NICE儿童发热指南(中英版)
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NICE儿童发热指南
NICE has accredited the process used by the Centre for Clinical Practice at NICE to produce guidelines. Accreditation is valid for 5 years from September 2009 and applies to guidelines produced since April 2007 using the proce**s described in NICE's 'The guidelines manual' (2007, updated 2009). More information on accreditation can be viewed at www.nice.org.uk/accreditation
Feverish illness in children
儿童发热
A**ssment and initial management in children younger than 5 years
针对5岁以下儿童的评估与初步诊疗指南
Issued: May 2013
出版日期：2013年5月
NICE clinical guideline 160
NICE临床指南160号
guidance.nice.org.uk/cg160
Contents
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Introduction
引言
Feverish illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. Feverish illness is very common in young children, with between 20 and 40% of parents reporting such an illness each year. As a result, fever is probably the commonest reason for a child to be taken to the doctor. Feverish illness is also the second most common reason for a child being admitted to hospital. Despite advances in healthcare, infections remain the leading cause of death in children under the age of 5 years.
儿童发热通常提示有潜在感染，同时这也是家长和护理人关心的一大原因。发热在儿童群体中非常常见，约20%到40%的家长称他们的孩子每年都会经历一次发热。因此，发热可能是孩子去看医生的最常见原因。同时，发热也是儿童入院的第二常见原因。尽管医疗保健系统已日趋完善，但是对于5岁以下儿童来说，感染依旧是头号死亡原因。
Fever in young children can be a diagnostic challenge for healthcare professionals because it is often difficult to identify the cause. In most cases, the illness is due to a self-limiting viral infection. However, fever may also be the presenting feature of serious bacterial infections such as meningitis or pneumonia. A significant number of children have no obvious cause of fever despite careful a**ssment. These children with fever without apparent source are of particular concern to healthcare professionals because it is especially difficult to distinguish between simple viral illne**s and life-threatening bacterial infections in this group. As a result, there is a perceived need to improve the recognition, a**ssment and immediate treatment of feverish illne**s in children.
对于一名医疗保健专业人员而言，小儿发热常常会成为一个诊断难题，因为很难去鉴别病因。在多数病例中，发热是由于自限性病毒感染所致。但是，发热也可能是严重细菌感染比如脑膜炎及肺炎的临床症状。有相当一部分儿童经过详细的诊断后依旧未能找到发热的原因。对于医疗保健专业人员来说，他们相当关注这一部分无法找到缘由的发热的患儿，因为要鉴别他们是因为单纯病毒感染还是致命细菌感染十分困难。因此，我们很有必要改善对发热患儿的诊断、评估以及及时的治疗措施。
The introduction of new vaccination programmes in the UK may have significantly reduced the level of admissions to hospital resulting from diseases covered by this guideline. For example, early analysis of the pneumococcal vaccination programme in England shows that the incidence of pneumococcal-related disease has fallen 98% in children younger than 2 years since vaccination was introduced. However, evidence suggests a 68% increase in the prevalence of disease caused by subtypes of bacteria not covered by vaccination programmes. Also, potentially serious cases of feverish illness are likely to be rare, so it is important that information is in place to help healthcare professionals distinguish these from mild cases.
英国一项新的疫苗接种计划可能会显著降低由本指南覆盖的疾病所致入院的人数。例如，英格兰肺炎疫苗接种早期数据分析显示2岁以下儿童肺炎相关疾病自肺炎疫苗接种后降低了98%。但是，证据提示由细菌亚型所导致疾病患病率提高68%，而这些细菌亚型恰恰不在接种范围内。同时，一些发热的潜在严重病例很可能是罕见的，因此这些信息对于帮助医疗保健专业人员将其与一般病例鉴别是很重要的。
This guideline is designed to assist healthcare professionals in the initial a**ssment and immediate treatment of young children with fever presenting to primary or secondary care.
本指南旨在为医疗保健专业人员在对实行初级护理或二级护理的发热儿童的初步评估和及时治疗提供帮助。
The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.
本指南是以处方者将使用药物基本特性来判断患者预后为假设前提。
For information on groups that are included and excluded in this guideline see Feverish illness in children: final scope.
本指南中包含或未包含的信息详见《儿童发热疾病：最后范围》
Patient-centred care
以患者为中心的护理
This guideline offers best practice advice on the care of children younger than 5 years with feverish illness.
本指南提供针对5岁以下发热儿童的最佳治疗建议。
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of lib**y safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
患者与医疗保健专业人员均有所有NICE指南中提及的权利和义务。治疗和护理应该考虑个体差异和喜好。患者应该拥有与他们的主治医师对自己的治疗和护理做出决定的机会。如果患者无行为能力，医疗保健专业人员应遵从卫生部规定、心智能力法以及自由保障剥夺的补充意见。在威尔士，医疗保健专业人员应遵照威尔士政府规定。
If the patient is under 16, healthcare professionals should follow the guidelines in the Department of Health's Seeking consent: working with children. Families and carers should also be given the information and support they need to help the child or young person in making decisions about their treatment.
若患者年龄为16岁以下，医疗保健专业人员应遵照卫生部指南《与儿童合作》。家人和护理人也同时应该提供医疗保健专业人员所需的可对患儿治疗方案起决定作用的信息并给予支持。
Key priorities for implementation
实施关键
The following recommendations have been identified as priorities for implementation.
以下建议均为建议首选措施。
Thermometers and the detection of fever
温度计和发热的判断
•In children aged 4 weeks to 5 years, measure body temperature by one of the following methods:
•对4周大婴儿到5岁儿童，测量体温可选择以下方法中的任意一种：
- electronic thermometer in the axilla
- 腋窝下使用电子体温计测量
- chemical dot thermometer in the axilla
- 腋窝下使用水银温度计测量
- infra-red tympanic thermometer.
- 红外耳膜温度计【2007】
•Reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals.
•发热患儿父母描述应被医疗保健专业人员高度重视。【2007】
Clinical a**ssment of the child with fever
发热儿童临床评估
•A**ss children with feverish illness for the presence or absence of symptoms and signs that can be used to predict the risk of serious illness using the traffic light system (see table 1).
•运用“交通灯”系统对发热儿童现有或既往症状进行危重疾病风险评估【2013】
•Measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine a**ssment of a child with fever.
•测量并记录发热儿童的体温、心率、呼吸频率以及毛细血管再充盈时间，这是常规评估的一部分。【2007】
•Recognise that children with tachycardia are in at least an intermediate-risk group for serious illness. Use the Advanced Paediatric Life Support (APLS) criteria below to define tachycardia:
•心动过速患儿至少应判为中危。可使用下面的儿科高级生命支持标准（如下）来进行鉴别。【2013新】
Age 年龄 Heart rate (bpm)心率
<12 months 小于12月龄 >160
12–24 months 12月龄到24月龄 >150
2–5 years2-5岁 >140
Management by remote a**ssment
远程评估诊疗
•Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be urgently a****d by a healthcare professional in a face-to-face setting within 2 hours.
•任何具有“红色”特征的但并不考虑有危及生命疾病的应该在2小时内立即由医疗保健专业人员进行面对面评估。【2007】
Management by the non-paediatric practitioner
非专业儿科医师的诊疗
•If any 'amber' features are present and no diagnosis has been reached, provide parents or carers with a 'safety net' or refer to specialist paediatric care for further a**ssment. The safety net should be 1 or more of the following:
•若任何具有“**”特征儿童没有得出诊断，请告知家长或护理人以安全须知或者推介专业儿科医生以进行进一步评估。安全须知应包含下列条目中至少一条
- providing the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be acce**d (see section 1.7.2)
- 提供给家长或者护理人口头和/或手写的信息，该信息应含有需警惕的症状以及可以实施的护理措施。（详见节1.7.2）
- arranging further follow-up at a specified time and place
- 安排详细时间进行进一步跟进诊疗
- liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further a**ssment is required.
- 联系其他医疗保健专业人员，包括非当班医生，以保证如果需要进一步评估时可以直接进行【2007】
Management by the paediatric specialist
儿科专家的诊疗
•Perform the following investigations in infants younger than 3 months with fever:
•对3月龄以下婴儿需要进行以下检查
- full blood count
- 全血细胞计数
- blood culture
- 血培养
- C-reactive protein
- C反应蛋白
- urine testing for urinary tract infection
- 尿常规（排除尿路感染）
- chest X-ray only if respiratory signs are present
- 当存在呼吸系统症状时拍胸片
- stool culture, if diarrhoea is present.
- 若腹泻，进行粪便培养【2013】
Antipyretic interventions
退热措施
•Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose.
•退热药物不能预防热性惊厥也不可进行预防性使用。【2007】
•When using paracetamol or ibuprofen in children with fever;
•当对发热儿童使用对乙酰氨基酚或者布洛芬时
- continue only as long as the child appears distre**d
- 只有当患儿表现痛苦不适时才可持续使用
- consider changing to the other agent if the child's distress is not alleviated
- 当患儿的不适并未减轻时可考虑更换其他药物
- do not give both agents simultaneously
- 切勿同时使用两种药物
- only consider alternating these agents if the distress persists or recurs before the next dose is due.
- 只有在患儿的不适持续或者复发同时在现有药物作用时间结束后才可考虑更换药物。【2013新】
1 Recommendations
建议
The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance.
以下建议均基于现有最优证据。完整版指南会提供理论细节以及用于升级指南的证据。
The wording used in the recommendations in this guideline denotes the c**ainty with which the recommendation is made (the strength of the recommendation). See About this guideline for details.
本建议使用的措辞展示了建议出台的必然性（建议强度）。可查看指南详情。
This guideline is intended for use by healthcare professionals for the a**ssment and initial management in young children with feverish illness. The guideline should be followed until a clinical diagnosis of the underlying condition has been made. Once a diagnosis has been made, the child should be treated according to national or local guidance for that condition.
本指南适用于需要对发热儿童进行评估和初步管理的医疗保健专业人员。在没有对潜在感染做出临床诊断前，均应遵从本指南。一旦确定临床诊断，患儿应该按照该疾病在国家或当地的诊疗常规进行治疗。
Parents or carers of a child with fever may approach a range of different healthcare professionals as their first point of contact, for example, a GP, a pharmacist or an emergency care practitioner. The training and experience of the healthcare professionals involved in the child's care will vary and each should interpret the guidance according to the scope of their own practice.
儿童的家长或监护人会根据所在地区的不同接触到不同的医疗保健专业人员，例如，全科医生，药剂师或者急诊医师。医疗保健专业人员所受的关于儿童保健的训练及其经验存在差异，每一位都应根据自己的执业范围做出相应的解释和引导。
For the purposes of this guideline, fever was defined as 'an elevation of body temperature above the normal daily variation'.
根据本指南，发热的定义为“体温高于平日正常体温”
This guideline should be read in conjunction with:
本指南应该配合以下指南共同阅读：
•Bacterial meningitis and meningococcal septicaemia (NICE clinical guideline 102).
•细菌性脑膜炎及脑膜炎球菌败血症（NICE临床指南102号）
•Urinary tract infection in children (NICE clinical guideline 54)
•儿童尿路感染（NICE临床指南54号）.
•Diarrhoea and vomiting in children under 5 (NICE clinical guideline 84).
•5岁以下儿童的腹泻和呕吐（NICE临床指南84号）
1.1 Thermometers and the detection of fever
温度计和发热的诊断
1.1.1 Oral and rectal temperature measurements
口腔温度及直肠温度的测量
1.1.1.1Do not routinely use the oral and rectal routes to measure the body temperature of children aged 0–5 years.
对0到5岁的儿童，测量口腔温度和直肠温度不作为测量体温的常规方式。【2007】
1.1.2 Measurement of body temperature at other sites
其他部位测量体温的方法
1.1.2.1In infants under the age of 4 weeks, measure body temperature with an electronic thermometer in the axilla.
4周龄以下的婴儿，测量体温可在腋窝下使用电子体温计。【2007】
1.1.2.2In children aged 4 weeks to 5 years, measure body temperature by one of the following methods:
对于4周龄到5岁儿童，测量体温可使用下列方法中的任意一种：
•electronic thermometer in the axilla
•腋窝下使用电子体温计
•chemical dot thermometer in the axilla
•腋窝下使用水银温度计
•infra-red tympanic thermometer.
•红外线耳膜温度计【2007】
1.1.2.3Healthcare professionals who routinely use disposable chemical dot thermometers should consider using an alternative type of thermometer when multiple temperature measurements are required.
习惯使用一次性体温计的医疗保健专业人员在需要进行多点测定温度时应该考虑更换温度计类型。【2007】
1.1.2.4Forehead chemical thermometers are unreliable and should not be used by healthcare professionals.
额部化学温度计不可靠，医疗保健专业人员不应使用。【2007】
1.1.3 Subjective detection of fever by parents and carers
家长和护理人的主观判断
1.1.3.1Reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals.
发热患儿父母描述应被医疗保健专业人员高度重视。【2007】
1.2 Clinical a**ssment of children with fever
针对发热患儿的临床评估
1.2.1 Life-threatening features of illness in children
危及生命的儿科疾病
1.2.1.1First, healthcare professionals should identify any immediately life-threatening features, including compromise of the airway, breathing or circulation, and decreased level of consciousness.
首先，医疗保健专业人员应该识别任何危及生命的体征，包括气道通畅度、呼吸、循环以及意识水平下降程度。【2007】
1.2.2 A**ssment of risk of serious illness
危重疾病风险评估
1.2.2.1A**ss children with feverish illness for the presence or absence of symptoms and signs that can be used to predict the risk of serious illness using the traffic light system (see table 1).
针对发热儿童现有和既往症状可以用交通灯系统（详见表格1）来预测危重疾病风险。【2013】
1.2.2.2When a**ssing children with learning disabilities, take the individual child's learning disability into account when interpreting the traffic light table.
当对具有学习障碍的儿童进行评估时，须将患儿的学习障碍考虑在内。【2013新】
1.2.2.3Recognise that children with any of the following symptoms or signs are in a high-risk group for serious illness:
发现儿童存在以下症状时，则可判断高危。
•pale/mottled/ashen/blue skin, lips or tongue
•苍白、斑驳、灰白、青紫的皮肤、嘴唇或舌头
•no response to social cues
•无对答
•appearing ill to a healthcare professional
•病态面容
•does not wake or if roused does not stay awake
•不醒或唤醒后不保持觉醒状态
•weak, high-pitched or continuous cry
•虚弱，高度紧张或持续哭泣
•Grunting
•大叫
•respiratory rate greater than 60 breaths per minute
•呼吸频率高于每分钟60次
•moderate or severe chest indrawing
•中度或重度胸部凹陷
•reduced skin turgor
•皮肤肿胀消退
•bulging fontanelle.
•涨囟【2013新】
1.2.2.4Recognise that children with any of the following symptoms or signs are in at least an intermediate-risk group for serious illness:
发现患儿具备下列症状，则可判断至少中危
•pallor of skin, lips or tongue reported by parent or carer
•家长或护理人报告皮肤、嘴唇或舌头苍白
•not responding normally to social cues 3
•对答不流利
•no smile
•无笑容
•wakes only with prolonged stimulation
•只有不断刺激才会保持清醒
•decreased activity
•活动减少
•nasal flaring
•鼻翼扇动
•dry mucous membranes
•粘膜干燥
•poor feeding in infants
•婴幼儿进食少
•reduced urine output
•尿量减少
•rigors.
•僵直【2013新】
1.2.2.5Recognise that children who have all of the following features, and none of the high- or intermediate-risk features, are in a low-risk group for serious illness:
发现儿童体征为以下条目同时无高危或中危体征时，则可判断低危。
•normal colour of skin, lips and tongue
•皮肤、嘴唇及舌头颜色正常
•responds normally to social cues 3
•对答流利
•content/smiles
•心情愉悦
•stays awake or awakens quickly
•清醒状态或可快速唤醒
•strong normal cry or not crying
•哭声响亮或不哭泣
•normal skin and eyes
•眼睛与皮肤无异常
•moist mucous membranes.
•黏膜湿润【2013新】
1.2.2.6Measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine a**ssment of a child with fever.
将体温、心率、呼吸频率以及毛细血管再充盈时间作为发热儿童常规评估的一部分进行测量并记录。【2007】
1.2.2.7Recognise that a capillary refill time of 3 seconds or longer is an intermediate-risk group marker for serious illness ('amber' sign).
毛细血管再充盈时间长于3秒或以上为中危（ “黄灯”症状）【2013】
1.2.2.8Measure the blood pressure of children with fever if the heart rate or capillary refill time is abnormal and the facilities to measure blood pressure are available.
当发热患儿心率或毛细血管再充盈时间异常并且有设备可测量血压时测量患儿血压【2007】
1.2.2.9In children older than 6 months do not use height of body temperature alone to identify those with serious illness.
6月龄以下儿童请勿单独使用身体温度高这一标准来鉴别危重疾病【2013】
1.2.2.10 Recognise that children younger than 3 months with a temperature of 38°C or higher are in a high-risk group for serious illness.
发现3月龄以下儿童体温为38℃或以上时则可判断高危【2013】
1.2.2.11 Recognise that children aged 3–6 months with a temperature of 39°C or higher are in at least an intermediate-risk group for serious illness.
发现3-6月龄儿童体温为39℃或以上时则判断至少中危。【2013新】
1.2.2.12 Do not use duration of fever to predict the likelihood of serious illness. However, children with a fever lasting more than 5 days should be a****d for Kawasaki disease (see recommendation 1.2.3.10).
请勿使用发热持续时间来判断危重程度。但是，发热持续至少5天以上应考虑川崎病（详见建议1.2.3.10）【2013新】
1.2.2.13 Recognise that children with tachycardia are in at least an intermediate-risk group for serious illness. Use the Advanced Paediatric Life Support (APLS) criteria below to define tachycardia:
发现患儿存在心动过速则可判断至少中危。使用儿科高级生命支持标准（如下）来鉴别是否为心动过速【2013新】
Age年龄 Heart rate (bpm)心率
<12 months小于12月龄 >160
12–24 months12月龄到24月龄 >150
2–5 years 2到5岁 >140
1.2.2.14 A**ss children with fever for signs of dehydration. Look for:
评估发热患儿是否存在脱水，可观察是否存在以下体征：
•prolonged capillary refill time
•毛细血管再充盈时间延长
•abnormal skin turgor
•皮肤异常肿胀
•abnormal respiratory pattern
•呼吸模式异常
•weak pulse
•脉弱
•cool extremities.
•四肢冰凉【2007】
1.2.3 Symptoms and signs of specific illne**s
某些特殊疾病的症状和体征
1.2.3.1Look for a source of fever and check for the presence of symptoms and signs that are associated with specific diseases (see table 2).
查找发热源并确定现有症状及体征是否与某种特殊疾病相关（详见表2）。【2007】
1.2.3.2Consider meningococcal disease in any child with fever and a non-blanching rash, particularly if any of the following features are present:
当发热患儿出现不褪色皮疹，同时出现下列症状的时候，考虑流行性脑膜炎
•an ill-looking child
•病态面容
•lesions larger than 2 mm in diameter (purpura)
•损伤直径大于2mm（紫癜）
•a capillary refill time of 3 seconds or longer
•毛细血管再充盈时间为3秒或以上
•neck stiffness.
•颈项强直【2007】
1.2.3.3Consider bacterial meningitis in a child with fever and any of the following features5:
当发热患儿存在以下任意症状时，考虑细菌性脑膜炎
•neck stiffness
•颈项强直
•bulging fontanelle
•涨囟
•decreased level of consciousness
•意识水平降低
•convulsive status epilepticus.
•惊厥性癫痫持续状态【2007,2013修订】
1.2.3.4Be aware that classic signs of meningitis (neck stiffness, bulging fontanelle, high-pitched cry) are often absent in infants with bacterial meningitis5.
需要注意的是患有细菌性脑膜炎的婴儿常常不可及脑膜炎基本体征（如颈项强直、涨囟、哭声高亢）。【2007】
1.2.3.5Consider herpes simplex encephalitis in children with fever and any of the following features:
发热患儿存在以下任意症状时考虑单纯疱疹脑炎
•focal neurological signs
•局限性神经系统损害
•focal seizures
•局灶性癫痫
•decreased level of consciousness.
•意识水平下降【2007】
1.2.3.6Consider pneumonia in children with fever and any of the following signs:
当发热患儿存在以下任意症状时考虑肺炎
•tachypnoea (respiratory rate greater than 60 breaths per minute, age 0–5 months; greater than 50 breaths per minute, age 6–12 months; greater than 40 breaths per minute, age older than 12 months)
•呼吸急促（0-5月龄：呼吸频率大于60次/分钟；6-12月龄：呼吸频率大于50次/分钟；12月龄以上：呼吸频率大于40次/分钟）
•crackles in the chest
•胸部听诊闻及啰音
•nasal flaring
•鼻翼扇动
•chest indrawing
•胸廓凹陷
•Cyanosis
•发绀
•oxygen saturation of 95% or less when breathing air.
•呼吸时血氧浓度为95%或以下【2007】
1.2.3.7Consider urinary tract infection in any child younger than 3 months with fever.
3月龄以下发热儿童考虑尿路感染。【2007】
1.2.3.8Consider urinary tract infection in a child aged 3 months or older with fever and 1 or more of the following6:
3月龄及以上发热儿童存在下列症状一个或以上时，考虑尿路感染
•Vomiting
•呕吐
•poor feeding
•进食少
•Lethargy
•昏睡
•Irritability
•烦躁
•abdominal pain or tenderness
•腹部疼痛或压痛
•urinary frequency or dysuria.
•尿频或排尿困难【2013新】
1.2.3.9Consider septic arthritis/osteomyelitis in children with fever and any of the following signs:
当发热儿童存在下列任意症状时，考虑化脓性关节炎/骨髓炎
•swelling of a limb or joint
•关节或四肢肿胀
•not using an extremity
•四肢无力
•non-weight bearing.
•不可负重【2007】
1.2.3.10 Consider Kawasaki disease in children with fever that has lasted longer than 5 days and who have 4 of the following 5 features:
当发热儿童发热时间长达5天或以上同时存在以下5个症状中的四个时，考虑川崎病
•bilateral conjunctival injection
•球结合膜出血
•change in mucous membranes in the upper respiratory tract (for example, injected pharynx, dry cracked lips or strawberry tongue)
•上呼吸道黏膜改变（例如咽喉充血、唇充血皲裂或草莓舌）
•change in the extremities (for example, oedema, erythema or desquamation)
•手足症状（例如：水肿、红斑及脱屑）
•polymorphous rash
•多形性皮斑
•cervical lymphadenopathy
- Information: Soft return used in paragraph
Be aware that, in rare cases, incomplete/atypical Kawasaki disease may be diagnosed with fewer features.
•颈部淋巴结肿大
需要注意的是，在某些罕见病例里，不足4个症状也可诊断川崎病。【2007】
1.2.4 Imported infections
输入性感染
1.2.4.1When a**ssing a child with feverish illness, enquire about recent travel abroad and consider the possibility of imported infections according to the region visited.
当评估发热儿童时，询问近期旅游记录同时考虑外来地区输入性感染可能。
Table 1 Traffic light system for identifying risk of serious illness
表格1 危重疾病风险评估交通灯系统【2013新】
Children with fever and any of the symptoms or signs in the red column should be recognised as being at high risk. Similarly, children with fever and any of the symptoms or signs in the amber column and none in the red column should be recognised as being at intermediate risk. Children with symptoms and signs in the green column and none in the amber or red columns are at low risk. The management of children with fever should be directed by the level of risk.
发热儿童存在“红灯”一栏里的任何症状时均可判断为高危。同样的，发热儿童存在“黄灯”一栏里的任何症状同时不存在“红灯”里的任何一项症状时可判断为中危。无“红灯”和“黄灯”一栏的符合“绿灯”一栏的儿童可判断为低危。对发热儿童的治疗应与危险程度匹配
This traffic light table should be used in conjunction with the recommendations in this guideline on investigations and initial management in children with fever.
在对发热患儿进行诊断及初步治疗时，交通灯系统应与本指南中的建议共同使用。
A colour version of this table is available.
Green – low risk
绿灯—低危 Amber – intermediate risk
黄灯—中危 Red – high risk
红灯—高危
Colour
(of skin, lips or tongue)
皮肤、嘴唇、舌头颜色 • Normal colour
• 正常
• Pallor reported by parent/carer
• 家长或护理人报告苍白 • Pale/mottled/ashen/blue
• 苍白、斑点状、发灰、青紫
Activity
行为 • Responds normally to social cues
• 对答流利
• Content/smiles
• 心情愉悦
• Stays awake or awakens quickly
• 清醒状态或可快速唤醒
• Strong normal cry/not crying
• 哭声响亮或不哭泣 • Not responding normally to social cues
• 对答不流利
• No smile
• 无笑容
• Wakes only with prolonged stimulation
• 长时刺激才可唤醒
• Decreased activity
• 活动度下降
• No response to social cues
• 无对答
• Appears ill to a healthcare professional
• 病态面容
• Does not wake or if roused does not stay awake
• 无法唤醒或无法保持清醒状态
• Weak, high-pitched or continuous cry
• 虚弱、哭声高亢或持续哭泣
Respiratory
呼吸 • Nasal flaring
• 鼻翼扇松
• Tachypnoea: respiratory rate
• 呼吸急促：呼吸频率
->50 breaths/minute, age 6–12 months;
-6-12月龄：大于50次/分钟
->40 breaths/minute, age >12 months
-大于12月龄：大于40次/分钟
• Oxygen saturation ≤95% in air
• 血氧饱和度95%或以下
• Crackles in the chest
• 肺部听诊可及啰音 • Grunting
• 咕哝声
• Tachypnoea: respiratory rate >60 breaths/minute
• 呼吸急促：呼吸频率大于60次/分钟
• Moderate or severe chest indrawing
• 中等或严重胸部凹陷
Circulation and hydration
循环和水合作用 • Normal skin and eyes
• 皮肤和眼睛正常
• Moist mucous membranes
• 黏膜湿润
• Tachycardia:
• 心动过速
->160 beats/minute, age <12 months
-12月龄以下：大于160次/分钟
->150 beats/minute, age 12–24 months
-12-24月龄：大于150次/分钟
->140 beats/minute, age 2–5 years
-2到5岁：大于140次/分钟
• Capillary refill time ≥3 seconds
• 毛细血管再充盈时间为3秒以上
Dry mucous membranes
• 粘膜干燥
• Poor feeding in infants
• 婴幼儿进食量少
• Reduced urine output
• 尿量减少
• Reduced skin turgor
• 皮肤肿胀消失
Other
其他 • None of the amber or red symptoms or signs
• 无“黄灯”或“红灯”中的症状或体征
• Age 3–6 months, temperature ≥39°C
• 3-6月龄，体温为39℃或以上
• Fever for ≥5 days
• 发热持续5天或以上
• Rigors
• 僵直
• Swelling of a limb or joint
• 四肢或关节肿胀
• Non-weight bearing limb/not using an extremity
• 无法负重/四肢无力
• Age <3 months, temperature ≥38°C
• 3月龄以下，体温为38℃或以上
• Non-blanching rash
• 不褪色皮疹
• Bulging fontanelle
• 涨囟
• Neck stiffness
• 颈项强直
• Status epilepticus
• 癫痫持续状态
• Focal neurological signs
• 局限性神经系统损害
• Focal seizures
• 局灶性癫痫
Table 2 Summary table for symptoms and signs suggestive of specific diseases
表格2 特殊疾病提示性症状总结表【2013】
Diagnosis to be considered
考虑诊断 Symptoms and signs in conjunction with fever
与发热同时出现的症状和体征
Meningococcal disease
流行性脑膜炎 Non-blanching rash, particularly with 1 or more of the following:
不褪色皮疹，同时伴随下列一个或以上症状：
• an ill-looking child
• 病态面容
• lesions larger than 2 mm in diameter (purpura)
• 损伤直径大于2mm（紫癜）
• capillary refill time of ≥3 seconds
• 毛细血管再充盈时间为3秒或以上
• neck stiffness
• 颈项强直
Bacterial meningitis
细菌性脑膜炎 Neck stiffness
颈项强直
Bulging fontanelle
涨囟
Decreased level of consciousness
意识水平下降
Convulsive status epilepticus
惊厥性癫痫持续状态
Herpes simplex encephalitis
单纯疱疹病毒脑炎 Focal neurological signs
局限性神经系统损害
Focal seizures
局灶性癫痫
Decreased level of consciousness
意识水平下降
Pneumonia
肺炎 Tachypnoea (respiratory rate >60 breaths/minute, age 0–5 months; >50 breaths/minute, age 6–12 months; >40 breaths/minute, age >12 months)
呼吸急促（0-5月龄：呼吸频率大于60次/分钟；6-12月龄：呼吸频率大于50次/分钟；12月龄以上：呼吸频率大于40次/分钟）
Crackles in the chest
肺部听诊闻及啰音
Nasal flaring
鼻翼扇动
Chest indrawing
胸廓凹陷
Cyanosis
发绀
Oxygen saturation ≤95%
血氧饱和度为95%或以下
Urinary tract infection
尿路感染 Vomiting
呕吐
Poor feeding
进食量少
Lethargy
昏睡
Irritability
烦躁
Abdominal pain or tenderness
腹部触痛或压痛
Urinary frequency or dysuria
尿频或排尿困难
Septic arthritis
化脓性关节炎/骨髓炎 Swelling of a limb or joint
关节或四肢肿胀
Not using an extremity
四肢无力
Non-weight bearing
不可负重
Kawasaki disease
川崎病 Fever for more than 5 days and at least 4 of the following:
发热5天或以上同时至少存在以下4条症状：
• bilateral conjunctival injection
• 球结合膜出血
• change in mucous membranes
• 上呼吸道黏膜改变（例如咽喉充血、唇充血皲裂或草莓舌）
• change in the extremities
• 手足症状（例如：水肿、红斑及脱屑）
• polymorphous rash
• 多形性皮斑
• cervical lymphadenopathy
• 颈部淋巴结肿大
1.3 Management by remote a**ssment
远程评估的治疗
Remote a**ssment refers to situations in which a child is a****d by a healthcare professional who is unable to examine the child because the child is geographically remote from the a**ssor (for example, telephone calls to NHS Direct). Therefore, a**ssment is largely an interpretation of symptoms rather than physical signs. The guidance in this section may also apply to healthcare professionals whose scope of practice does not include the physical examination of a young child (for example, community pharmacists).
远程评估指一儿童因地理原因因此医疗保健专业人员无法进行查体而只能远程评估（如致电NHS）。因此，该评估更多程度上是症状的口头描述而非可观体征。本章节同样适用于执业范围不包括儿科的医疗保健专业人员（如社区药师）。
1.3.1 Management according to risk of serious illness
根据危险程度进行治疗
1.3.1.1Healthcare professionals performing a remote a**ssment of a child with fever should seek to identify symptoms and signs of serious illness and specific diseases as described in section 1.2 and summarised in tables 1 and 2.
医疗保健专业人员在对发热儿童进行远程评估时应该去询问危重疾病和特殊疾病具有鉴别意义的症状和体征（如章节1.2和表格1及2总结所示）。【2007】
1.3.1.2Children whose symptoms or combination of symptoms suggest an immediately life-threatening illness (see recommendation 1.2.1.1) should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance).
当患儿的症状或综合症状时提示有危及生命的疾病（见建议1.2.1.1）应该立即送往急诊。【2007】
1.3.1.3Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be urgently a****d by a healthcare professional in a face-to-face setting within 2 hours.
•任何具有“红色”特征的但并不考虑有危及生命疾病的儿童应该在2小时内立即由医疗保健专业人员进行面对面评估。【2007】
1.3.1.4Children with 'amber' but no 'red' features should be a****d by a healthcare professional in a face-to-face setting. The urgency of this a**ssment should be determined by the clinical judgement of the healthcare professional carrying out the remote a**ssment.
存在“黄灯”症状但不存在“红灯”症状的儿童应该由医疗保健专业人员进行面对面评估。此评估的紧迫性应该由进行远程评估的医疗保健专业人员所得出的临床判断决定。【2007】
1.3.1.5Children with 'green' features and none of the 'amber' or 'red' features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services (see section 1.7).
无任何“黄灯”或“红灯”症状并符合“绿灯”症状的儿童可由给予了适当护理建议的家长或护理人照顾，护理建议包括何时需要对照医疗保健建议（详见章节1.7）。【2007，2013修订】
1.4 Management by the non-paediatric practitioner
非儿科执业医师治疗
In this guideline, a non-paediatric practitioner is defined as a healthcare professional who has not had specific training or who does not have exp**ise in the a**ssment and treatment of children and their illne**s. This term includes healthcare professionals working in primary care, but it may also apply to many healthcare professionals in general emergency departments.
在本指南里，非儿科执业医师指未接受专业儿科评估和治疗培训的医疗保健专业人员。此类人员包括在社区医院工作的医疗保健专业人员，但也同时适用于日常急诊的医疗保健专业人员。
1.4.1 Clinical a**ssment
临床评估
1.4.1.1Management by a non-paediatric practitioner should start with a clinical a**ssment as described in section 1.2. Healthcare practitioners should attempt to identify symptoms and signs of serious illness and specific diseases as summarised in tables 1 and 2.
非儿科执业医师应根据临床评估（章节1.2所示）开展治疗。执业医师应该尝试鉴别表格1和2中列举的危重疾病和特殊疾病。【2007】
1.4.2 Management according to risk of serious illness
根据危重程度进行治疗
1.4.2.1Children whose symptoms or combination of symptoms and signs suggest an immediately life-threatening illness (see recommendation 1.2.1.1) should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance).
当患儿的症状或综合症状提示有危及生命的疾病（见建议1.2.1.1）应该立即送往急诊。【2007】
1.4.2.2Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be referred urgently to the care of a paediatric specialist.
任何具有“红色”特征的但并不考虑有危及生命疾病的儿童应该转至专业儿科医生处。【2007】
1.4.2.3If any 'amber' features are present and no diagnosis has been reached, provide parents or carers with a 'safety net' or refer to specialist paediatric care for further a**ssment. The safety net should be 1 or more of the following:
若任何具有“**”特征儿童没有得出诊断，告知家长或护理人以安全须知或者推介专业儿科医生以进行进一步评估。安全须知应包含下列条目中至少一条
•providing the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be acce**d (see section 1.7.2)
•提供给家长或护理人口头和/或手写的讯息，该讯息应含有需警惕的症状以及可以实施的护理措施
•arranging further follow-up at a specified time and place
•安排详细时间进行进一步跟进治疗
•liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further a**ssment is required.
•联系其他医疗保健专业人员，包括非当班医生，以保证如果需要进一步评估时可以直接进行。【2007】
1.4.2.4Children with 'green' features and none of the 'amber' or 'red' features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services (see section 1.7).
无任何“黄灯”或“红灯”症状并符合“绿灯”症状的儿童可由给予了适当护理建议的家长或护理人照顾，护理建议包括何时需要对照医疗保健建议（详见章节1.7）。【2007，2013修订】
1.4.3 Tests by the non-paediatric practitioner
非儿科执业医师可执行的检查
1.4.3.1Children with symptoms and signs suggesting pneumonia who are not admitted to hospital should not routinely have a chest X-ray.
对存在提示肺炎的症状和体征的但并未收入院的儿童，胸透不应作为常规检查。【2007】
1.4.3.2Test urine in children with fever as recommended in Urinary tract infection in children (NICE clinical guideline 54).
在儿童尿路感染指南（NICE临床指南54）中，建议发热儿童查尿常规。【2007】
1.4.4 Use of antibiotics by the non-paediatric practitioner
非儿科执业医师抗生素使用
1.4.4.1Do not prescribe oral antibiotics to children with fever without apparent source.
对未明确病原体的发热儿童，不开具口服抗生素。【2007】
1.4.4.2Give parenteral antibiotics to children with suspected meningococcal disease at the earliest opportunity (either benzylpenicillin or a third-generation cephalosporin) 5.
对可疑流行性脑膜炎患儿尽早使用注射用抗生素（青霉素或三代头孢均可）。【2007】
1.3 Management by remote a**ssment
远程评估的治疗
Remote a**ssment refers to situations in which a child is a****d by a healthcare professional who is unable to examine the child because the child is geographically remote from the a**ssor (for example, telephone calls to NHS Direct). Therefore, a**ssment is largely an interpretation of symptoms rather than physical signs. The guidance in this section may also apply to healthcare professionals whose scope of practice does not include the physical examination of a young child (for example, community pharmacists).
远程评估指一儿童因地理原因因此医疗保健专业人员无法进行查体而只能远程评估（如致电NHS）。因此，该评估更多程度上是症状的口头描述而非可观体征。本章节同样适用于执业范围不包括儿科的医疗保健专业人员（如社区药师）。
1.3.1 Management according to risk of serious illness
根据危险程度进行治疗
1.3.1.1Healthcare professionals performing a remote a**ssment of a child with fever should seek to identify symptoms and signs of serious illness and specific diseases as described in section 1.2 and summarised in tables 1 and 2.
医疗保健专业人员在对发热儿童进行远程评估时应该去询问危重疾病和特殊疾病具有鉴别意义的症状和体征（如章节1.2和表格1及2总结所示）。【2007】
1.3.1.2Children whose symptoms or combination of symptoms suggest an immediately life-threatening illness (see recommendation 1.2.1.1) should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance).
当患儿的症状或综合症状时提示有危及生命的疾病（见建议1.2.1.1）应该立即送往急诊。【2007】
1.3.1.3Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be urgently a****d by a healthcare professional in a face-to-face setting within 2 hours.
•任何具有“红色”特征的但并不考虑有危及生命疾病的儿童应该在2小时内立即由医疗保健专业人员进行面对面评估。【2007】
1.3.1.4Children with 'amber' but no 'red' features should be a****d by a healthcare professional in a face-to-face setting. The urgency of this a**ssment should be determined by the clinical judgement of the healthcare professional carrying out the remote a**ssment.
存在“黄灯”症状但不存在“红灯”症状的儿童应该由医疗保健专业人员进行面对面评估。此评估的紧迫性应该由进行远程评估的医疗保健专业人员所得出的临床判断决定。【2007】
1.3.1.5Children with 'green' features and none of the 'amber' or 'red' features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services (see section 1.7).
无任何“黄灯”或“红灯”症状并符合“绿灯”症状的儿童可由给予了适当护理建议的家长或护理人照顾，护理建议包括何时需要对照医疗保健建议（详见章节1.7）。【2007，2013修订】
1.4 Management by the non-paediatric practitioner
非儿科执业医师治疗
In this guideline, a non-paediatric practitioner is defined as a healthcare professional who has not had specific training or who does not have exp**ise in the a**ssment and treatment of children and their illne**s. This term includes healthcare professionals working in primary care, but it may also apply to many healthcare professionals in general emergency departments.
在本指南里，非儿科执业医师指未接受专业儿科评估和治疗培训的医疗保健专业人员。此类人员包括在社区医院工作的医疗保健专业人员，但也同时适用于日常急诊的医疗保健专业人员。
1.4.1 Clinical a**ssment
临床评估
1.4.1.1Management by a non-paediatric practitioner should start with a clinical a**ssment as described in section 1.2. Healthcare practitioners should attempt to identify symptoms and signs of serious illness and specific diseases as summarised in tables 1 and 2.
非儿科执业医师应根据临床评估（章节1.2所示）开展治疗。执业医师应该尝试鉴别表格1和2中列举的危重疾病和特殊疾病。【2007】
1.4.2 Management according to risk of serious illness
根据危重程度进行治疗
1.4.2.1Children whose symptoms or combination of symptoms and signs suggest an immediately life-threatening illness (see recommendation 1.2.1.1) should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance).
当患儿的症状或综合症状提示有危及生命的疾病（见建议1.2.1.1）应该立即送往急诊。【2007】
1.4.2.2Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be referred urgently to the care of a paediatric specialist.
任何具有“红色”特征的但并不考虑有危及生命疾病的儿童应该转至专业儿科医生处。【2007】
1.4.2.3If any 'amber' features are present and no diagnosis has been reached, provide parents or carers with a 'safety net' or refer to specialist paediatric care for further a**ssment. The safety net should be 1 or more of the following:
若任何具有“**”特征儿童没有得出诊断，告知家长或护理人以安全须知或者推介专业儿科医生以进行进一步评估。安全须知应包含下列条目中至少一条
•providing the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be acce**d (see section 1.7.2)
•提供给家长或护理人口头和/或手写的讯息，该讯息应含有需警惕的症状以及可以实施的护理措施
•arranging further follow-up at a specified time and place
•安排详细时间进行进一步跟进治疗
•liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further a**ssment is required.
•联系其他医疗保健专业人员，包括非当班医生，以保证如果需要进一步评估时可以直接进行。【2007】
1.4.2.4Children with 'green' features and none of the 'amber' or 'red' features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services (see section 1.7).
无任何“黄灯”或“红灯”症状并符合“绿灯”症状的儿童可由给予了适当护理建议的家长或护理人照顾，护理建议包括何时需要对照医疗保健建议（详见章节1.7）。【2007，2013修订】
1.4.3 Tests by the non-paediatric practitioner
非儿科执业医师可执行的检查
1.4.3.1Children with symptoms and signs suggesting pneumonia who are not admitted to hospital should not routinely have a chest X-ray.
对存在提示肺炎的症状和体征的但并未收入院的儿童，胸透不应作为常规检查。【2007】
1.4.3.2Test urine in children with fever as recommended in Urinary tract infection in children (NICE clinical guideline 54).
在儿童尿路感染指南（NICE临床指南54）中，建议发热儿童查尿常规。【2007】
1.4.4 Use of antibiotics by the non-paediatric practitioner
非儿科执业医师抗生素使用
1.4.4.1Do not prescribe oral antibiotics to children with fever without apparent source.
对未明确病原体的发热儿童，不开具口服抗生素。【2007】
1.4.4.2Give parenteral antibiotics to children with suspected meningococcal disease at the earliest opportunity (either benzylpenicillin or a third-generation cephalosporin) 5.
对可疑流行性脑膜炎患儿尽早使用注射用抗生素（青霉素或三代头孢均可）。【2007】
1.6 Antipyretic interventions
退热药物干预
1.6.1 Effects of body temperature reduction
降温效果
1.6.1.1Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose.
退热药物不能预防热性惊厥也不可进行预防性使用。【2007】
1.6.2 Physical interventions to reduce body temperature
物理退热
1.6.2.1Tepid sponging is not recommended for the treatment of fever.
不推介将温水擦拭作为发热治疗的一种方式。【2007】
1.6.2.2Children with fever should not be underdre**d or over-wrapped.
发热儿童不应不穿衣服或穿衣过多。【2007】
1.6.3 Drug interventions to reduce body temperature
药物退热
1.6.3.1Consider using either paracetamol or ibuprofen in children with fever who appear distre**d.
当发热儿童表现出不适时才考虑使用对乙酰氨基酚或布洛芬。【2013新】
1.6.3.2Do not use antipyretic agents with the sole aim of reducing body temperature in children with fever.
请勿为了退热而退热。【2013新】
1.6.3.3When using paracetamol or ibuprofen in children with fever:
当使用对乙酰氨基酚或布洛芬时：
•continue only as long as the child appears distre**d
•只有当患儿表现出不适是才继续使用
•consider changing to the other agent if the child's distress is not alleviated
•当患儿的不适并未减轻时可考虑更换其他药物
•do not give both agents simultaneously
•切勿同时使用两种药物
•only consider alternating these agents if the distress persists or recurs before the next dose is due.
•只有在患儿的不适持续或者复发同时在现有药物作用时间结束后才可考虑更换药物
1.7 Advice for home care
家庭护理建议
1.7.1 Care at home
在家护理
1.7.1.1Advise parents or carers to manage their child's temperature as described in section 1.6.
建议家长或护理人按照章节1.6进行护理。【2007】
1.7.1.2Advise parents or carers looking after a feverish child at home:
建议在家护理的家长或护理人：
•to offer the child regular fluids (where a baby or child is breastfed the most appropriate fluid is breast milk)
•规律补液（若处于哺乳期的婴幼儿最合适的液体就是母乳）
•how to detect signs of dehydration by looking for the following features:
•如何在护理中判断是否脱水：
sunken fontanelle
囟门下陷
dry mouth
口唇干燥
sunken eyes
眼眶下陷
absence of tears
少泪
poor overall appearance
虚弱
•to encourage their child to drink more fluids and consider seeking further advice if they detect signs of dehydration
•若发现孩子存在脱水征鼓励孩子多补充液体并咨询进一步建议
•how to identify a non-blanching rash
•鉴别不褪色皮疹
•to check their child during the night
•夜间察看
•to keep their child away from nursery or school while the child's fever persists but to notify the school or nursery of the illness.
•当孩子持续发热时，切勿让孩子上幼儿园或学校同时需要告知幼儿园或学校【2007】
1.7.2 When to seek further help
何时寻求帮助
1.7.2.1Following contact with a healthcare professional, parents and carers who are looking after their feverish child at home should seek further advice if:
在家照顾发热患儿的家长或护理人在面对下列情况时应该咨询医疗保健专业人员：
•the child has a fit
•孩子突然出现痉挛
•the child develops a non-blanching rash
•孩子出现不褪色皮疹
•the parent or carer feels that the child is less well than when they previously sought advice
•家长或护理人主观感觉孩子较咨询意见前情况未好转
•the parent or carer is more worried than when they previously sought advice
•家长或护理人较咨询意见前更加焦虑
•the fever lasts longer than 5 days
•发热长达5天或以上
•the parent or carer is distre**d, or concerned that they are unable to look after their child.
•家长或护理人很伤心，或者担心他们无法照顾孩子。【2007】
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