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Correlating changes in body temperature with infectious outcome in febrile children who receive acetaminophen
W A Bonadio1, T Bellomo, W Brady
1Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee.
Insights
Acetaminophen effectively reduces fever in young children, but does not always lead to an afebrile state. The temperature decrease is age-dependent and does not differentiate between bacterial or non-bacterial infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Fever is a common symptom in young children.
- Acetaminophen is a widely used antipyretic medication.
- Differentiating between serious bacterial infections and non-bacterial illnesses based on fever response can be challenging.
Purpose of the Study:
- To investigate the effectiveness of acetaminophen in reducing fever in infants and young children.
- To determine if the temperature response to acetaminophen can help distinguish between bacterial meningitis, isolated bacteremia, and non-bacterial febrile illnesses.
- To explore the relationship between patient age and the magnitude of fever reduction.
Main Methods:
- A retrospective review of 140 children aged 2-24 months with fever (≥39.0°C).
- Children received acetaminophen (10-15 mg/kg) and temperature was remeasured 60-90 minutes later.
- Patients were categorized into three groups: bacterial meningitis, isolated bacteremia, and non-bacterial febrile illness.
Main Results:
- No significant difference in the percentage of patients becoming afebrile (<38.0°C) across the three groups after acetaminophen administration.
- Significant temperature decrease was observed within each group, but not significantly different between groups.
- An inverse relationship was found between patient age and the magnitude of temperature decrease (degrees C of defervescence = 1.66 - (0.028 x patient age in months)).
Conclusions:
- Therapeutic doses of acetaminophen significantly reduce fever in young children with and without invasive bacterial infections.
- Acetaminophen does not commonly lead to an afebrile state in these patients.
- The degree of fever reduction is age-dependent and does not reliably distinguish between infectious outcomes.
Abstract:
We reviewed the body-temperature patterns of 140 children ages 2 to 24 months who had fever > or = 39.0 degrees C, received acetaminophen 10 to 15 mg/kg, and had their temperatures remeasured 60 to 90 min later. The children comprised three groups: 22 had bacterial meningitis; 59, isolated bacteremia; and 59, nonbacterial febrile illness. Percentages of patients who became afebrile (temperature < 38.0 degrees C) after receiving acetaminophen were not significantly different among the three groups. Differences in mean temperature decrease after antipyretic was given were significant within each group but not between groups. An inverse relation (P < .004) between patient age and magnitude of temperature was revealed by the following formula: degrees C of defervescence = 1.66 - (0.028 x patient age in months). Thus, highly febrile young children with and without invasive bacterial infections who receive a therapeutic dose of acetaminophen experience a significant temperature drop after 60 to 90 min but do not commonly defervesce to an afebrile state. The degree of defervescence is age-dependent and does not distinguish between infectious outcomes.