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FEBRA IN PATOLOGIA PEDIATRICACONF DR MIHAI CRAIU

CLINICA II PEDIATRIEIOMC ALFRED RUSESCU

FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII

DIMENSIUNEA PROBLEMEI

DEFINITIE

Se defineste ca fiind febra o ascensiune a temperaturii la >38C [rectal]

Valori periculoase [hipertermie] sunt considerate cele >416 C

Temperatura corporal - valori normaleNu exist consens n ceea ce privete grania dintre temperatura corporal normal i febr

Limita superioar a normalului variaz cu vrsta: - nou nscui 38.0 C - ntre o lun i 2 luni 38.1 C - ntre 2 luni i 3 luni 38.2 C - > 3 luni 37.6 37.8 C

Herzog L, Phillips S. Adressing concerns about fever. Clinical Pediatrics 2011; 50(5):383-390

FRECVENTAFrecventa febrei este mai mare la copil decat la adult*

3.7 episoade / an la copil [frecventa aproape dubla la cei cu varsta

Copiii fac deseori febra! [20-40% din parinti raporteaza cel putin un episod de febra pe an]

FRECVENTAFebra este cea mai frecventa cauza de prezentare a copilului la medic si a doua cauza de spitalizare [dupa bolile respiratorii cu tuse / dispnee] *.

* Feverish illness in children: Assessment and initial management in children younger than 5 years. NICE clinical guidelines 2007.

FRECVENTAFebra este cauza frecventa de apelare la MF *34% din telefoane MF au vizat intrebari despre copil

FRECVENTAFebra este cauza frecventa de prezentare in UPU *32% din cele 120.000 prezentari la UPU [Spit Regional Nottingham] au fost la copil20% din prezentati aveau febra, 48% din copiii internati aveau febra

Febra este un motiv frecvent de prezentare la CPU

Chart3

367

1386

PACIENTII CU FEBRA PREZENTATI LA CPU IOMC [367 PAC din 1753 Prezentati - esantion Ian - Nov 2012]

Sheet1

numevarstasexdomicdgtratGTteste cutanateIgER AdverseComplicatiiEozinofileAHCObs

Anastasiu M39MUTC+RA12.593

Anastasiu M41MUTC+RA12.593poz pt par caineidem 2

Ancu IEFRTC+RA17113

Andronie SG133MUAB+RAFlt/inh36141Pectus escav

Anghel DI36MRWR1394

Anghel IT83MUWR+RA25.5124.5spirofrate WR

Anghel M17MUWR+RAMonteluk9.2frate WRDermatita

Anghel V72MUWR+RA241233890/7103

Angheluta GM66FRWR17.5113

Apostol MA33FUWR1390Spasmul hohot plans

Apostol MA37FUWRMonteluk13.592Spasmul hohot plansidem 11

Ardelean A31FUWRfrate WR

Ardelean I66MUWR+RAsora WR

Asmarandei T14MUWR96

Asmarandei T15MUWR indV96idem 89

Badea A72FUWR18.5116mama astm trat cu ICS+LABAUrticarie

Badea AL60MUWR+RAMonteluk+Mometaz/nas19119spiro

Badea AL66MUWR+RAMonteluk+Mometaz/nas20121spiroCONTROLATOSA

Badea AL64MUAB+RAMonteluk+Flixo/inh+Mometaz/nas20121spiroCONTROLATOSA

Badita TN79MUWR21119687

Balanica T106MRAB27.5133

Banca V31MRTC+wheezing14.595.5

Banica AA59MRWR+RAMonteluk+Flt/nas16.8110spiro/poz acarieni3000EVOL FAVORRA severa

Barsan MI52FUWR+RAMonteluk+Flt/inh HD18104spiroRA severaidem 38Dermat4 exac in 10 luni

Barsan MI53FUWR+RAMonteluk+Flt/inh HD18104spiroidem 17Dermat

Barsan MI54FUWR+RAMonteluk+Flt/inh HD19106spiroRA severaidem 7 - 8dermat

Barsan MI55FUWR+RAMonteluk+Flt/inh19106spiroCONTROLAT - se scade doza Flt/inhRA severaidem 22. 23. 24Dermatita

Barsan MI56FUWR+RAMonteluk+Flt/inh18106spiroCONTROLATRA severaidem 23-26Dermatita

Bicher SM46MUWR+RA17.5

Botea S32MUWRnegNDermatita

Botez LA17MUWRBDP - ventilat mecanic 10 z

Brezeanu TG53MUTC+RA22115spiroNTRAHEOMALACIE1 exacerb in 5 luni

Brezeanu TG56MUTC+RA23116spiroTRAHEOMALACIEidem 28

Brezeanu TG59MUTC+RA22118CONTROLATTRAHEOMALACIEidem 31, 32

Buhnia T106MUABspiro

Buican R9MUWR+RA291%Dermat++

Buican R12MUWR+RAMonteluk291%idem 34Dermat++

Bulai L27MUWR14.593NN

Cadar R63MUWR+RA21.5116232.5O serM AB, T RA+urticarii

Calin MA71FUWR42127.5spirofrate cu RAObezitate

Calman MD63MUAB+RA26.5119.5spiro/poz acarieni+mucegaiRA severa

Cantoneru L50MUWR+RA16106

Caracuda C60FUTC+RA21.3116spiroRA severa

Ceausu IA61FUWR26118spiro10.75.6%[400]SUPRAPOND

Cernica TD56FURA18116

Chebarus AD23MUWR+RAMontelukpoz cazeinaIPLVDermat

Chebarus AD25MUWR+RAMontelukpoz cazeina42.2IPLVidem 43

Chirita S67FRAstm+RA20119.2spiro / pozNev Ota

Cioroianu EB56MUTC+RAMonteluk+Momet/nas20115spiroEVOL BUNA DE 6L

Cioroianu EB58MUWR+RAMonteluk+Mometaz/nas20115spiroNECONTROLAT - TC=WR>3/an[scor CR+]T AB M fumatidem 43

Citea M90MRTC+RAMonteluk23.5124spiro72M fumatoare

Ciucur R134MUAstm+RA

Codrea DM68MUTC+RARA severa

Cojocaru AL124MUWR+RAMonteluk47150spiro/poz acarieni>>RA severa

Coman AR66MRAB+RAMonteluk+Mometaz/nas32.5123spiro

Coman AR70MRAB+RAMonteluk+Xyzal36125spiroCONTROLATSUPRAPONDidem 48Dermat++

Constantin RCMUWR+RA26123

Constantin TA35MUWR+RAMonteluk+Mometaz/naspoz albus ou26.85%

Constantinescu S92FUAstm+RA22.512866511.4% [680]

Constantinescu S95FUAB+RAFlt/inh+Flt/nas23.5130spiroCONTROLATidem 48

Corcodel D40MUAB+RATC - N VienaNO serRA severa

Coricica AM23MUWRMonteluk10.882T SUDORII - 3413.70%repetate scaune cu sange

Cosma IA35FUWR+RAMontelukO ser

Costache MC47FUWr+TC

Costache T48MUWR+RA22122

Costan M36MURA18.5102O serDermat

Craiciu RM19MUWR indVMonteluk12.21 episod BO "dramatic"

Croitoru A27MUWR+RAMonteluk13101.7RA severa

Dane A68MUWR17.5110

Dasu M84MU4327.50%

Dinca BA158MUABICS+LABA [Seretide discus]59167spiroCONTROLAT

Dinu EA48MUWRMonteluk15105strabunica astm, matusa mat alergie polen

Dinu LC43FUTC+RA20.5107RGE

Dirla AO72MUAB+RAFlt/inhspirodepresie monteluk

Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie majora Montelukidem 51

Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie Majora Montelukidem 51 si 208

Dirla AO77MUAB+RAFlt/inh+Deslor+Mometaz/nasCONTROLATDepresie majora Montelukidem 68, 69, 70

Dobre CL55MUWR+RAMonteluk+Momet/nas14.7100.512115%RA severa

Dobrila V67MUAstm+RA24118RA severa

Dobrila V68MUAB+RAMonteluk+antihistTS 34; ECO C nRA severaidem 21

Dobrila V70MUWR+RAMonteluk+Mometaz/nas24118CONTROLATM RARA severaidem 53, 54

Dogaru CA52MUAB+RA22116poz polenuri

Donose MA51MUTC+RA17.2107.576.3VDC

Draghia AC148FRTC+RA56160spiroDermatita

Dragotoniu AE36FRWR+RAMonteluk1497.510.80%Tata & Mama RARA severaDermat

Dragotoniu AE42FRWR+RAMonteluk14.599CONTROLAT10.80%T si M RARA severaidem 78

Dumitrescu AMUWR+RA24.3120spirovar cu WRADHD?

Dumitrescu A73MUWR+RAMonteluk+Mometaz/nasspiroCONTROLAT

Dumitrescu S37MUAB+RA14.5Dermatita

Dumitriu V50MUWR+RAspiroDermat

Dumitru FC111MUAstm41138.5spiro

Duta RN62MUWR+RAMonteluk+Mometaz/nas+Ketof20114spiro>>10.90%RA severaDermatita

Duta RN66MUWR+RAMonteluk?Mometaz/nas+Ketof20.5116spiro>>CONTROLAT10.90%RA severaidem 84Dermatita ++

Enache DC47MRAstm [Ex]Mometa+Deslor+Monteluk17spiro

Filipoiu AM13FUTC10.9sora WRMACROSOM

Florea C171FUTC58.5151Obezitate

Florea V75MUAstm [Ex]+RA29128

Furdui TA48MUWR/exacerb usoaraMontelukspiro

Geambazzi AA20MRWR [Ex]MontelukPectus escav

Geambazzi AA22MRWR/exacerb usoaraMontelukEVOL >3epis WR/ansora cu WRidem 25Pectus escav

Geambazzi SP47FRWR [Ex]Monteluk

Geambazzi SP51FRWRCONTROLATidem 83

Georgescu AI61FUWR+RAMonteluk20.5115.8spirofrate WR

Georgescu MA66MRWR+RA20.5121poz mucegai18.3Polipi corzi vocale

Georgescu RA72MUWR+RAMonteluk+Flt/nasO ser

Gherghelescu I14FUWRMonteluk

Ghidrigan SC104MUAstm [Ex]+RA29.5132.5374Depresie Majora5%

Ghidrigan SC107MUAstm+RALABA+ICS29.5133spiroDepresie Majora5%

Ghincea MA136FUABspiroVCD, OBEZ

Gorgan M31FUTC+RA22

Gramescu A60FUTC20.5113.5TRAHEOMALACIE

Grecu A42FUTC+RA16.51026.2%[510]

Grigoras C67FUWR IACRS23NEFRECTOMIE PARTIALA

Grigoras C69FUWR23idem 64

Grigorgore M26FUWRDermatita

Grozavu D76MRTC+RA20115

Guzu A29MUWR+RAMontelukRA severa

Guzu A30MUWR+RAMonteluk+Flt/nasEVOL FAVOR RARA severaIDEM 58

Guzu A32MUWR+RAMonteluk+Flt/nasCONTROLATRA severaidem 75,76

Himpa T103MUAB+RAMonteluk+Mometaz/nas40138.5spiroCONTROLATRA severa

Hornoiu B27MUWR+RAMonteluk11.593

Hornoiu B31MUWR+RAMonteluk1496CONTROLATidem 97

Iacob-Ritzi A18MUWR+RAFlt/inh11.2Pectus escav

Iancu MA98FUTC+RA34139spiroHipertrofie adenoamigdaliana - operatie

Iancu MA100FUTC+RA36141spiroPubertate precoceidem 69

Ichim EG78FRTC

Ilia RV102MUWRFlt/inh32136.5

Ilia RV103MUWRFlt/inh33136.5idem 35

Ilia RV104MUWRFlt/inhEVOL FAVOR

Ilia RV105MUWRFlt/inh HDspiro

Ilie CN125MUAstm+RAMonteluk+DeslorRA severa dupa oprirea medic)idem 70

Ilie CN126MUAstm+RAMonteluk+Deslor38142spiroidem 19

Incicas A52FUAstm+RA18.5111poz mucegai>>Dermat

Ion R72FUWR+RApoz polenuri+mucegai

Ion RE20FUWRM AB

Ionescu LA27MUTC13

Ionica M54FUWR

Iordache R7MUWR767Traheomalacie

Iordachi S27MUWR[Ex]

Iordan AA56MUWR+RAMonteluk15106spiro60.2Dermat

Jurubita AA31FUWR+RAMonteluk+Flt/inh13.598IPLVDermat

Jurubita AA32FUWR+RAMonteluk+Flt/inh+Mometaz/nas13.598IPLVidem 189Dermat

Jurubita AA34FUWR+RAMonteluk+Flt/inh+Mometaz/nas14100poz cazeinaIPLVidem 115, 116Dermat

Karali A32FUTC11.590Dermat

Lacraru RP53MUAB+RAMonteluk+ketotif18.5113spiroEVOL FAVORDermat

Lambrea DMUWR35141spirovar cu WR

Lazar AL26MUWR16MACROSOM

Leanca DC10MRWRRGE

Leonte DFUAstmspirobunic decedat astm

Licu MI50MUWR15108Pectus escavidem 53

Licu MI51MUWR [Ex]15.5108Pectus escavidem 31

Licu MI52MUWR15.5108idem 31

Luca AL108FUTC40.5130VCD, SUPRAPOND

Luca AL109FUTC40.5130VCD, SUPRAPONDidem 134

Maftei MP119MUAstm+RAFlt/inh+Mometaz/nas36143Dermatita

Maftei MP120MUAB+RAFlt/inh+Mometaz/nas36143idem 89Dermatita

Maftei MP125MUAB+RAMontelukspiroCONTROLAT - se scoate doza Flt/inh

Mainov IM66MUWR+RAMonteluk+Flt/nas35.6120spiroNfrate RA+unchi WRHipertrofie adenoamigdalianaDermat

Mainov IM68MUWR+RAMonteluk+Flt/nas+Flt/inh29121spiroCONTROL MEDIOCRU - adaugat ICSO serfrate WR+ unchi WRRA severaidem 105

Mainov MI71MUAB+RAMonteluk+Flt/inh29120spiroCONTROLATfrateWR/RA+unchi WROBEZ, OASidem 147

Mainov SG40MUWR+RAMonteluk16.5102frateRA+unchi WRPectus escavatum

Mainov SG42MUWR+RAMonteluk16.2103frate WR+ unchi WRPectus escavatumidem 106

Mainov SG44MUWR+RAMonteluk16.5104CONTROLATfrateAB/RA+unchi WRPectus escavatumidem 148-149

Marin DC69MRAB+RAMonteluk18.5109spiroCONTROLATPectus escavatum

Marin EF37FUWR+RAMonteluk1599128NECONTROLAT - ADAUGAT Flt/inh+Deslor+Mometaz/nasRA severa

Marin EF38FUAB+RA1599.5spiroRA severaidem 46

Marin EF40FUAB+RAMonteluk+Flt/inh+Deslor+Mometaz/nas15.6101RA severaidem 109

Marin MA10FRWRMonteluk8.57725M RA, matusa WR

Marinescu AM35FUWR+RAMontelukCONTROLAT PARTIAL - se introd Monetaz/nas

Marin-Gogan M51MURA

Matache M21MRWRMonteluk

Matei A51MUWR+RA625.6%[493]T WR+RABDP

McCollum M87MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroEVOL FAVOR DUPA EXACERB SEVERARA severaDematita

McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroRA severaDematita

McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26132RA severaidem 112 si 113Dematita

Meita D101MUABFlt/inh HD29134spiro/paneluri+>>T dermat M RA

Meita D101MUABFlt/inh HD29134spiro>>EVOL FAVORT dermat M RAidem 95

Meita D103MUAB[exacerb]+RA29134spiroidem 153, 154

Mereuta R168MUAB+RA50.4164spiro/ +polen

Mereuta R168MUAB+RA50164spiroidem 86

Mihai T72MUWR+RAMonteluk20116Hipertrofie adenoamigdaliana - coblatie

Mihai T73MUWR+RAidem 98

Mirea AM150MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operat

Mirea AM151MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 218

Mirea AM152MUTC+RA56154spiroCONTROLATTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 148, 149

Mirea RMUWR

Mocanita VM60MUTC+RA

Munteanu M204FUAB+RAspiro/poz par pisicaDermatita

Munteanu M206FUAB+RAspiro/poz par pisicaidem 162Dermat

Murata A81MUWR+RAspiro

Naftan DG54MUWR+RAMonteluk+Deslor6594%T RARA severa

Naghy N69FUAB+RAFlt/inh+Mometaz/nas19.5118spiroM RARA severa2 exacerb in 5 luni

Naghy N69FUAB[exacerb]+RAFlt/inh+Mometaz/nas19.5118spiroRA severaidem 175

Naghy N70FUAB+RAFlt/inh+Mometaz/nas+Deslor20118spiroM RARA severaidem 175. 178

Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas+Deslor21119spiroCONTROLATM RARA severaidem 123,124, 125

Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas20119spiroCONTROLATM RARA severaidem 165-168

Neacsu P17MUTCPneumonii recurente - deficit imuniv A+G select

Neagu AF63MUWR+RA1919Pectus escavatum

Nica TA25MUWR+RAMonteluk17.2EVOL FAVORDermatita ++

Niculae AM42MUWR+RA16.5101RA severa

Niculae AM43MUWR+RAMonteluk16r adv FLTinhEVOL FAVORO CRIZA SEVERAidem 103

Niculeasa MT54FUTC+RA17

Nita-Manu MA48MUWRFlt/inh EPISODICEVOL >3epis WR/an

Novac TMUAB19.5117.8Limfom Hodgkin

Obiziuc A44MUWR+RAFlt/nas21.5112idm 57

Obiziuc A45MUWR+RAFlt/nas21.5112idem 4

Ocheana DA62MRRA17.5113poz pt acarieni2864.20%

Oprea AM55FRTC+RA21.5116spiro

Oprea EA133FRAB+RAMonteluk58144spiroCONTROLATOBEZITATE

Palos VD24MUWR

Pandaru-Rugina D15MURC10.7frate WRStridor laring cong

Pandaru-Rugina MA38MUWR+RAMonteluk16102.5spiro

Pandaru-Rugina MA40MUWR+RAMonteluk16103spiro

Pantile TC83MRWR+RAMonteluk+Flt/inh+Mometaz/nas20119spiroO ser

Pantile TC89MRAB+RAMonteluk+Flt/inh+Monetaz/nas21.5121spiroCONTROLATidem 141

Parascu A48MRWR+RA26119.5spiro284RA severa

Pascu MV99MUWR+RA37140spiro3.5%[232]T WR M WR+Dermatita

Patrascanu FR42MUTC+RAMometa+Deslor151016.2N

Paun Z30FUWR/exacerb usoarasora cu atopieDermatitaINTERNATA

Paunescu T42MUWR+RAT RA severa, M RA+urticarieDermat

Pedrazzini34MRWR+RAFlt/inh+DeslorAgit MontelukO seridem 74

Pedrazzini35MRWR+RAFlt/inh+DeslorRA severaidem 14

Petrescu DA93MUWR+RA21.5125poz acarieni780/234015%

Petrescu J36FUAstm+RAMonteluk+Flt/inh

Picu AE60FUWR16.5104.5ADHD

Pirjolescu FS64FUTC+RAMonteluk+Mometaz/nas25118CONTROLAT

Platteeuw L163MUABFlt/inh63.5180spiroConvalescent Pneumonie cu r pleurala si HRB

Polifrone SM85MUWR+RA24123.7spiro>>

Pop AF74MUWRMonteluk36131OBEZ, hiperemotiv, sechele PC

Popa M54FRWR+RA16104

Popescu A122FRWR+RAMontelukspiro

Popescu AMG88FUAB+RAFlt/inh HD+Monteluk18118spiro/ poz mucegai1256/1788RA severaastm sever

Popescu AMG90FUAB+RAFlt/inh HD+Monteluk18118spiro/poz mucegai1256CONTROLATRA severaidem 189Astm sever

Popescu EM41FUWRMonteluk13.898

Popescu R53MUTC+RA18.5105

Popescu S97MUAB+RA25125spiro808

Popescu VA105MUTC+RAMonteluk+Mometaz/nas+D330130.5232HipoCa

Posea R34MUWR+RAMonteluk+Mometaz/nas14100478Dermat

Posea R35MUWR+RAMonteluk+Mometaz/nas14101478idem 221Dermatita

Puiu CLMUWR+RA23.5119

Radu AAMUAstm+RAspiro

Radu AV158MUTC50155spirofrate TC si EIB

Radu MS37MUWR indVSUPRAPOND

Radu SA121MUTC+RA40139spiro/poz polen238frate TC si EIB

Radulescu MIFUAB+RALoratadina30134spiro25.82.48%mama RA

Radulescu MIFUABMontelukspiroidem 111

Rangu AG41FWR+RA

Rizea DC82MRTC+RA27.7128

Roman E28MUTC13

Sandulescu T85MUWR+RAMonteluk22.2120spiro84CONTROLATDermatita

Sebes LV44MUWR+RA15.5101.5IPLVDermat

Secula TI75MUWR22.3119.5bunica astmDermatita

Setareh SFUTC+RA21.5116RA severaDermat

Simion M57MUAstm+RAMonteluk+Flt/inh+Deslor16375RA severa

Sisu VC48MUWR+RA711RGEDermat

Sisu VC49MUWR+RAMonteluk17105711RA severa

Sitaru ARMRWRpoz par hamster280

Sitaru EDFRWR+RAfrate WR, sensibilizat par hamsterDermat

Sofron D90FRTC+RAMometaz/nas27128spiro6.2VCD

Stan MG41MUWR+RA14.597alergie medic - beta-lactami

Stancescu DG79MRAB20119poz pt acarieni

Stanciu A43FRWR+RA15O ser

Stancu MT94FUAB[exacerb]+RAFlt/inh HD + SABA30138spiro/poz par pisica, calNECONTROLAT - dat ICS+LABA [Symbicort]Dermat++

Stancu MT95FUAB+RASymbicort [ICS+LABA}30138spiro/poz par pisica, calCONTROLAT - scos Symbicort - ICS HD+Montelukidem 243Dermat++

Stanga AM43MUWR+RAMonteluk161025.60%Bunica RARA severa

Stanga AM46MUWR+RAMonteluk+Mometaz/nas+Deslor16104EVOL FAVOR5.60%Bunica RARA severaidem 139

Stanga AM49MUWR+RaMonteluk+Mometaz/nas17107CONTROLAT5.60%Bunica RARA severaidem 244, 245

Stejar T74MRAstm+RAMonteluk21.5121spiro157.8

Stejar T78MUAB+RAMonteluk21.5121spiro/poz polen175.8CONTROLAT AB, pt RA - Mometaz/nasO seridem 226Dermat

Stoica R4MUWR7

Stoican ACMRWR+RA19110

Stoicescu T31MUWR+RAMonteluk17106>>CONTROLATDermatita

Suta DC8MUTC+RADeslor9M dermatita, surori cu WR,

Szilagy A14MUWR+RAMonteluk11.4RA severaDermat

Szilagy DO44MUWR+RA94O ser6%IgA si G usor39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]

PACIENTI NETERMOMETRIZATI[141 PAC din 1753 Prezentati - esantion Ian - Nov 2012]

Febra inalta este frecventa?

Chart5

34

333

FEBRA >39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]

Sheet1




Ancu IEFRTC+RA17113


Anghel DI36MRWR1394
































































Dane A68MUWR17.5110

Dasu M84MU4327.50%








































Gorgan M31FUTC+RA22


Grecu A42FUTC+RA16.51026.2%[510]














Ichim EG78FRTC









Ion RE20FUWRM AB

Ionescu LA27MUTC13

Ionica M54FUWR











Leanca DC10MRWRRGE






















Marin-Gogan M51MURA
















Mirea RMUWR
























Palos VD24MUWR





































Rangu AG41FWR+RA


Roman E28MUTC13





















Stoica R4MUWR7






Mecanismele FebreiFebra in sine nu este o boala!

Febra este un mecanism fiziologic pentru combaterea diverselor infectii.Incetineste replicarea virala sau bacterianaAccelereaza productia de PMN si limfocite TAccelereaza traficul de celule cu rol imun

Modalitati de evaluare copilmasurare rectala & orala

Modalitati de evaluare scolarmasurare axilara & orala

Erori de masurare tehnice 1

Erori de masurare tehnice 2

BOLI CU FEBRA LA COPILNu numai infectiile pot genera febra!Inflamatii acuteBoli reumatismale [ACJ, RAA, LES, PAN, Sindrom Kawasaki, etc]Inflamatie alergicaIntoxicatii acute [accidentale, iatrogene]Anomalii termoreglare [tumori diencefalice]Febra factitiala / sindr Munchausen

BOLI CU FEBRA LA COPILSemne de gravitate

BOLI CU FEBRA LA COPIL

Boli febrile cu potential de severitate >>SepticemieMeningitaPielonefritaPneumonie acuta

Care este ponderea cauzelor de febra?Cea mai frecventa cauza de febra fara focar la copilul prescolar sunt bolile virale

Bolile de colagen reprezinta 9%Malignitatile reprezinta 6%

* Chow A, Robinson JL.Fever of unknown origin in children: a systematic review. World J Pediatr. 2011 Feb;7(1):5-10.

Dar la sugar ?Nici la sugarul cu varsta sub 3 luni, care are doar febra izolata nu exista un risc semnificativ de boala bacteriana.

2.1% din 1112 sugari cu varsta

Infectiile febrile grave apar la

Criteriile Rochester pentru severitate redusa in infectii cu febra la sugar

TRATAMENT FEBRA

Este foarte diferita perspectiva asupra tratamenului febrei la :copil parinte medic

Perspectiva pacientului COPILUL SCOLARFebra legitimeaza statutul de pacient / pacient

Febra produce empatie / ingrijorare / toleranta

Febra aduce BENEFICIISunt bolnav nu mai merg la scoala Nu mai fac lectii Pot sa stau acasa si sa ma joc

Perspectiva parintelui - 1Febra produce ingrijorare *

CAUZA NR 1 de ingrijorare parentala

Motiv frecvent de medicatie fara prescriptie sau consult medical

*Kay J What worries parents when their preschool children are acutely ill and why? : a qualitative study. BMJ 1996;313:983-6.

Perspectiva parintelui - 2

Parintii administreaza antitermice chiar si in conditii de temperatura putin crescuta, unori aproape normala*.

* Sullivan JE et al - Fever and antipyretic use in children. Pediatrics. 2011 ;127(3):580-7.

Perspectiva parintelui - 3Febra produce PANICA, fiind expresia unei situatii GRAVE in acceptiunea parintilor*

Termenul fever phobia este introdus de Barton Schmitt in 1980

*Schmitt BD Fever phobia. Am J Dis Child 1980;134:176-81.

Perspectiva parintelui - 4Parintii sunt convinsi ca febra in sine * poate produce:Leziuni neurologice (38,1%)Deshidratare (15,7%)Leziuni ale altor organe [rinichi, ficat] (14,2%)

* Zyoud SH et al - Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine. BMC Pediatr. 2013;13:66.

Perspectiva parintelui - 5Parintii masoara febra cu ajutorul *:Termometrului (31,6%)Mainii, prin atingere (65,4%)Atingere apoi termometrizare (3%)


Fever phobia la halatele albe *230 medici de CPU intervievati in SUA. temperatura considerata a fi febra 37.8C Temperatura medie considerata ca fiind nociva 40.6C [limite 37.8 - 43.3C]. Temperatura medie la care s-au inceput antipireticele 37.8C Peste 1/3 din medici au recunoscut ca au administrat antipireticele inadecvat [exces de zel]. * Poirier MP, Collins EP, McGuire E Fever phobia: a survey of caregivers of children seen in a pediatric emergency department. Clin Pediatr (Phila). 2010;49:530-4.

Perspectiva medicului 2

Alte date din practica

In UK medicii de familie folosesc rareori termomentrul *Deseori tehnica de termomentrizare este incorecta

* Clarke S The use of thermometers in general practice. Br Med J 1992;304:961-3.

In Romania realitati despre termometrizare

Chart1

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Stoica R4MUWR7







Caz Mara A 4 ani 9 luni Mesajul mamei : Atasate sunt analizele recoltate miercuri 07 nov, in a 7-a zi de raceala (zilele 1 si 2 cu febra 38.8C, zilele 3 si 4 cu 37.5C si zilele 6 si 7 cu temperatura normala ziua si cu 35.5C! insotite de transpiratii reci noaptea -- urmate de inca 2 zile cu 35.5C si transpiratiidoar noaptea). []Am asteptat sa-i fac analize in stare de sanatate, dar numai in muci si raceli o tine

Caz Mara A 4 ani 9 luni Asteptarile / ingrijorarile materne:

Febra este o cauza de ingrijorare [vezi precizia masuratorilor si notarea valorilor!]

Parintele vrea certitudini analize

Investigatii

Raspunsul medicului

Investigatiile evoca natura virala a bolii. Mai ales prin numarul relativ scazut de leucocite.

Nu exista elemente de deficit imunologic (valorile diverselor imunoglobuline sunt normale si complementul seric este normal) [...]

Raspunsul medicului [...]Pana aici nimic semnificativ! Un copil care nu are elemente de infectie acuta NU TREBUIE termometrizat.

Din pacate va mai face viroze. Suntem la inceputul iernii. Pastrati-va energia pentru afectiuni acute...

Ce facem la un copil febril ?Antibiotice ??Investigatii ??Altceva ?!

Care sunt optiunile terapeutice imediate ?

OPTIUNILE TERAPEUTICE IMEDIATELa copilul mic [

Asteptarile parinteluiParintii abordeaza PERSONAL febra cu * :Antipiretice (34,8%)Manevre hipotermizante (49,8%)Medicatie homeopata (3,2%)53,2% cred ca antipireticele sunt nocive!


Reactia parinteluiParintii pot fi influentati sa administreze corect antitermicele de * :Sfatul medicului (61,7%)Febra foarte mare (14,9%)Recomandarile de prescriptie de pe flaconul de medicament (13,7%)


FEBRA LA COPILRolul antitermicelor in preventia recurentei convulsiilor febrile

NU scad semnificativ statistic riscul de recurenta *22.7% recurenta cu AT & 24.4% cu placebo

* Rosenbloom E et al - Do antipyretics prevent the recurrence of febrile seizures in children? A systematic review of randomized controlled trials and meta-analysis. Eur J Paediatr Neurol.2013 May 21. pii: S1090-3798(13)00065-2

FEBRA LA COPILRolul antiinflamatoarelor nesteroidiene in IACRS

Mai degraba NU*Nu reduce evolutia boliiNu scade scorul de simptome

* Kim SY et al - Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev. 2013 Jun 4;6:CD006362.

PROTOCOALE S R Ped

FEBRA LA COPILCe putem administra la copil [SRPed]Paracetamolpo sau IR 10-15 mg/kg/doza la 4-6hiv 15 mg/kg/doza la 6hIbuprofenpo 5-10 mg/kg/doza la 6-8hKetoprofenpo 0.5 mg/kg/doza x 3 Schemele alternative la 3h cu Ib+Paracetamol

Agentia Nationala a Medicamentului

Ibuprofen Suspensie n comparaie cu ParacetamolWalson PD, et al. Clin Pharmacol Ther 1989;46:9-17. Ibuprofen Suspensie 10 mg/kg reduce temparatura semnificativ mai mult dect paracetamol 10 mg/kg (p

Asocierea alternativ a Ibuprofen si paracetamol este eficace 1,2Nabulsi MM, et al. BMC Med 2006;4:4., 2. Sullivan JE et al Pediatrics 2011 ;127(3):580-7 Metodologia folosit a putut demonstra o non-inferioritate n administrarea alternativ ibuprofen-paracetamol n comparaie cu ibuprofen n monoterapie

Asocierea Ibuprofen i Paracetamol se dovedete a fi un regim antipiretic eficientHay AD, et al. BMJ 2008;337:a1302 2. Sullivan JE et al Pediatrics 2011 ;127(3):580-7

Terapia combinat se dovedete a fi superioar paracetamol n a scdea perioaadei de manifestare a febrei, efect manifestat n primele 4 ore de dup administrare

Alte Optiuni

Paracetamol iv [Perfalgan]7mg/kgc/doza Dilutie 1:10 la copil micPev lenta cel putin 30 min [nu iv flush!]Diclofenac supozitoare [Voltaren 50mg]1.5 mg/kgc doza

EFECTE ADVERSEEfectele adverse ale antitermicelor

EFECTE ADVERSE

Acestea depind si de concordanta prescriptiei cu medicamentul cumparatAntitermicele PENTRU copil trebuie cumparrate de la farmacie!9% din recomandarile de AT in alte facilitati decat farmacia au fost eronate*

* Bardage C et al - Non-prescription medicines for pain and fever--a comparison of recommendations and counseling from staff in pharmacy and general sales stores. Health Policy.2013 Apr;110(1):76-83.

Managementul febreiNu se recomand metode fizice de reducere a febrei [desi populare si frecvent uzitate] DECAT la non-responderi Majoritatea metodelor fizice de scdere a febrei se pot asocia cu reacii adverse severe: cretere paradoxal a febrei datorit vasoconstriciei; tremurturi i frisoane prelungite cu pierdere crescut de energie; hipoglicemie sever, com, deces (mpachetrile cu alcool).Management of Fever in Children: Summary of the Italian Pediatric Society Guidelines. Clinical Therapeutics Volume 31, Number 8, 2009

Managementul febrei

mpachetrile cu ap cldu nu se asociaz cu aceste efecte adverse severe, dar pot determina disconfort.Management of Fever in Children: Summary of the Italian Pediatric Society Guidelines. Clinical Therapeutics Volume 31, Number 8, 2009

CONCLUZIIFebra este foarte frecvent intalnita!Prima cauza de prezentare la MFA doua cauza de spitalizare la copil

Febra este temuta fever phobiaDe parintiDe medici

CONCLUZIIFebra este deseori evaluata eronat!Parintii termometrizeaza copilul febril in mod corect doar in 1/3 cazuri

Combaterea febrei este temuta de parinti~ parinti considera antitermicele nocive

CONCLUZII

Din fericire majoritatea parintilor (>60%) rezoneaza favorabil la indicatiile medicului privind medicatia hipotermizanta

CONCLUZII

Ibuprofenul intruneste aceste expectative parentale dar si ale mediculuiSingur [in doza 10mg/kgc x 3/zi]Sau in asociere cu Paracetamol [de prima intentie in febra + durere]

CONCLUZII

Brufenul are ca avantaje:SIGURANTASuspensie vascoasa care nu curge usor prin capac si nu poate fi bauta accidental de copilDozare precisa si individualizataEFICIENTAAtat singur cat si in combinatie cu paracetamol

LECTURA SUPLIMENTARAPentru cei interesati de problematica febrei la copil Ghidul de Practica al Academiei Americane de Pediatrie 2011 Committee on Drugs, Section on Clinical Pharmacology and Therapeutics

http://pediatrics.aappublications.org/content/127/3/580.long

**Methods: Single-dose, placebo-controlled, double-blind, parallel-group studyCompared the efficacy, tolerability and dose-response of BRUFEN Syrup and paracetamol in 127 children (aged 2 to 11 years) with oral temperatures between 38.3C and 40.0CRandomised to BRUFEN Syrup 5 mg/kg (n=32), BRUFEN Syrup 10 mg/kg (n=28), paracetamol 10 mg/kg (n=33), or placebo (n=34)Children stratified into four groups depending on whether they were receiving concomitant oral antibiotics and whether they had low (38 to 39.1C) or high (39.2 to 40.0C) baseline oral temperatures1Results: 118 children included in the efficacy analysisAll active treatment agents were well-tolerated and significantly more effective than placebo (p