Heating does not burn the brain, but be careful of these dangerous signals …
Willian Osler (1849-1919), a well-known Canadian medical scientist, said, “There are only three enemies in humans: fever, famine, and war. “The important position of human development process reveals people’s fear of fever.
If a child is a bit cough, or runny nose or diarrhea, parents may not take it to the hospital to see (many times they will give some medicine to take medicine according to their experience). However, as long as the fever occurs, most parents will take it to the hospital for a doctor.
In pediatric outpatient emergency, fever is definitely the most common complaint, none of them. Therefore, for pediatricians, it is particularly important to grasp the diagnosis and treatment strategy of fever.
First, is it heated?
Heating refers to the body temperature exceeding the normal range of the normal range. The definition of acute fever in China as the upper limit of normal body temperature fluctuations in normal body temperature rising by more than one day.
The heating of the definition of a certain fixed body temperature is too absolute, but most medical research uses anal temperature ≥38 ° C as heating; in clinical work, anal temperature is usually defined as heating.
However, fever is affected by changes in gender, age, race, day and night, season, etc., and different measurement methods, the measured body temperature is not the same. In addition, the clothes are too thick, after breastfeeding, after meals, or crying, which will cause too much body temperature.
Different measurement methods and temperatures are not the same, and there are differences in judgment standards.
How to classify fever?
(1) Classification according to body temperature level
1. Low heat: <38 ℃
2. Moderate heat: 38 ~ 38.9 ℃
3. High heat: 39 ~ 41 ℃
4. Ultra -high heat: ≥ 41 ℃
(2) Classification according to the course of disease
1. Acute heating: fever time ≤7 days;
2. Short -term fever: fever time ≤ 2 weeks;
3. Reasons for unknown reasons (FUO): The fever time is ≥1 weeks, and the cause of the medical history, physical examination and preliminary laboratory examination is temporarily unclear;
4. Chronic fever: The heat time is more than 1 month.
Third, why does it get fever?
(1) Creating thermal original fever
The most common mechanism of fever is: cause heat -primitive fever, including infectious fever and non -infectious fever.
Exogenous heat origin includes various pathogens and its metabolites, vaccines, etc.;
Internal heat -derived thermal original acts on the host cells, producing endogenous heat -derived thermal originals, and then acting on the hill brain temperature adjustment center, resulting in the increased point of the body temperature increase and the temperature of the body temperature.
Non -infectious heat -derived original includes tumor, trauma, surgery, immune disease, etc., which causes injury, abnormal cells and tissue necrosis, stimulating the internal device in the body, which causes fever.
Thermal fever is the most common clinical, including various infections, immunity and tumors, and the vast majority of fever account for fever.
(2) Excessive heat production (mostly low heat)
1. Strong exercise, convulsions, crying, etc.;
2. Intake the protein too high and high -thermal energy diet;
3. High metabolic patients such as hyperthyroidism.
Clinical scene
The body temperature is slightly higher than the normal level after crying, after the twitching or eating, mostly, mostly low heating.
(3) Heat dissipation disorders
1. Khan gland deficiency: extraordinitis, burns, and poor development of outer embryo;
2. The environmental temperature and humidity are too high;
3. Too much clothes and too thick: Heathear syndrome.
Clinical scene
In the summer, the newborn who was just born, the parents wrapped tightly, and the measurement of the body temperature was higher than normal.
Hurriedly took to the hospital to see the emergency department. The doctor checked that the clothes were too thick, and the clothes were appropriately reduced, and the temperature returned to normal.
(4) Abnormal body temperature regulation function
1. Humanic brain temperature adjustment center involvement: brain dysplasia, craniocerebral injury, postoperative cerebral tumor surgery, cerebral palsy, etc.;
2. Hyulniamia;
3. Newborn dehydration;
4. Drug poisoning: sleeping pills, etc.;
5. Summer fever.
Clinical scene
The author once encountered a Prader-Willi syndrome. He took a year of fever for 1 year and passed the domestic three hospitals. In the end, he did not find a clear cause.
Consult the relevant literature. Children with this disease may have a dysfunction of the hypothalamus-pituitary dysfunction.
This kind of fever is usually very high in body temperature, but generally good, conventional heating drugs are invalid, and antibiotics are invalid.
Fourth, the effect of heat on the body
The impact of fever on the body includes favorable effects and possible impacts.
1. Heating is conducive to enhanced immune response and inhibitory pathogens.
The endogenous heat of the fever can enhance the development of immune cells and immune factors, and promote the function of neutral granulocytes and B/T lymphocytes. In addition, excessive body temperature can reduce the virus load and inhibit the value -added of the pathogen.
2. Heating can also cause children’s physical discomfort, which is also the main reason for parents to take children.
The fever has accelerated the metabolism of the body, increased oxygen consumption, and the loss of moisture; it can lead to dehydration, increased heart rate, increased heart load, and rapid breathing.
■ Heat affects the nervous system and increases the excitement of the nervous system. Often manifested as mental fatigue, irritability, anxiety, irritability, etc. Some children can cause convulsions due to high fever or body temperature changes, which may be related to the immature development of children’s central nervous system.
It is worth mentioning that many heads are afraid of “fever will burn the brain”,
This is why the caregiver is extremely nervous when it comes to fever. Although studies have shown that if the body temperature continues to exceed 42 ° C, the nervous system of children will be damaged. However, clinically, there are fewer high fever, most of which are low heat, moderate heating and high fever. Most of this situation will not cause nervous system damage, let alone “burn the brain”.
Only by fever caused by central disease, such as purulent meningitis and viral encephalitis, can cause damage to the nervous system. However, the fever and central nervous system damage is caused by purulent meningitis, not the central nervous system damage caused by fever.
■ Heat will also cause rapid heart rate (the heart temperature increases by 15 times/minute per ℃ per ℃), increasing the burden on the heart, and it is easy to induce heart failure;
■ Heating causes the sensitivity of the respiratory center to increase the sensitivity of carbon dioxide, accelerates the breathing, and increases the burden on the respiratory system;
■ Heating can also affect digestive function, leading to decreased digestive fluid secretion, and decreased digestive enzyme activity. Therefore, children often have bad appetite, bloating, constipation, etc.
5. What are the common reasons for fever?
A large number of studies have shown that the first three reasons for children’s fever are: infectious diseases, autoimmune diseases, and auto -inflammatory diseases, and hematological diseases.
In 2011, there was a collection of analysis. For 18 studies, 1338 studies including children’s fever (Fuo) children showed that:
51%are infectious diseases (59%of bacteriality), and the common pathogenic body in high -income countries is Balttoma body disease and urinary tract infection. Most of the low -income countries are Brucelli disease, tuberculosis and typhoid fever.
23%without a clear diagnosis;
9%is immune rheumatism;
6%is blood malignant tumors.
6. Dangerous warning signal of heat
In most cases, the symptoms of fever are mostly manifested with minor and self -limited diseases, but some of the fever may be the manifestation of severe diseases. Clinically, comprehensive assessment needs to be identified early to identify high -risk children in order to treat in time and improve prognosis.
(1) Heating level
It is not a risk factor for serious diseases, but <3 months of baby temperature ≥38 ° C or 3 to 6 months of baby temperature ≥39 ℃, which is one of the risk factors (IIA grade evidence) of severe bacterial infection.
(2) The duration of fever
The risk factors (IIB -level evidence) of severe diseases (IIB -level evidence), acute infants and young children with unknown causes cannot fully predict the overall risk of bacterial infection (IID grade evidence).
However, for <3 -year -old infants and young children, the cause is unknown acute fever, the fever time is ≥2 days, and the risk of urinary system infection is high (IC -level evidence).
(3) response to antipyretics
The cause of the cause of the disease is not clear, the reaction of the application of heat -relieving analgesic drugs, and it cannot determine that it has a forecasiest effect on severe bacterial infections (ID -level evidence).
(4) Holocated warning signal of heat
(5) Diseases that need to be vigilant needed for fever
Heating may be a manifestation of some serious diseases, such as delay diagnosis or treatment that may cause fever diseases that cause death or disability.
These diseases include purulent, bacteria, bacterial meningitis, pneumonia (various pathogen infections), urinary system infection, gastroenteritis, soft skin tissue infection, purulent osteitis, arthritis, otitis media, herpes virus infection, herpes cylindrical virus infection, herpesium virus infection, shepen virus infection, shepen virus infection, herpesium virus infection, herpesium virus infection, herpesium virus infection, herpesium virus, Viral encephalitis, severe hand, foot and mouth disease, and Kawasaki disease.
(6) Other high -risk factors
In addition to the identification of children with severe severe children, the following special circumstances should also be paid to:
Any newborn fever should attract enough attention, which may mean serious bacterial infections;
The age of 1 to 3 months is unknown for acute infants and young children, accompanied by poor general state or abnormal laboratory indicators (blood routine, urine routine, CRP/PCT) positive should be alert to bacterial infection, urinary tract infection or intracranial infection;
In the heating disease spectrum, the proportion of infectious fever is the highest. So, what is the specific diagnosis and treatment of fever in pediatric infectious fever? Tomorrow for everyone tomorrow.
references:
1. Wang Yi, Wan Chaomin. China 0 to 5 years old children with unknown acute heating diagnosis treatment guidelines (simplified version). China Evidence -based pediatric magazine, 2009 (3): 310: 310
2. Luo Shuanghong et al.. China 0 to 5-year-old children with unknown acute heating diagnosis and treatment of several issues (standard edition). Chinese evidence-based pediatric magazine, 2016 (2): 81-96
3. Renwei Publishing House “Pediatric Science” (8th edition)
4. Renwei Publishing House “Zhu Futang Practical Pediatric Science” (8th edition)
5.NICE Clinical Guideline.feverish Illness in Children: Assessment and Initial Management in Children Younger than 5 Years.2013.May
