full pdf of issue - Middle East Journal of Family Medicine

MEDICINE AND SOCIET YApproach to Febrile Infants in the Southern PeripheralHospitals of the Royal Medical Services, JordanAbdallah M. GhanmaCorrespondence:Abdallah M. Ghanma, M.D.Senior specialist in Pediatrics.Royal Medical ServicesP.O. Box 855038Amman, JordanMobile phone 00962 795578777Email: farrisghanma@yahoo.comAbstractObjectives:The aim of this studywas to help pediatricians andfamily doctors to triage younginfants presenting with fever tothe Emergency department, intoserious and dischargeable patients.This will help in decreasingthe unnecessary use of potentantibiotics, the number of admissions,as well as the unnecessaryinvasive and noninvasive laboratoryinvestigations.Methods: Specially designedmedical records abstract formswere filled with data collectedfrom 200 infants (over a period of12 months) who presented withfever more than 38.2ºc rectally tothe pediatric emergency room attwo peripheral hospitals in thesouthern part of Jordan (PrincessHaya Hospital in Aqaba, andPrince Ali Hospital in Al-Karak).Full detailed medical historyand physical examination wereperformed. Laboratory tests wereperformed including CompleteBlood Count, C-reactive protein,chest X-ray, urine analysis andculture, stool analysis and culture(if diarrhea is present), in additionto Blood culture and Cerebrospinalfluid sampling in seriously illadmitted infants.All candidates were closely followedup daily over the next twodays if discharged from the emergencyroom, otherwise, they wereadmitted.The final diagnosis was correlatedwith the preliminary findingsand tests to define significanceand possibility of depending onfuture assessment of similarpatients.Results: Significant correlationwas noticed between positiveBlood Cultures and/or positivechest X-ray findings with thesymptoms of poor feeding, hypoactivity,convulsion and attacks ofcyanosis.The most important signs wereabdominal distension, irritability,respiratory distress and bulginganterior fontanel.The significant laboratory findingsthat we depended upon foradmission were:White Blood Cells count of morethan 14.000, with more than 40%Neutrophils, urine analysis withWhite Blood Cells more than6/High power field, positive C-reactive protein, and chest X-rayfindings.Conclusion: It can be concludedthat poor feeding, hypo-activity,convulsion and cyanosis are consideredindicators of serious illnesses,necessitating admissionand treatment. Simple Laboratoryinvestigations are very helpful topediatricians and family doctorsto spot the serious cases, andspare many young infants theunnecessary admissions to thehospital.Key words: Fever, CompleteBlood Count, CRP, Chest X-ray,Urine AnalysisMIDDLE MIDDLE EAST EAST JOURNAL JOURNAL OF OF FAMILY MEDICINE VOLUME • VOLUME 10 ISSUE 7, ISSUE 7 10 25