A5V4d

Feverish illness in children
A third EL 2+ prospective population study to determine the causes of status epilepticus in children
was submitted by the GDG. 137 In this UK study, 17% of children with a first-ever febrile convulsive
status epilepticus had bacterial meningitis.
GDG translation
The GDG considered neck stiffness, a bulging fontanelle and a decreased conscious level as being
‘red’ features. Although the management of febrile convulsions is outside the scope of the guideline
the GDG felt it important to highlight the risk of bacterial meningitis in children with a prolonged febrile
seizure. The GDG also felt it was important to highlight to healthcare professionals that classical
features of bacterial meningitis are often absent in infants.
Recommendations
The recommendations covering bacterial meningitis are presented at the end of section 5.5.
Herpes simplex encephalitis
Narrative evidence and summary
Only one EL 3 retrospective case series138 conducted in Scotland was found which looked at the signs
of herpes simplex encephalitis (HSE) in children. Focal neurological signs (89%) and seizures (61%),
especially focal seizures, were the most frequent signs of HSE, but also neck stiffness (65%) and a
decreased conscious level (52%).
GDG translation
Although the evidence was weak, the GDG felt that it was important to highlight these signs because
early treatment of HSE improves outcomes.
The GDG considered neck stiffness, focal neurological signs, partial (focal) seizures and a decreased
conscious level as being ‘red’ features.
Recommendations
The recommendations covering Herpes simplex encephalitis are presented at the end of section 5.5.
Pneumonia
Narrative evidence and summary
Six EL 2+ prospective studies 139–144 that looked at clinical features of pneumonia were found. The
study sites varied widely, from the USA, 139,140 the Philippines, 141 India 142 and Jordan 143 to Lesotho. 144
The age included also varied from 2 years 140 to < 6 years. 143
Respiratory rate is a useful marker of pneumonia. Using age-related respiratory rates for tachypnoea
(> 59 breaths/minute in the age group 0–5 months, > 52 breaths/minute in the age group 6–
12 months and > 42 breaths/minute in the age group > 12 months) there is a relative risk (RR) of
7.73 140 of having radiological signs of pneumonia. Other overall findings are:
132
presence of cough has a sensitivity of 98% and specificity of 70% in children admitted
for pneumonia 143
crepitations has a RR of 16.2 142
cyanosis has a RR of 4.38 142
oxygen saturations = 95% have an RR of 3.5 139
chest indrawing has an RR of 8.38 142
nasal flaring if age