Neisseria meningitidis meningococcal disease. Vomiting or coughing - occurs in the distribution of the superior vena cava which is above the level of the nipples. Local physical pressure eg holding child during procedure, tight tourniquet. Non-accidental injury or accidental injury. Immune thrombocytopenia ITP. Note: There are additional causes of petechiae that should be considered in newborns eg congenital cytomegalovirus, toxoplasmosis, neonatal lupus.
Any newborn with petechiae should be promptly reviewed with a senior clinician. Blood also can collect under the tissue in larger flat areas called purpura , or in a very large bruised area called an ecchymosis. Aside from the common bruise, bleeding into the skin or mucous membranes is a very significant sign and should always be checked out by a health care provider.
Redness of the skin erythema should not be mistaken for bleeding. Areas of bleeding under the skin do not become paler blanch when you press on the area, like the redness from erythema does. Protect aging skin. Avoid trauma such as bumping or pulling on skin areas. For a cut or scrape, use direct pressure to stop the bleeding. If you have a drug reaction, ask your provider about stopping the drug. Otherwise, follow your prescribed therapy to treat the underlying cause of the problem.
Hayward CPM. Clinical approach to the patient with bleeding or bruising. Hematology: Basic Principles and Practice. Philadelphia, PA: Elsevier; chap The acutely ill patient with fever and rash.
Palpable purpura is purpura than can be felt, due to inflammation of the blood vessels vasculitis. All children with fever and petechiae should be reviewed by a registrar or consultant.
The majority of children with fever and petechiae do not have an identifiable cause - they are presumably due to viral infections. However, recognition and early treatment of the child with meningococcal disease is paramount.
Clinical signs and laboratory investigations may help determine those who should be treated for suspected meningococcal disease.
All unwell children with fever and petechiae should be treated for meningococcaemia. See Meningococcaemia Guideline for details on the management of a child with suspected meningococcal disease. Important principles in the management of meningococcal disease include immediate fluid resuscitation, early administration of antibiotics 3rd generation cephalosporin and involvement of intensive care staff.
Children who are well and have a clear history of a mechanical cause for their petechiae do not require investigation and may be discharged with clinical review planned within 24 hours. This can be with the GP. Local physical pressure such as a tight tourniquet, being held tightly for procedures, stroller straps, car seats, leg caught in cots. If there is any doubt about the aetiology of the petechiae, children should be managed as below.
These children should ideally be reviewed by a senior medical officer prior to any disposition decisions being made.
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