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Abstract: Fever in newborns is most often associated with infection and the clinical presentation is atypical in the neonatal period, so early consultation for relevant investigations is needed to assist the diagnosis. The child in this paper presented to the hospital with an unexplained fever of up to 38.9°C. The family indicated that the child was mentally weak during the fever, but did not cough or vomit, and after a series of tests, he was diagnosed as having neonatal fever caused by urinary tract infection. After giving medication, the child’s body temperature returned to normal and the urinary tract infection was cured.
Basic information】Male, 19 days
Disease Type】Neonatal fever
Hospital】Fudan University Hospital of Pediatrics
Date of Consultation】September 2021
Treatment plan】Medication (ceftriaxone sodium, 5% glucose injection, cefixime granules)
Treatment period】7 days of hospitalization, followed by 3 days of outpatient treatment
Treatment effect] Temperature returned to normal, urinary tract infection cured
I. Initial consultation
The parents brought their 19-day-old newborn to the clinic. The family indicated that the child had an unexplained fever, up to 38.9℃, and was mentally weak during the fever, but did not cough or vomit. The blood count was 18.44×10^9/L and the percentage of neutrophils was 53.9%. Therefore, we considered that the fever was caused by acute infection and admitted the patient immediately.
II. Treatment
After admission, blood culture was done for the infectious agent of the fever, and the result was negative, chest X-ray was not abnormal, but urine routine examination microscopic leukocyte 8-10/HP, which was initially determined to be a neonatal fever caused by urinary tract infection. Subsequently, an intravenous infusion of ceftriaxone sodium and 5% glucose injection was given clinically. On the third day of medication, the child’s temperature dropped. Since the clean urine culture result showed Escherichia coli infection after admission, the diagnosis of urinary tract infection causing neonatal fever was confirmed at this time, so the child was instructed to take ceftriaxone sodium for 7 days continuously.
III. Treatment effect
After the child was hospitalized and treated with medication, her body temperature dropped to normal on the third day, her mental status improved significantly, and her white blood cell indexes returned to normal in routine blood tests and disappeared in routine urine tests. At 7 days of hospitalization, the child’s condition was assessed to be stable, with normal milk intake, good mental status and good response, and was discharged. Parents were instructed to give oral cefixime pellets to the child after discharge and to follow up the child at the outpatient clinic three days later.
IV. Notes
We are glad that the cause of the fever was clarified through timely examination and the child’s condition improved with medication. When the child was discharged from the hospital, the family was instructed to continue to take cefixime pellets orally according to the doctor’s prescription, avoid stopping or decreasing the dosage at will, and follow up with the outpatient clinic in 3 days. They also advised the child to keep air circulation in the room during home time and to pay attention to the way of feeding to avoid choking and coughing. Families should pay special attention to the cleanliness of the child’s urethra, and ensure that the child has sufficient sleep, and try not to take the child to crowded places to avoid cross-infection.
V. Personal insight
In this case, although the clinical symptoms of fever were not obvious, the peripheral blood leukocytes were obviously abnormal, and the urine routine examination of leukocytes increased after admission, and then the clean urine culture found the pathogenic bacteria, so the diagnosis of urinary tract infection was clear. After aggressive drug treatment, the body temperature dropped rapidly and the urinary routine and blood routine indexes returned to normal, indicating that the treatment was effective.