. CHILDREN (BASEL, SWITZERLAND) 2024; 11:539. [PMID: 38790534 PMCID: PMC11120056 DOI: 10.3390/children11050539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Fever is one of the most frequent symptoms highlighted during medical assistance. Due to this great impact, our study has the purpose of analyzing the demographic and laboratory characteristics of patients hospitalized in our center and identifying predictive markers to make the differential diagnosis between infectious and non-infectious fever. METHODS Our population included 220 children, collected from January 2017 to August 2022, hospitalized for continuous fever (4 days or more in duration with at least one temperature peak ≥37.5 °C) and excluded cases of discharge against medical advice and/or transfer to other operating units. Demographic (mean age at the time of admission, frequency of hospitalization, and mean days of hospitalization), laboratory, and instrumental variables were analyzed in order to find correlation with fever etiology. RESULTS Older age at the time of hospitalization, family history of periodic fever, fever lasting more than 8 days, and longer hospitalization are strongly associated with non-infectious fever, together with anemia, high platelet count, high CRP and ferritin, and hyponatremia at the time of admission. Paracetamol is the preferred antipyretic treatment. Echocardiogram has shown anomalies in patients with infectious fever, while ECG anomalies were detected in non-infectious fever. CONCLUSIONS Our data underline the importance of predictive markers, such as clinical and laboratory parameters, to differentiate infectious from non-infectious fevers, but further studies are necessary.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Federica D’Amico
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Giulia La Barbera
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Carlo Maria Cassone
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Silvia Patafi
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Fortunato Lombardo
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Tommaso Aversa
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Malgorzata Gabriela Wasniewska
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Giuseppina Salzano
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Carmela Morace
- Department of Clinical and Sperimental Medicine, University of Messina, 98121 Messina, Italy;
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2
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Cunico D, Rossi A, Verdesca M, Principi N, Esposito S. Pain Management in Children Admitted to the Emergency Room: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1178. [PMID: 37631093 PMCID: PMC10459115 DOI: 10.3390/ph16081178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Pain is a biopsychosocial experience characterized by sensory, physiological, cognitive, affective, and behavioral components. Both acute and chronic pain can have short and long-term negative effects. Unfortunately, pain treatment is often inadequate. Guidelines and recommendations for a rational approach to pediatric pain frequently differ, and this may be one of the most important reasons for the poor attention frequently paid to pain treatment in children. This narrative review discusses the present knowledge in this regard. A literature review conducted on papers produced over the last 8 years showed that although in recent years, compared to the past, much progress has been made in the treatment of pain in the context of the pediatric emergency room, there is still a lot to do. There is a need to create guidelines that outline standardized and easy-to-follow pathways for pain recognition and management, which are also flexible enough to take into account differences in different contexts both in terms of drug availability and education of staff as well as of the different complexities of patients. It is essential to guarantee an approach to pain that is as uniform as possible among the pediatric population that limits, as much as possible, the inequalities related to ethnicity and language barriers.
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Affiliation(s)
- Daniela Cunico
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | - Arianna Rossi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | - Matteo Verdesca
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
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3
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Patel DV, Barot RB, Cecil R, Phatak AG, Shinde MK, Patel AJ, Nimbalkar SM. Temperature Monitoring in Children: An Agreement Study. JOURNAL OF NEONATOLOGY 2023; 37:134-141. [DOI: 10.1177/09732179231164527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Background: Noncontact infrared thermometer (NCIT) measures temperature rapidly and noninvasively. It is commonly used at forehead, but other potential sites such as axilla and abdomen are yet to be explored. We assessed agreement of temperature recordings of axillary temperature by glass mercury thermometer (the “gold standard”) with axillary temperature by the digital thermometer as well as with NCIT at forehead, axilla, mid abdomen, and at right hypochondriac areas. Methods: Neonates and children below 5 years admitted in neonatal and pediatrics wards were enrolled in the study through convenience sampling. For each participant, temperature was measured using NCIT at forehead, mid abdomen, right hypochondrium, and right axilla as well as using digital thermometer at right axilla and using glass mercury thermometer at right axilla. The agreement between methods was presented as mean difference (95% limits of agreement) using Bland-Altman analysis. Results: Total 400 temperature readings were taken for each method from 132 participants. There was a good agreement between mercury axillary with digital axillary in both the groups, that is, neonates and children (>1 month to 5 years) (Mean difference [95% limits of agreement] = –0.046 [–0.26 to 0.169]°C and –0.028 [–0.183 to 0.128]°C, respectively). While for all the methods using NCIT, there was a poor agreement with mercury axillary temperature in both the groups. Conclusion: Agreement between axillary temperatures using digital and glass mercury thermometers was good, while agreements between the axillary temperature using glass mercury thermometer with NCIT readings at different sites were poor in neonates and children below 5 years.
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Affiliation(s)
- Dipen V. Patel
- Department of Neonatology, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Rushi B. Barot
- Department of Pediatrics, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Rashmin Cecil
- Department of Pediatrics, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Ajay G. Phatak
- Central Research Services, Shree Krishna Hospital, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Mayur K. Shinde
- Central Research Services, Shree Krishna Hospital, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Arya J. Patel
- Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Somashekhar M. Nimbalkar
- Department of Neonatology, Bhaikaka University, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
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Faisantieu N, Kowalski V, Soulié B. [Benefits and risks of ibuprofen in children with fever: Overview of the literature with a view to producing a written information tool for parents]. Therapie 2020; 75:553-567. [PMID: 32571587 DOI: 10.1016/j.therap.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/02/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
Drug information, as it appears in package leaflet, lacks relevant encrypted data for the patient. The aim of our research was to propose a written model of drug information inspired from the concept of the "Drug Facts Box", about ibuprofen in children with fever. To this end, we carried out a systematic review of systematic literature reviews ("overview") to look for data on the benefits and risks of ibuprofen compared to placebo, paracetamol or a treatment alternating or combining paracetamol and ibuprofen in children with fever aged 0-18 years. 9 systematic reviews were included from the Pubmed/Medline, Embase and Cochrane databases. 1 clinical practice guideline and 2 documents published by the French Haute Autorité de santé (HAS) and the French Agence nationale de sécurité du médicament et des produits de santé (ANSM) were also included. Paracetamol and ibuprofen have a comparable efficacy and safety profile in children with fever. A low increased risk of adverse reactions to ibuprofen is to be feared in specifics clinical situations (chicken pox, pneumonia, angina). Treatments alternating or combining paracetamol and ibuprofen can further lower the temperature compared to paracetamol or ibuprofen alone, but there is no evidence of improved child comfort. The limited data available on the adverse effects of these treatment regimens suggests that they should not be routinely recommended. There is little evidence of the comfort of the febrile child even though it is the primary objective of antipyretic treatment.
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Affiliation(s)
| | | | - Benoît Soulié
- Cabinet de médecine générale, 8, rue des Cerisiers, 14210 Evrecy, France.
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5
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Alqudah M, Cowin L, George A, Johnson M. Child fever management: A comparative study of Australian parents with limited and functional health literacy. Nurs Health Sci 2018; 21:157-163. [PMID: 30328255 DOI: 10.1111/nhs.12574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 01/11/2023]
Abstract
Health literacy, or the ability to read and understand health information, is critical to the health of children. In this study, we compared the fever management knowledge of parents attending the emergency department with a child with fever. A cross-sectional survey of 33 parents/carers with limited health literacy and 122 with functional health literacy was undertaken. There were no differences in the overall proportion of correct responses to knowledge or management questions posed by the two scales between the two groups. Both groups presented with limited knowledge and poor practices (<60% correct in both scales) in relation to fever knowledge and management in their children. Although health literacy impacts health utilization, we did not find any differences in these groups. Inappropriate practices, such as when to give medications, were evident. Educational programs, responsive to health literacy, are urgently needed to address these information needs for parents. An assessment of parents' health literacy level can guide the selection of information that can be easily read, understood, and acted upon to deliver the best health outcomes for children.
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Affiliation(s)
- Muahammad Alqudah
- School of Nursing and Midwifery, The University of Newcastlee, Newcastle, New South Wales, Australia
| | - Leanne Cowin
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes, Research Translation and Evaluation, Western Sydney University, Sydney, New South Wales, Australia.,South Western Sydney Local Health District, Sydney, New South Wales, Australia.,School of Dentistry, University of Sydney, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
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6
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Bertille N, Purssell E, Hjelm N, Bilenko N, Chiappini E, de Bont EGPM, Kramer MS, Lepage P, Lava SAG, Mintegi S, Sullivan JE, Walsh A, Cohen JF, Chalumeau M. Symptomatic Management of Febrile Illnesses in Children: A Systematic Review and Meta-Analysis of Parents' Knowledge and Behaviors and Their Evolution Over Time. Front Pediatr 2018; 6:279. [PMID: 30345264 PMCID: PMC6183237 DOI: 10.3389/fped.2018.00279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/13/2018] [Indexed: 01/22/2023] Open
Abstract
Recommendations to guide parents' symptomatic management of febrile illnesses in children have been published in many countries. The lack of systematic appraisal of parents' knowledge and behaviors and their evolution over time precludes an analysis of their impact and identification of targets for future educational messages. We systematically searched for studies published between 1980 and 2016 that reported a quantitative evaluation of knowledge and behaviors of >50 parents for managing fever in children. We used MEDLINE and tracked related articles, citations and co-authors personal files. Study selection and data extraction were independently performed by two reviewers. For each item of knowledge and behaviors, we calculated mean frequencies during the first and last quinquennials of the studied period and assessed temporal trends with inverse-variance weighted linear regression of frequencies over years. We observed substantial methodological heterogeneity among the 62 included articles (64 primary studies, 36,791 participants, 30 countries) that met inclusion criteria. Statistically significant changes over time were found in the use of rectal (98 to 4%) and axillary temperature measurement (1-19%), encouraging fluid intake (19-62%), and use of acetylsalicylic acid (60 to 1%). No statistically significant change was observed for the accurate definition of fever (38-55%), or the use of acetaminophen (91-92%) or ibuprofen (20-43%). Parents' knowledge and behaviors have changed over time but continue to show poor concordance with recommendations. Our study identified future targets for educational messages, including basic ones such as the definition of fever.
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Affiliation(s)
- Nathalie Bertille
- Inserm U1153 Équipe de Recherche en Épidémiologie Obstétricale, Périnatale et Pédiatrique, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker-Enfants malades, AP-HP, Université Paris Descartes, Paris, France
| | - Edward Purssell
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Nils Hjelm
- Inserm U1153 Équipe de Recherche en Épidémiologie Obstétricale, Périnatale et Pédiatrique, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Natalya Bilenko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Elena Chiappini
- Department of Health Science, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Eefje G P M de Bont
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Philippe Lepage
- Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Sebastiano A G Lava
- University Children's Hospital Bern-University of Bern, Bern, Switzerland.,Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain.,Biocruces Health Research Institute, University of the Basque Country, Bilbao, Spain
| | - Janice E Sullivan
- Department of Pediatrics, University of Louisville, Louisville, KY, United States
| | - Anne Walsh
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jérémie F Cohen
- Inserm U1153 Équipe de Recherche en Épidémiologie Obstétricale, Périnatale et Pédiatrique, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker-Enfants malades, AP-HP, Université Paris Descartes, Paris, France
| | - Martin Chalumeau
- Inserm U1153 Équipe de Recherche en Épidémiologie Obstétricale, Périnatale et Pédiatrique, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker-Enfants malades, AP-HP, Université Paris Descartes, Paris, France
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Pérez-Conesa MC, Sánchez Pina I, Ridao Manonellas S, Tormo Esparza A, García Hernando V, López Fernández M. Análisis de los cuidados y los conocimientos parentales sobre la fiebre en la infancia. Aten Primaria 2017; 49:484-491. [PMID: 28292580 PMCID: PMC6875997 DOI: 10.1016/j.aprim.2016.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 11/24/2022] Open
Abstract
Objetivo Describir los conocimientos y los cuidados parentales de la fiebre en niños menores de 2 años y relacionarlos con características sociodemográficas. Diseño Estudio descriptivo transversal de correlación multicéntrico. Emplazamiento Realizado en 5 equipos de atención primaria de Barcelona. Participantes Padres, madres o tutores legales de niños menores de 2 años que acuden para la administración de una vacuna incluida en el calendario sistemático. Participaron un total de 311 sujetos. Mediciones principales Las variables principales son 9 ítems de conocimientos y 8 de cuidados o manejo de la fiebre obtenidos con la adaptación del cuestionario de Chiappini et al. (2012). Resultados El 69,8% tienen un manejo/cuidado correcto de la fiebre. Un 3,9% acertaron todos los ítems de conocimientos. La puntuación de conocimientos es menor en personas sin estudios (p = 0,03), mayor en europeos y sudamericanos y menor en Asia y África (p < 0,001). El 100% de los pacientes crónicos tuvieron todos los ítems de cuidado/manejo correctos (p = 0,03). Se observa que la correlación entre las puntuaciones de conocimiento y manejo es positiva (rho = 0,15, p = 0,008). Conclusiones Se observan unos cuidados correctos de la fiebre a pesar de la falta de conocimientos. Una buena estrategia para fomentar el adecuado manejo del niño febril es dar información actualizada y adaptada a los padres, incidiendo en los grupos étnicos que parecen tener creencias inexactas sobre la fiebre.
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8
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Verrotti A, Ambrosi M, Pavone P, Striano P. Pediatric status epilepticus: improved management with new drug therapies? Expert Opin Pharmacother 2017; 18:789-798. [PMID: 28481700 DOI: 10.1080/14656566.2017.1323873] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
| | - Michela Ambrosi
- Department of Pediatrics, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
| | - Piero Pavone
- Acute and Emergency Paediatric and General Paediatric Operative Unit, Policlinico Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, DINOGMI-Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, “G. Gaslini” Institute, Genova, Italy
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Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology 2017; 25:1-9. [PMID: 28063133 PMCID: PMC5306275 DOI: 10.1007/s10787-016-0302-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022]
Abstract
The antipyretic analgesics, paracetamol, and non-steroidal anti-inflammatory agents NSAIDs are one of the most widely used classes of medications in children. The aim of this review is to determine if there are any clinically relevant differences in safety between ibuprofen and paracetamol that may recommend one agent over the other in the management of fever and discomfort in children older than 3 months of age.
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10
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Chiappini E, Venturini E, Remaschi G, Principi N, Longhi R, Tovo PA, Becherucci P, Bonsignori F, Esposito S, Festini F, Galli L, Lucchesi B, Mugelli A, Marseglia GL, de Martino M. 2016 Update of the Italian Pediatric Society Guidelines for Management of Fever in Children. J Pediatr 2017; 180:177-183.e1. [PMID: 27810155 DOI: 10.1016/j.jpeds.2016.09.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/29/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review new scientific evidence to update the Italian guidelines for managing fever in children as drafted by the panel of the Italian Pediatric Society. STUDY DESIGN Relevant publications in English and Italian were identified through search of MEDLINE and the Cochrane Database of Systematic Reviews from May 2012 to November 2015. RESULTS Previous recommendations are substantially reaffirmed. Antipyretics should be administered with the purpose to control the child's discomfort. Antipyretics should be administered orally; rectal administration is discouraged except in the setting of vomiting. Combined use of paracetamol and ibuprofen is discouraged, considering risk and benefit. Antipyretics are not recommended preemptively to reduce the incidence of fever and local reactions in children undergoing vaccination, or in attempt to prevent febrile convulsions in children. Ibuprofen and paracetamol are not contraindicated in children who are febrile with asthma, with the exception of known cases of paracetamol- or nonsteroidal anti-inflammatory drug-induced asthma. CONCLUSIONS Recent medical literature leads to reaffirmation of previous recommendations for use of antipyretics in children who are febrile.
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Affiliation(s)
- Elena Chiappini
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
| | - Elisabetta Venturini
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Giulia Remaschi
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Nicola Principi
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Riccardo Longhi
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Pier-Angelo Tovo
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Paolo Becherucci
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Francesca Bonsignori
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Susanna Esposito
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Filippo Festini
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Bice Lucchesi
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alessandro Mugelli
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Gian Luigi Marseglia
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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- Department of Science Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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11
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Vlcek C, Rack-Hoch A, von Both U, Jansson A. [Fever in infants: investigating the source]. MMW Fortschr Med 2016; 158:58-66. [PMID: 27646382 DOI: 10.1007/s15006-016-8229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Christine Vlcek
- Dr. von Haunersches Kinderspital, Klinikum der Universität München, Lindwurmstr. 4, D-80337, München, Deutschland.
| | - Anita Rack-Hoch
- Dr. von Haunersches Kinderspital, Klinikum der Universität München, Lindwurmstr. 4, D-80337, München, Deutschland
| | - Ulrich von Both
- Dr. von Haunersches Kinderspital, Klinikum der Universität München, Lindwurmstr. 4, D-80337, München, Deutschland
| | - Annette Jansson
- Dr. von Haunersches Kinderspital, Klinikum der Universität München, Lindwurmstr. 4, D-80337, München, Deutschland
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Bertille N, Fournier-Charrière E, Pons G, Khoshnood B, Chalumeau M. Enduring large use of acetaminophen suppositories for fever management in children: a national survey of French parents and healthcare professionals' practices. Eur J Pediatr 2016; 175:987-92. [PMID: 27193104 DOI: 10.1007/s00431-016-2732-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED The pharmacological specificities of the rectal formulation of acetaminophen led to a debate on its appropriateness for managing fever in children, but few data are available on the formulation's current use and determinants of use. In a national cross-sectional study between 2007 and 2008, healthcare professionals were asked to include five consecutive patients with acute fever. Among the 6255 children (mean age 4.0 years ± 2.8 SD) who received acetaminophen given by parents or prescribed/recommended by healthcare professionals, determinants of suppository use were studied by multilevel models. A suppository was given by 27 % of parents and prescribed/recommended by 19 % of healthcare professionals, by 24 and 16 %, respectively, for children 2 to 5 years old, and by 13 and 8 %, respectively, for those 6 to 12 years old. Among children who received suppositories from parents and healthcare professionals, 83 and 84 %, respectively, did not vomit. Suppository use was independently associated with several patient- and healthcare professional-level characteristics: young age of children, presence of vomiting, or lack of diarrhea. CONCLUSION We report an enduring large use of suppositories in France for the symptomatic management of fever in children, including in non-vomiting and/or older children. The rational for such use should be questioned. WHAT IS KNOWN • The pharmacological specificities of the rectal formulation of acetaminophen have led to a debate on its appropriateness for managing fever in children. Few data are available on the formulation's current use and determinants of the use. What is New: • In a national cross-sectional study, we observed a large use of suppositories in France for symptomatic management of fever in children. Suppositories were frequently used for the youngest children but also for older and/or non-vomiting children.
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Affiliation(s)
- Nathalie Bertille
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, IFD, Paris, France. .,Department of General Pediatrics, Hôpital Necker-Enfants malades, Assistance publique - Hôpitaux de Paris (AP-HP), Paris-Descartes University, Paris, France.
| | | | - Gérard Pons
- Clinical Pharmacology, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris-Descartes University, Paris, France.,Inserm U663 Pediatric epilepsies and brain plasticity, Paris, France
| | - Babak Khoshnood
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France
| | - Martin Chalumeau
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France.,Department of General Pediatrics, Hôpital Necker-Enfants malades, Assistance publique - Hôpitaux de Paris (AP-HP), Paris-Descartes University, Paris, France
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Fever and Pain Management in Childhood: Healthcare Providers' and Parents' Adherence to Current Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050499. [PMID: 27187436 PMCID: PMC4881124 DOI: 10.3390/ijerph13050499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/17/2016] [Accepted: 05/09/2016] [Indexed: 01/16/2023]
Abstract
In order to evaluate the adherence of healthcare providers and parents to the current recommendations concerning fever and pain management, randomized samples of 500 healthcare providers caring for children and 500 families were asked to complete an anonymous questionnaire. The 378 health care providers (HCPs) responding to the survey (75.6%) included 144 primary care pediatricians (38.1%), 98 hospital pediatricians (25.9%), 62 pediatric residents (16.4%), and 71 pediatric nurses (19.6%); the 464 responding parents (92.8%) included 175 whose youngest (or only) child was ≤5 years old (37.7%), 175 whose youngest (or only) child was aged 6–10 years (37.7%), and 114 whose youngest (or only) child was aged 11–14 years (24.6%). There were gaps in the knowledge of both healthcare providers and parents. Global adherence to the guidelines was lower among the pediatric nurses than the other healthcare providers (odds ratio 0.875; 95% confidence interval 0.795–0.964). Among the parents, those of children aged 6–10 and 11–14 years old, those who were older, and those without a degree answered the questions correctly significantly less frequently than the others. These findings suggest that there is an urgent need to improve the dissemination of the current recommendations concerning fever and pain management among healthcare providers and parents in order to avoid mistaken and sometimes risky attitudes, common therapeutic errors, and the unnecessary overloading of emergency department resources. Pediatric nurses and parents with older children, those who are older, and those with a lower educational level should be the priority targets of educational programmes.
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Sollai S, Dani C, Berti E, Fancelli C, Galli L, de Martino M, Chiappini E. Performance of a non-contact infrared thermometer in healthy newborns. BMJ Open 2016; 6:e008695. [PMID: 26983944 PMCID: PMC4800130 DOI: 10.1136/bmjopen-2015-008695] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the performance of a non-contact infrared thermometer (NCIT) in comparison with digital axillary thermometer (DAT) and infrared tympanic thermometers (ITT) in a population of healthy at term and preterm newborns nursed in incubators. SETTING 1 level III maternity hospital, and its intensive neonatal care unit. PARTICIPANTS 119 healthy at term newborns and 70 preterm newborns nursed in incubators were consecutively enrolled. Exclusion criteria were unstable/critical conditions, polymalformative congenital syndromes and severe congenital syndromes. INTERVENTIONS Body temperature readings were prospectively collected. Each participant underwent bilateral axillary temperature measurement with DAT, bilateral tympanic measurement with ITT and mid-forehead temperature measurements using NCIT. PRIMARY OUTCOME MEASURES Degree of agreement between methods was evaluated by the Bland and Altman method. RESULTS 714 measurements in 119 healthy at term newborns and 420 measurements in 70 preterm newborns nursed in incubators were performed. Clinical reproducibility of NCIT was 0.0455 °C for infants in incubators and 0.0861 °C for infants outside an incubator. Bias was 0.029 °C for infants in incubators and <0.0001 °C for infants outside an incubator. Zero outliers were recorded. The mean difference between methods was good both for newborns at term (0.12 °C for NCIT vs DAT and 0.02 °C for NCIT vs ITT) and preterm newborns in incubators (0.10 °C for NCIT vs DAT and 0.14 °C for NCIT vs ITT). Limits of agreement were 0.99 to -0.75 and 0.78 to -0.75 in at term newborns and were particularly satisfactory in preterm newborns in incubators (95% CI: 0.48 to -0.27 and 0.68 to -0.40). CONCLUSIONS Our results with Bland and Altman analysis demonstrate that NCIT is a very promising tool, especially in preterm newborns nursed in incubators. TRIAL REGISTRATION The study was approved by the Careggi University Hospital Ethics Committee (07/2011).
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Affiliation(s)
- Sara Sollai
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Carlo Dani
- Department of Neuroscience, Psychology, Drug Research and Child Health, Careggi University Hospital, Florence, Italy
| | - Elettra Berti
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Claudia Fancelli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta-analysis. Ann Intern Med 2015; 163:768-77. [PMID: 26571241 DOI: 10.7326/m15-1150] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Body temperature is commonly used to screen patients for infectious diseases, establish diagnoses, monitor therapy, and guide management decisions. PURPOSE To determine the accuracy of peripheral thermometers for estimating core body temperature in adults and children. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL Plus from inception to July 2015. STUDY SELECTION Prospective studies comparing the accuracy of peripheral (tympanic membrane, temporal artery, axillary, or oral) thermometers with central (pulmonary artery catheter, urinary bladder, esophageal, or rectal) thermometers. DATA EXTRACTION 2 reviewers extracted data on study characteristics, methods, and outcomes and assessed the quality of individual studies. DATA SYNTHESIS 75 studies (8682 patients) were included. Most studies were at high or unclear risk of patient selection bias (74%) or index test bias (67%). Compared with central thermometers, peripheral thermometers had pooled 95% limits of agreement (random-effects meta-analysis) outside the predefined clinically acceptable range (± 0.5 °C), especially among patients with fever (-1.44 °C to 1.46 °C for adults; -1.49 °C to 0.43 °C for children) and hypothermia (-2.07 °C to 1.90 °C for adults; no data for children). For detection of fever (bivariate random-effects meta-analysis), sensitivity was low (64% [95% CI, 55% to 72%]; I2 = 95.7%; P < 0.001) but specificity was high (96% [CI, 93% to 97%]; I2 = 96.3%; P < 0.001). Only 1 study reported sensitivity and specificity for the detection of hypothermia. LIMITATIONS High-quality data for some temperature measurement techniques are limited. Pooled data are associated with interstudy heterogeneity that is not fully explained by stratified and metaregression analyses. CONCLUSION Peripheral thermometers do not have clinically acceptable accuracy and should not be used when accurate measurement of body temperature will influence clinical decisions. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Daniel J. Niven
- From Peter Lougheed Centre, Foothills Medical Centre, and University of Calgary, Calgary, Alberta; and Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Jonathan E. Gaudet
- From Peter Lougheed Centre, Foothills Medical Centre, and University of Calgary, Calgary, Alberta; and Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Kevin B. Laupland
- From Peter Lougheed Centre, Foothills Medical Centre, and University of Calgary, Calgary, Alberta; and Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Kelly J. Mrklas
- From Peter Lougheed Centre, Foothills Medical Centre, and University of Calgary, Calgary, Alberta; and Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Derek J. Roberts
- From Peter Lougheed Centre, Foothills Medical Centre, and University of Calgary, Calgary, Alberta; and Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Henry Thomas Stelfox
- From Peter Lougheed Centre, Foothills Medical Centre, and University of Calgary, Calgary, Alberta; and Royal Inland Hospital, Kamloops, British Columbia, Canada
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Abstract
Fever is a common symptom of childhood infections that in itself does not require treatment. The UK’s National Institute for Health and Care Excellence (NICE) advises home-based antipyretic treatment for low-risk feverish children only if the child appears distressed. The recommended antipyretics are ibuprofen or paracetamol (acetaminophen). They are equally recommended for the distressed, feverish child; therefore, healthcare professionals, parents and caregivers need to decide which of these agents to administer if the child is distressed. This narrative literature review examines recent data on ibuprofen and paracetamol in feverish children to determine any clinically relevant differences between these agents. The data suggest that these agents have similar safety profiles in this setting and in the absence of underlying health issues, ibuprofen seems to be more effective than paracetamol at reducing NICE’s treatment criterion, ‘distress’ (as assessed by discomfort levels, symptom relief, and general behavior).
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Affiliation(s)
- Dipak Kanabar
- Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK,
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17
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Sun Jeong Y, Sun Kim J. Childhood fever management program for Korean pediatric nurses: A comparison between blended and face-to-face learning method. Contemp Nurse 2015. [DOI: 10.1080/10376178.2014.11081951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Has the use of antipyretics been modified after the introduction of different concentrations of ibuprofen into the market? An Pediatr (Barc) 2014. [DOI: 10.1016/j.anpede.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Marchisio P, Tagliabue M, Klersy C, Mira E, Pagella F, Baggi E, Fattizzo M, Esposito S, Principi N. Patterns in acute otitis media drug prescriptions: a survey of Italian pediatricians and otolaryngologists. Expert Rev Anti Infect Ther 2014; 12:1159-63. [PMID: 25075863 DOI: 10.1586/14787210.2014.944503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate whether physicians follow current guidelines for managing acute otitis media (AOM) and whether educational programs are needed to improve knowledge of AOM treatment among paediatricians (PEDs) and otolaryngologists (ENTs) Methods: A total of 1270 PEDs and 852 ENTs were randomly selected and interviewed with an anonymous questionnaire about how they managed AOM. RESULTS Inappropriate AOM approaches were identified among 60.2% of PEDs and 88.5% of ENTs (p < 0.001). Amoxicillin and amoxicillin with clavulanic acid were appropriately chosen as first-line drugs by the majority of PEDs and ENTs, although significantly more ENTs reported otherwise (15.8% PEDs vs 25.5% ENTs; p < 0.001). ENTs were significantly more likely than PEDs to report prescribing decongestants, mucolytics, anti-inflammatory drugs, and steroids (p < 0.001). CONCLUSION These results show that AOM prescriptions for antibiotics and adjunctive treatments are often inappropriate and highlight the need for educational strategies aimed at PEDs and ENTs to improve their compliance with evidence-based guidelines for AOM treatment.
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Affiliation(s)
- Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Niehues T. The febrile child: diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 110:764-73; quiz 774. [PMID: 24290365 DOI: 10.3238/arztebl.2013.0764] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 09/10/2013] [Accepted: 09/10/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fever accounts for 70% of all consultations with pediatricians and family physicians. Fever without an identifiable cause (<7 days' duration) and fever of unknown origin (FUO, ≥ 7 days' duration) are particularly challenging clinical situations. METHOD This article is based on a selective literature search for publications containing the term "pediatric fever management," with special attention to meta-analyses and systematic reviews. RESULTS The mainstay of diagnosis is physical examination by a physician who is experienced in the care of children and adolescents. The frequency of severe bacterial infection (SBI) is about 10% in neonates, 5% in babies aged up to 3 months, and 0.5% to 1% in older infants and toddlers. The mortality of SBI in neonates is about 10%. Both the degree of the parents' and the physician's concern are important warning signs for SBI. Clinical signs of SBI include cyanosis, tachypnea, poor peripheral perfusion, petechiae, and a rectal temperature above 40°C. Antipyretic drugs should only be used in special, selected situations. More than 40% of cases of FUO are due to infection; in more than 30% of cases, the cause is never determined. CONCLUSION Aspects of central importance include the repeated physical examination of the patient, and parent counseling and education of medical and nursing staff pertaining to the warning signs for SBI. Research is needed in the areas of diagnostic testing and the development of new vaccines.
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Affiliation(s)
- Tim Niehues
- Centre for Pediatric and Adolescent Medicine, HELIOS Klinikum Krefeld
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21
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[Has the use of antipyretics been modified after the introduction of different concentrations of ibuprofen into the market?]. An Pediatr (Barc) 2014; 81:383-8. [PMID: 24629903 DOI: 10.1016/j.anpedi.2014.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 01/21/2014] [Accepted: 01/24/2014] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Due to the emergence of new pharmaceutical presentations of ibuprofen (40 mg/ml), an analysis was made on the use of antipyretics in pediatric outpatient in Spain. PATIENTS AND METHODS A cross-sectional, observational, descriptive study was carried out on a sample of children under 14 years old with treated febrile syndrome, seen in the Emergency Room of the Hospital General Universitario de Valencia from November 2012 to January 2013. RESULTS Of the 217 children included, 144 were treated with paracetamol or ibuprofen, 69 received both drugs, and one received paracetamol and metamizol. There were 58.7% of exposures to paracetamol and 40.9% to ibuprofen. The parents decided the use of antipyretics in 63.2% of cases. In 98 exposures the dose was different from that authorized in the labeling of the drug (off-label use). Ibuprofen was used off-label in 40.2% of cases, mostly by underdosing (35.9%). Paracetamol was used off-label in 29.8% of cases, predominantly overdose (26.8%), with the difference being statistically significant. No significant differences were observed in the off-label use in either monotherapy or combined use. There were also no differences when antipyretics prescribed by doctors or given directly by parents were evaluated separately. CONCLUSIONS The majority of children with treated febrile syndrome seen in the Emergency Room were receiving antipyretic drugs after a parental decision. Paracetamol is the most commonly used drug and one in three children received it simultaneously with ibuprofen. The antipyretics were used off label in one-third of the cases. Off label use of ibuprofen is increasing, and is probably due to the existence of different pharmaceutical presentations.
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Teller J, Ragazzi M, Simonetti GD, Lava SAG. Accuracy of tympanic and forehead thermometers in private paediatric practice. Acta Paediatr 2014; 103:e80-3. [PMID: 24127699 DOI: 10.1111/apa.12464] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/07/2013] [Accepted: 10/10/2013] [Indexed: 01/16/2023]
Abstract
AIM To compare infrared tympanic and infrared contact forehead thermometer measurements with traditional rectal digital thermometers. METHODS A total of 254 children (137 girls) aged one to 24 months (median 7 months) consulting a private paediatric practice because of fever were prospectively recruited. Body temperature was measured using the three different devices. RESULTS The median and interquartile range for rectal, tympanic and forehead thermometers were 37.6 (37.1-38.4)°C, 37.5 (37.0-38.1)°C and 37.5 (37.1-37.9)°C, respectively (p < 0.01). The limits of agreement in the Bland-Altman plots were -0.73 to +1.04°C for the tympanic thermometer and -1.18 to +1.64°C for the forehead thermometer. The specificity of both the tympanic and forehead thermometers for detecting fever above 38°C was good, but sensitivity was low. Forehead measurements were susceptible to the use of a radiant warmer. CONCLUSION Both the tympanic and forehead devices recorded lower temperatures than the rectal thermometers. The limits of agreement were particularly wide for the forehead thermometer and considerable for the tympanic thermometer. In the absence of valid alternatives, because of the ease to use and little degree of discomfort, tympanic thermometers can still be used with some reservations. Forehead thermometers should not be used in paediatric practice.
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Affiliation(s)
- J Teller
- Private Paediatric Practice; Langnau i.E Switzerland
| | - M Ragazzi
- Division of Paediatric Nephrology; University Children's Hospital Bern; University of Bern; Bern Switzerland
| | - GD Simonetti
- Division of Paediatric Nephrology; University Children's Hospital Bern; University of Bern; Bern Switzerland
| | - SAG Lava
- Division of Paediatric Nephrology; University Children's Hospital Bern; University of Bern; Bern Switzerland
- Department of Paediatrics; Ospedale Regionale Bellinzona e Valli; Bellinzona and University of Bern; Bern Switzerland
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Bertille N, Fournier-Charrière E, Pons G, Chalumeau M. Managing fever in children: a national survey of parents' knowledge and practices in France. PLoS One 2013; 8:e83469. [PMID: 24391772 PMCID: PMC3877061 DOI: 10.1371/journal.pone.0083469] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/03/2013] [Indexed: 01/18/2023] Open
Abstract
Introduction Identifying targets to improve parental practices for managing fever in children is the first step to reducing the overloaded healthcare system related to this common symptom. We aimed to study parents' knowledge and practices and their determinants in managing fever symptoms in children in France as compared with current recommendations. Methods We conducted an observational national study between 2007 and 2008 of French general practitioners, primary care pediatricians and pharmacists. These healthcare professionals (HPs) were asked to include 5 consecutive patients from 1 month to 12 years old with fever for up to 48 hr who were accompanied by a family member. Parents completed a questionnaire about their knowledge of fever in children and their attitudes about the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables. Results In all, 1,534 HPs (participation rate 13%) included 6,596 children. Parental concordance with current recommendations for temperature measurement methods, the threshold for defining fever, and physical (oral hydration, undressing, room temperature) and drug treatment was 89%, 61%, 15%, and 23%, respectively. Multivariate multi-level analyses revealed a significant HP effect. In general, high concordance with recommendations was associated with high educational level of parents and the HP consulted being a pediatrician. Conclusions In France, parents' knowledge and practices related to managing fever symptoms in children frequently differ from recommendations. Targeted health education interventions are needed to effectively manage fever symptoms in children.
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Affiliation(s)
- Nathalie Bertille
- Inserm U953 Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Paris, France ; Paris-Descartes University, Paris, France ; Department of Paediatrics, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | | | - Gérard Pons
- Paris-Descartes University, Paris, France ; Clinical Pharmacology, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France ; Inserm U663 Pediatric epilepsies and brain plasticity, Paris, Bicêtre, France
| | - Martin Chalumeau
- Inserm U953 Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Paris, France ; Paris-Descartes University, Paris, France ; Department of Paediatrics, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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Valkhoff VE, Schade R, 't Jong GW, Romio S, Schuemie MJ, Arfe A, Garbe E, Herings R, Lucchi S, Picelli G, Schink T, Straatman H, Villa M, Kuipers EJ, Sturkenboom MCJM. Population-based analysis of non-steroidal anti-inflammatory drug use among children in four European countries in the SOS project: what size of data platforms and which study designs do we need to assess safety issues? BMC Pediatr 2013; 13:192. [PMID: 24252465 PMCID: PMC4225575 DOI: 10.1186/1471-2431-13-192] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 11/14/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Data on utilization patterns and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in children are scarce. The purpose of this study was to investigate the utilization of NSAIDs among children in four European countries as part of the Safety Of non-Steroidal anti-inflammatory drugs (SOS) project. METHODS We used longitudinal patient data from seven databases (GePaRD, IPCI, OSSIFF, Pedianet, PHARMO, SISR, and THIN) to calculate prevalence rates of NSAID use among children (0-18 years of age) from Germany, Italy, Netherlands, and United Kingdom. All databases contained a representative population sample and recorded demographics, diagnoses, and drug prescriptions. Prevalence rates of NSAID use were stratified by age, sex, and calendar time. The person-time of NSAID exposure was calculated by using the duration of the prescription supply. We calculated incidence rates for serious adverse events of interest. For these adverse events of interest, sample size calculations were conducted (alpha = 0.05; 1-beta = 0.8) to determine the amount of NSAID exposure time that would be required for safety studies in children. RESULTS The source population comprised 7.7 million children with a total of 29.6 million person-years of observation. Of those, 1.3 million children were exposed to at least one of 45 NSAIDs during observation time. Overall prevalence rates of NSAID use in children differed across countries, ranging from 4.4 (Italy) to 197 (Germany) per 1000 person-years in 2007. For Germany, United Kingdom, and Italian pediatricians, we observed high rates of NSAID use among children aged one to four years. For all four countries, NSAID use increased with older age categories for children older than 11. In this analysis, only for ibuprofen (the most frequently used NSAID), enough exposure was available to detect a weak association (relative risk of 2) between exposure and asthma exacerbation (the most common serious adverse event of interest). CONCLUSIONS Patterns of NSAID use in children were heterogeneous across four European countries. The SOS project platform captures data on more than 1.3 million children who were exposed to NSAIDs. Even larger data platforms and the use of advanced versions of case-only study designs may be needed to conclusively assess the safety of these drugs in children.
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Affiliation(s)
- Vera E Valkhoff
- Department of Medical Informatics, Erasmus University Medical Center, Dr, Molewaterplein, Rotterdam, The Netherlands.
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Bettinelli A, Provero MC, Cogliati F, Villella A, Marinoni M, Saettini F, Bianchetti MG, Nespoli L, Galluzzo C, Lava SAG. Symptomatic fever management among 3 different groups of pediatricians in Northern Lombardy (Italy): results of an explorative cross-sectional survey. Ital J Pediatr 2013; 39:51. [PMID: 24004953 PMCID: PMC3844467 DOI: 10.1186/1824-7288-39-51] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/27/2013] [Indexed: 01/09/2023] Open
Abstract
Background In the care of feverish children, symptomatic management is pivotal. Thus, the Italian Pediatric Society has recently published guidelines on fever management in children. Our aim was to investigate whether pediatric hospitalists, community pediatricians and pediatric residents differ in their every-day clinical practice with respect to symptomatic management of feverish children. Methods 79 out of 118 physicians involved in pediatric care in an area of Northern Lombardy (Italy) filled in a modified version of the questionnaire derived from the Swiss national survey on symptomatic fever management. Results Pediatric hospitalists (N = 29), community pediatricians (N = 30) and pediatric residents (N = 20) did not differ with respect to temperature threshold for symptomatic fever treatment, role of general appearance in modulating the threshold for fever management, first choice antipyretic drug, frequency of ibuprofen prescription, prescription of physical antipyresis, influence of exaggerated fear of fever on its management and potential to reassure families about this fear. On the other side, some significant differences were found. Pediatric residents more frequently lower the treatment threshold in children with a past history of febrile seizures (P < 0.001) and prescribe an aggressive treatment for fever not responding to the first antipyretic drug (P < 0.01) than their more experienced colleagues. Community pediatricians represent the unique investigated group using homeopathic remedies, both in the acute setting (P < 0.001) as well as a prophylaxis (P < 0.0001). Finally, paediatric residents less often (P < 0.05) stated to encounter exaggerated fear of fever among parents than their more experienced colleagues. Conclusions The present explorative inquiry globally shows limited discordance among pediatric residents, community pediatricians and pediatric hospitalists with respect to symptomatic fever management.
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Current World Literature. Curr Opin Allergy Clin Immunol 2013. [DOI: 10.1097/aci.0b013e3283619e49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Intricacies of body temperature measurement. Indian J Pediatr 2013; 80:249-51. [PMID: 23436193 DOI: 10.1007/s12098-013-0988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
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