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Pyrexia

Pyrexia is defined as a body temperature above the normal range (36-37C). It is a common sign of bacterial or viral infection, and can be an important early indication of serious infection including puerperal sepsis, chorioamnionitis, wound infection, breast infection, pyelonephritis, pneumonia or sub-acute bacterial endocarditis, which may lead to systemic sepsis causing significant maternal morbidity and maternal and fetal mortality. In labour, the most common causes of pyrexia are maternal dehydration, chorioamnionitis and effects of epidural anaesthesia. The Modified Early Obstretric Warning Scoring (MEOWS) system charts should be used to ensure timely recognition, treatment and referall of the woman who may have, or be developing, a critical illness.

Temperature control

  • Paracetamol 1gm given orally or intravenously may be used to reduce pyrexia, although the possibility of masking underlying sepsis should not be overlooked.
  • Intravenous rehydration may be required if the woman shows signs of dehydration
  • If temperature remains at ? 38.0C for 30 minutes, antibiotics should be initiated

Pyrexia in neonates Early-onset neonatal bacterial infection (infection with onset within 72 hours of birth) is a significant cause of mortality and morbidity in newborn babies. Parent organisations and the scientific literature report that there can be unnecessary delays in recognising and treating sick babies. In addition, concern about the possibility of early-onset neonatal infection is common. This concern is an important influence on the care given to pregnant women and newborn babies. There is wide variation in how the risk of early-onset neonatal infection is managed in healthy babies. The approach taken needs to:

  • Prioritise the treatment of sick babies
  • Minimise the impact of management pathways on healthy women and babies
  • Use antibiotics wisely to avoid the development of resistance to antibiotics.

Parents and carers whose babies are at risk of or have an early-onset neonatal infection should have the opportunity to make informed decisions about their baby's, and their own, care and treatment, in partnership with their healthcare professionals. Sometimes if a baby appears to have a serious illness that could indicate the need for urgent treatment the medical staff may not have time to fully discuss what is involved in that treatment beforehand. In an emergency, if the person with parental responsibility cannot be contacted, healthcare professionals may give treatment immediately if it is in the baby's best interests.

Further reading

Mid-Essex Hospital Services NHS Trust (2012). Management of pyrexia in the pregnancy and the intrapartum period. http://www.meht.nhs.uk/EasysiteWeb/getresource.axd?AssetID=2759

Chen KT. (2016) Intrapartum fever. http://www.uptodate.com/contents/intrapartum-fever

NICE (2012). Neonatal infection: antibiotics for prevention and treatment. https://www.nice.org.uk/guidance/cg149

Polin RA., the Committee on Fetus and Newborn (Amedica Academy of Pediatrics) Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 129, 5. http://pediatrics.aappublications.org/content/129/5/1006

 

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