Bulging fontanelle in febrile infants: is lumbar puncture mandatory?

Shacham, Shira; Kozer, Eran; Bahat, Hilla; Mordish, Yair; Goldman, Michael

doi:10.1136/adc.2009.158956

Cited by 14 publications

(7 citation statements)

References 7 publications

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“…Bulging fontanelle: while a bulging fontanelle can be a sign of bacterial meningitis, it may also be due to more benign causes (e.g., sixth disease). In a series of 153 febrile infants between 3 and 11 months of age with fever and a bulging fontanelle, only 1 (0.6%) had bacterial meningitis [ 48 ]. Of note, this patient also had other alarm features and leukopenia.…”

Section: The Value Of Associated Clinical Findingsmentioning

confidence: 99%

Fever in Children: Pearls and Pitfalls

et al. 2017

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Fever in children is a common concern for parents and one of the most frequent presenting complaints in emergency department visits, often involving non-pediatric emergency physicians. Although the incidence of serious infections has decreased after the introduction of conjugate vaccines, fever remains a major cause of laboratory investigation and hospital admissions. Furthermore, antipyretics are the most common medications administered to children. We review the epidemiology and measurement of fever, the meaning of fever and associated clinical signs in children of different ages and under special conditions, including fever in children with cognitive impairment, recurrent fevers, and fever of unknown origin. While the majority of febrile children have mild, self-resolving viral illness, a minority may be at risk of life-threatening infections. Clinical assessment differs markedly from adult patients. Hands-off evaluation is paramount for a correct evaluation of breathing, circulation and level of interaction. Laboratory markers and clinical prediction rules provide limited help in identifying children at risk for serious infections; however, clinical examination, prudent utilization of laboratory tests, and post-discharge guidance (“safety netting”) remain the cornerstone of safe management of febrile children.

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Section: The Value Of Associated Clinical Findingsmentioning

confidence: 99%

Fever in Children: Pearls and Pitfalls

et al. 2017

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“…In rare cases a specific etiology may not be found and may be considered idiopathic. In one study, the final diagnosis of pyelonephritis was made in 4 infants presenting with a bulging fontanelle [15]. However, unlike in our patient, these patients had evidence of pyuria on initial laboratory investigation, making the E. coli urinary tract infection in this patient a less likely cause of the bulging fontanelle.…”

Section: Discussionmentioning

confidence: 50%

“…Notably, Roseola infantum, caused by human herpesvirus 6 is a common etiology. Other etiologies such as otitis media and post-vaccination status have also been described [9][10][11][12][13][14][15]. In rare cases a specific etiology may not be found and may be considered idiopathic.…”

Section: Discussionmentioning

confidence: 99%

Covid-19 presenting as a bulging fontanelle

Schiff

Brennan

2021

The American Journal of Emergency Medicine

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The 2019 novel coronavirus disease has become a global pandemic that has struck the United States particularly hard. While it has disproportionately caused severe illness in the elderly and older adult population, many children have also been infected with the virus and some have become critically ill. It is important to recognize COVID-19 may present differently in children; specifically, those under twelve months of age. We report a case of COVID-19 infection in an infant characterized by a bulging anterior fontanelle without any additional symptoms.

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“…With regard to infection, in a study done on 153 febrile children with bulging AF, 1 child had bacterial meningitis and the other etiologies were aseptic meningitis (26.7%), upper respiratory tract infection (18.3%), viral not otherwise specified (15.6%), roseola infantum (8.5%), acute otitis media (6.5%) and pneumonia (4.5%). 6 In our case with sterile CSF, blood, urine, negative human herpes virus-6 and negative nasopharyngeal aspirate for all respiratory viruses except for SARS-CoV-2, COVID-19 was the likely etiology. This is further supported by the finding of foci of increased signal intensity in the white matter in MRI which has been described as the most common radiological abnormality in children with COVID-19.…”

Section: Discussionmentioning

confidence: 58%