What management should be offered to a 17-month-old ex-preterm infant, born at 25 weeks (twenty-five weeks) of gestation, presenting with a 24-hour history of fever and dry cough?

From the Guidelines

For a 17-month-old ex-premature infant born at 25 weeks who has had fever for 24 hours with a dry cough, I recommend prompt medical evaluation, preferably in a pediatric emergency department or urgent care setting. While waiting for medical care, acetaminophen (Tylenol) can be given for fever management at a dose of 10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours. Ensure adequate hydration by offering frequent small amounts of clear fluids. Monitor for signs of respiratory distress including rapid breathing, retractions, nasal flaring, or bluish discoloration. This child requires professional assessment because premature infants, especially those born at 25 weeks, have higher risks for respiratory complications from common viral illnesses, as noted in studies such as 1 and 1. Their lungs may be underdeveloped with chronic lung disease (bronchopulmonary dysplasia) making them more vulnerable to respiratory infections. The combination of prematurity history, young age, fever, and cough warrants medical evaluation to rule out serious conditions like pneumonia, RSV, or other respiratory infections that may require specific treatments beyond supportive care, as discussed in guidelines such as 1 and 1.

Key considerations in the management of this child include:

• The importance of early recognition and treatment of potential respiratory complications, as emphasized in 1 and 1.
• The need for careful assessment of the child's respiratory status, including monitoring for signs of distress and potential complications, as discussed in 1 and 1.
• The potential benefits of antiviral medications, such as oseltamivir, in the treatment of influenza, as noted in 1.
• The importance of considering the child's individual risk factors, including prematurity and underlying medical conditions, in determining the best course of management, as emphasized in 1.

Overall, prompt medical evaluation and careful management are essential to ensure the best possible outcomes for this child.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Management of a 17-month-old Ex-preterm Infant

The management of a 17-month-old ex-preterm infant, born at 25 weeks of gestation, presenting with a 24-hour history of fever and dry cough, should be based on the individual's medical history and current clinical presentation.

• The infant's history of prematurity is significant, as extremely preterm infants are at a higher risk of respiratory complications and may require closer monitoring and more intensive management 2.
• The symptoms of fever and dry cough could be indicative of a respiratory infection, such as COVID-19, which has been shown to present with a wide range of symptoms, including fever, cough, and shortness of breath 3, 4.
• The management of COVID-19 in outpatient settings is primarily supportive, with a focus on education about isolation and symptom management 3.
• However, given the infant's history of prematurity and potential for respiratory complications, closer monitoring and more intensive management may be necessary.
• The use of noninvasive ventilation and other respiratory support measures may be considered, depending on the infant's clinical presentation and medical history 5.
• It is also important to consider the potential for coexisting alternative diagnoses, such as spontaneous tension pneumothorax or acute pulmonary emboli, which have been reported in patients with COVID-19 4.

Considerations for Ex-preterm Infants

• Ex-preterm infants are at a higher risk of post-operative apnoea and other respiratory complications, and require careful management and monitoring in the post-operative period 6.
• The use of regional anaesthesia and avoidance of opioids and muscle relaxants may be recommended for ex-preterm infants undergoing surgery 6.
• Close monitoring and follow-up are essential for ex-preterm infants, particularly those with a history of respiratory complications or other medical conditions.