Paeds Vivas · infectious-diseases
Approach to fever by age and immune status — viva
Branching structured oral on the age- and immune-status-aware approach to the febrile child.
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Target exams
RACP DCEMRCPCH Clinical
Prompt
You are the paediatric registrar. Triage calls about three febrile children in sequence: a 2-week-old, a well-looking 6-week-old, and a 7-year-old on chemotherapy.
Opening (must-hit)
"I clear the threat gate first — any toxic or shocked febrile child gets ABCDE and a sepsis pathway. If the child is well-appearing, I stratify by age band, using Step-by-Step or the PECARN rule for young infants, and I check immune status explicitly because any immunocompromised child is an emergency regardless of how well they look." [1] [2] [5]
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References7Show ledgerHide ledger
- [1]Biondi EA Prevalence of Bacteremia and Bacterial Meningitis in Febrile Neonates and Infants in the Second Month of Life: A Systematic Review and Meta-analysis JAMA Netw Open, 2019.PMID 30901044
- [2]Gomez B Validation of the Step-by-Step Approach in the Management of Young Febrile Infants Pediatrics, 2016.PMID 27382134
- [3]Kuppermann N A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections JAMA Pediatr, 2019.PMID 30776077
- [4]De S Lack of Accuracy of Body Temperature for Detecting Serious Bacterial Infection in Febrile Episodes Pediatr Infect Dis J, 2015.PMID 26065864
- [5]Lehrnbecher T Guideline for the Management of Fever and Neutropenia in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update J Clin Oncol, 2023.PMID 36689694
- [6]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study Lancet Child Adolesc Health, 2025.PMID 40451224
- [7]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis Br J Gen Pract, 2025.PMID 39117428