FEBRA IN PATOLOGIA

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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

  • 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