by Katherine Vaughn, MD


IT'S-PERSONAL-AS-WE-SEE-IT-KATHERINE-VAUGHNI am a pediatrician in general practice, and am now on my second generation of patients. One of the immensely satisfying aspects of my practice is seeing the children that I took care of grow up and become parents themselves.

I was reflecting back on my nearly 28 years in pediatrics and the changes I have seen. A major one is the need to do less invasive evaluations and procedures on young infants when they have a fever.

When I started my training in pediatrics 28 years ago, we had only a few vaccines, specifically DTwP, oral polio and MMR.

We saw quite a few cases of bacterial meningitis, and if an infant developed a fever in the first 2 months of life, they were almost guaranteed to need a ‘full septic workup’ including a spinal tap, blood work and urine sample to make sure they didn’t have a dangerous illness, such as bacteria in their blood (bacteremia), spinal fluid (meningitis), or urinary tract.

The hospital would frequently have one or more patients hospitalized with pneumococcal or haemophilus meningitis (HIB), 2 types of serious bacterial meningitis.

More infants would be hospitalized for ‘rule out sepsis,’ which meant they were admitted for 48 hours of antibiotics after the blood/urine/spinal tests were done until we could make sure they didn’t have a serious infection.

Those children with meningitis could be very sick, and have long term effects such as hearing loss or brain damage, and they were in the hospital longer.

IT'S PERSONAL AS WE SEE IT KATHERINE VAUGHNThe HIB vaccine came out during my training, and by the time I was in private practice, we were seeing less meningitis due to haemophilus, but still quite a few cases of pneumococcal meningitis.

We knew that seeing a young infant with a fever would usually mean a full evaluation. As a physician, I don’t want to poke babies, but I do want to make sure they don’t have a serious illness. The pneumococcal vaccine came out in 2000, and we have since seen a major drop in these infections as well.

From my perspective, one major value of vaccination is that infants and children have fewer very serious illnesses, such as bacterial meningitis, and there is less need to do invasive procedures, such as spinal taps and blood draws.

We still have to consider serious bacterial illness as a cause of a fever, but see many fewer cases.

The infant needs less stressful procedures done, parents have less worry and anxiety, and physicians truly enjoy doing less pokes! That’s a win-win.