A 20-day-old term infant has a rectal temperature of 38.4 degrees Celsius but feeds well and looks well. Which management is most appropriate?
Answer and explanation
Correct answer: A. Full sepsis evaluation including lumbar puncture, then ampicillin plus cefotaxime with admission
- Step 1: Any fever of 38.0 degrees Celsius or more under 28 days old requires a full evaluation because serious bacterial infection cannot be excluded clinically.
- Step 2: This includes blood, urine and cerebrospinal fluid cultures, admission and empirical ampicillin plus cefotaxime or gentamicin, avoiding ceftriaxone in neonates because of bilirubin displacement and calcium precipitation.
Answer
Full sepsis evaluation including lumbar puncture, then ampicillin plus cefotaxime with admission.
Why not the others: Discharge is unsafe at this age; deferring lumbar puncture risks missing meningitis; a well appearance does not exclude sepsis in neonates.
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