Emergency Management of Febrile Infants With Bulging Fontanelles

Abstract

E mergency physicians face challenging diagnosis and management of infants presenting with acute fever and bulging fontanelle from time to time. We have recently managed a previously healthy infant presenting to the emergency department with acute-onset high fever, bulging fontanelle, and tachycardia with prompt meningitic dosage of intravenous ceftriaxone after a thorough clinical assessment and obtaining a peripheral blood culture. Cerebrospinal lumbar fluid (CSF) pleocytosis and very high C-reactive protein (CRP) were present. The infant recovered well despite negative blood and CSF culture and extensive viral investigations. Several management issues are encountered. We performed a literature review to address these issues.