Understanding Discomfort in Order to Appropriately Treat Fever

Doria, Mattia; Careddu, Domenico; Ceschin, Flavia; Libranti, Maria; Pierattelli, Monica; Perelli, Valentina; Laterza, Claudia; Chieti, Annarita; Chiappini, Elena

doi:10.3390/ijerph16224487

Cited by 13 publications

(15 citation statements)

References 25 publications

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“…By now, it is the consensus of numerous experts that the actual goal of antipyretic therapy is not to normalize core body temperature but to reduce discomfort in children with fever who seem distressed [14][15][16]. This consensus is reaching the intensive wards too [17,18].…”

Section: Fever Managementmentioning

confidence: 99%

Warming up for a better fever: a randomized pilot study in pediatric oncology

Krafft

Raak

Jenetzky

et al. 2022

Pilot Feasibility Stud

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Background Fever in children is a major problem in pediatric oncology. Usual management leads to immediate antibiotic and antipyretic therapy, although there is consensus that antipyretic therapy should not be utilized with the sole aim of reducing body temperature. Increased body temperature during fever appears to be an effective modifier in terms of viral replication and enhanced host defense mechanisms against pathogens. Therefore, it might be beneficial to support febrile patients by applying gentle heat during the onset of fever to help the body to reach its new thermoregulatory set point. Methods A randomized pilot study over 6 months will be conducted in a pediatric oncology department in an academic hospital in Germany. This study is a preparation for a multicenter clinical trial with two parallel groups concerning the efficacy of heat application vs. treatment as usual. One of the inclusion criteria is body temperatures ≥ 38.0 °C in n = 24 cases of patients receiving chemotherapy aged 18 months to 17 years. The first intervention consists of gentle heat application with hot water bottles at any sign of illness and onset of fever. The aim is to achieve a warm periphery equilibrated to trunk temperature of less than 0.5 °C. The second intervention is the avoidance of antipyretics. The control group receives the standard antipyretic treatment from the participating hospital. The purposes of this pilot study are proof of principle of intervention, evaluation of safety, feasibility, definition of endpoints, and to receive basic data for sample size calculation and needed resources. Discussion The main goal is to improve the care of children with cancer by providing the best possible support for febrile episodes. If fever support by heat reduces discomfort, administration of antipyretics and maybe even antibiotics, this would be an advancement in oncological fever management. This pilot study is intended to provide a basis for a main, multicenter, randomized trial and demonstrate the practicability of heat application in febrile patients in pediatric oncology. Trial registration German Clinical Trials Register (DRKS), DRKS00028273. Registered on 14 April 2022

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Section: Fever Managementmentioning

confidence: 99%

Warming up for a better fever: a randomized pilot study in pediatric oncology

Krafft

Raak

Jenetzky

et al. 2022

Pilot Feasibility Stud

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“… In the absence of illness that requires specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy for a child with fever. Therefore it is important to assess the child's level of discomfort ( Table 8 ) [ 71 ]. Table 8 Signs of distress in a child with fever and factors to consider when evaluating the level of distress [ 71 ].

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Section: Section B Full Guidelinementioning

confidence: 99%

“… Antipyretics should be used to make the child more comfortable and not used routinely with the sole aim of reducing the temperature [ 2 , 3 , 21 , 71 ]. When antipyretics are not indicated at time of consultation, one or two days of antipyretic medication may be prescribed for use at home should it become necessary (see Box 4 , Box 5 ).…”

Section: Section B Full Guidelinementioning

confidence: 99%

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Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

Green

Webb²,

Jeena

et al. 2021

African Journal of Emergency Medicine

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Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

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“…We kunnen hen helpen te leren om koorts als losstaand symptoom (zonder andere alarmerende symptomen) ongemoeid te laten. 8 Koortsstuipen komen voor bij ongeveer 3% van de kinderen, meestal tussen de leeftijd van zes maanden tot vijf jaar. Een koortsstuip bij een kind wordt door ouders begrijpelijkerwijs als uiterst indrukwekkend en beangstigend ervaren.…”

Section: Merel Kolderieunclassified

Koorts als Kracht

Kolderie¹

2021

Homœopathic Links

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Understanding Discomfort in Order to Appropriately Treat Fever

Cited by 13 publications

References 25 publications

Warming up for a better fever: a randomized pilot study in pediatric oncology

Warming up for a better fever: a randomized pilot study in pediatric oncology

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

Koorts als Kracht

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