The need for a second dose of ceftriaxone in febrile infants age 4-8 weeks.

OBJECTIVE: To determine if a second intramuscular injection of ceftriaxone was necessary in febrile infants who meet low-risk criteria for outpatient therapy. SETTING: Children's Hospital Emergency Department. PATIENTS: Febrile infants 4-8 weeks of age. METHODS: Outpatient treatment criteria included non-toxic appearance, no identifiable source for infection on physical examination, CSF WBC > or = 10/mm3, peripheral WBC < or = 15,000/mm3, normal UA, and normal chest radiograph study, if obtained. Additional requirements included a reliable caretaker and re-evaluation in 24 hours. Infants who met these criteria received intramuscular ceftriaxone 50 mg/kg with instructions to follow-up in 24 hours. At the follow-up visit, infants with no identifiable source for infection and negative cultures received a second dose of intramuscular ceftriaxone and were discharged. Cultures were read at 48 hours and at the conclusion of the study. Medical records were reviewed to identify delayed complications. RESULTS: 172 infants were enrolled. The mean age was 45 days. All CBC, UA, CSF analyses were normal. Chest radiographs were obtained in 56 (30%) infants; all were normal. One (.05%) patient was admitted at the follow-up visit. The mean time to follow-up was 25 hours. Two positive cultures were identified at the re-evaluation visit; one blood culture grew Salmonella and a urine culture grew E. coli. The CSF cultures were all negative at follow-up and remained negative. CONCLUSION: Febrile infants 4-8 weeks of age who meet outpatient therapy criteria and have negative cultures and no identifiable source for infection at 24 hours may not require the second dose of intramuscular ceftriaxone.

Efficacy of measuring BUN in assessing children with dehydration due to gastroenteritis.

We conducted a prospective study of 50 consecutive cases of children with gastroenteritis and dehydration to assess the correlation of alterations in the blood urea nitrogen (BUN) concentration. Symptoms included 24 children with vomiting and 26 with vomiting and diarrhea. All children were estimably dehydrated-appearing on examination by traditionally used criteria and had metabolic acidosis (serum bicarbonate concentration of less than 20 mEq/L) and increased anion gap (more than 12 mEq/L). Of these 50 children, 44 (88%) had a BUN concentration within the limits of normal--17 were less than or equal to 10 mg/dL, 17 were between 11 and 14 mg/dL, and ten were between 14 and 18 mg/dL. We discuss the physiologic factors that influence the BUN concentration in conditions of dehydration. Although commonly used, measurement of the magnitude of the BUN concentration is not an accurate method for assessing the hydration status of children with dehydration due to gastroenteritis.

Infectious complications during peripheral intravenous therapy with Teflon catheters: a prospective study.

Infectious complication rates and associated risk factors occurring during peripheral intravenous therapy with Teflon catheters were determined during a prospective study of 286 cannula insertions. Suppurative phlebitis, cannula-related sepsis or suspected sepsis did not occur. Semiquantitative cannula cultures revealed a colonization rate of 10.4% (12 of 115). Coagulase-negative nonadherent Staphylococcus was the most common colonizing organism occurring in 10 of 12 positive catheters. Alpha Streptococcus and adherent coagulase-negative Staphylococcus colonized the remaining catheters. Colonization was not related to the rate of phlebitis, extravasation or cannulation time. No patient- or catheter-related factors increased the risk of colonization. In children in a general pediatric ward the risk of catheter colonization and subsequent sepsis should not be used as reasons for routinely removing complication-free peripheral Teflon catheters at 72 hours.