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The Short Textbook of Pediatrics
Suraj Gupte
PART ONE: CORE PEDIATRICS
CHAPTER 1:
Pediatric History-taking and Clinical Examination
GOALS
THE ART OF HISTORY TAKING
Basic Information
Presenting Complaints
History of Present Illness
History of Past Illnesses
Birth History
Developmental Milestones
Immunization Status
Dietetic History
Personal History
Family History
Socioeconomic Status
System Review
THE ART OF PHYSICAL EXAMINATION
General Appearance
Anthropometry
Skin
Lymph Nodes
Head
Face
Eyes
Nose
Mouth and Throat
Ears
Neck
Chest
Diastolic Murmurs may be
Abdomen
Genitalia
Rectal Examination
Limbs and Feet
Spine and Back
Neurologic Examination
A SAMPLE (MODEL) PEDIATRIC CASE SHEET
PHYSICAL EXAMINATION*
SYSTEMIC EXAMINATION
SUMMARY OF THE CASE
DISCUSSION
INVESTIGATIONS (You would like to do) PROGRESS NOTES
FURTHER READING
CHAPTER 2:
Pediatrics in the Developing World
CONTEMPORARY PEDIATRICS
Definition and Origin
An Independent and Unique Specialty
CHANGING PEDIATRIC SCENARIO
TROPICAL PEDIATRICS: NEW DEFINITION
RIGHTS OF THE CHILD: YESTERDAY, TODAY AND TOMORROW
CONTEMPORARY DISEASE PATTERN AND CHANGING CONCERNS
MORTALITY SCENARIO AND DELIVERY OF CHILD HEALTH CARE
PEDIATRIC EDUCATION
NEW CHALLENGES
BETTER TOMORROW
FURTHER READING
Articles/Chapters
CHAPTER 3:
Growth and Development
DEFINITIONS
GROWTH STUDIES
VARIOUS FACTORS INFLUENCING GROWTH AND DEVELOPMENT
Genetic Factors
Nutritional Factors
Socioeconomic Factors
Environmental and Seasonal Factors
Chronic Diseases
Growth Potentials
Prenatal and Intrauterine Factors
Emotional Facors
Hormonal Factors
VARIOUS PERIODS OF GROWTH
Prenatal
Postnatal
LAWS (PRINCIPLES) OF GROWTH
Order of Growth
Postnatal Growth Patterns
General Type
Genital Type
Neural Type
Lymphoid Type
Variations in Body Proportions
Types of Body Build (Somatotypes)
Growth Spurts
IMPORTANT CRITERIA/ INDICES FOR ASSESSMENT OF GROWTH
Weight
Length/Height
Weight for Height
Growth Velocity
Body Ratio
Head
Head/Chest Circumference Ratio
Midarm Circumference
Skin-fold Thickness
Body Mass Index (BMI)
Dentition
Bone Age
LINEAR CATCHUP GROWTH
Definition
Influencing Factors
Types
Operative Factors
GROWTH (REFERENCE) STANDARDS: LOCAL OR INTERNATIONAL?
PUBERTY (Adolescence)
DEVELOPMENT
NORMAL DEVELOPMENTAL MILESTONES
ASSESSMENT OF DEVELOPMENT
Denver Developmental Screening Test (DDST)
Denver II (Modified DDST)
Baroda DST
Trivandrum DST
Other Development Screening Tests
APPROACHES TO DEVELOPMENTAL SCREENING
FURTHER READING
Book/Monograph
CHAPTER 4:
Growth Disorders
FAILURE TO THRIVE (FTT)
Defintion
Etiology
Clinical Features
Diagnosis
Treatment
Long-term Sequelae/Consequences
THE CHILD WITH SHORT STATURE
Deflation
Etiology
Diagnostic Approach
Management
OBESITY
FURTHER READING
Book/Monograph
CHAPTER 5:
Developmental Disorders
DEVELOPMENTAL DELAY
Definition
Causes (Table 5.1)
Diagnosis
Management
LEARNING DISABILITY (DYSLEXIA)
Etiology
Classification
Clinical Features
Diagnosis
Treatment
ATTENTION DEFICIT HYPERACIVITY DISORDER (ADHD)
Classification
Etiology
Diagnosis
Management
Tutoring
Pharmacotherapy
Prognosis
AUTISTIC SPECTRUM DISORDERS (ASDs)
Epidemiology
Etiology
Clinical Features
Diagnosis
Management
General
Pharmacothrapy
Prognosis
ENURESIS (BEDWETTING)
Clinical Features
Etiology
Diagnosis
Treatment
CEREBRAL PALSY (CP)
BEHAVIORAL PROBLEMS
FURTHER READING
Books/Monographs
CHAPTER 6:
Child Psychiatry and Behavioral Problems
INTRODUCTION
PSYCHIATRIC DISORDERS: AN OVERVIEW
BEHAVIORAL PROBLEMS
PICA (Geophagia)
Etiology
Clinical Features
Treatment
ANOREXIA NERVOSA AND BULIMIA
ENURESIS (Bedwetting)
ENCOPRESIS
SLEEP WALKING (Somnambulism)
BREATH-HOLDING SPELLS
Etiology
Clinical Features
Diagnosis
Treatment
Prognosis
THUMB SUCKING AND NAILBITING
TEETH GRINDING (Bruxism)
STUTTERING
TICS (Habit Spasm)
SCHOOL PHOBIA (School Refusal, School Withdrawal)
DRUG ABUSE (Substance Abuse)
PERIODIC SYNDROME
HYSTERIA (Hysterical Conversion Reaction)
Common Presentations
Management
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
AUTISM
CHILD ABUSE AND NEGLECT
PRINCIPLES OF COUNSELING IN BEHAVIORAL DISORDERS
FURTHER READING
Book/Monograph
CHAPTER 7:
Adolescence
INTRODUCTION
SPECIAL FEATURES OF THREE STAGES OF ADOLESCENCE
PUBERTY CHANGES (Changes during Adolescence)
Morphological Changes
Order of Morphological Changes in Girls
Order of Morphological Changes in Boys
Psychological Changes
FACTORS INFLUENCING ADOLESCENT HEALTH AND DEVELOPMENT
A. Modifiable (External) Factors
Protective Factors
Social, Cultural and Political Factors
Gender-related Factors
B. Nonmodifiable (Internal) Factors
ADOLESCENT PSYCHOLOGY
Self Esteem (Self Concept)
Formation of the Identity
Psychological Problems
ADOLESCENT SEXUALITY
Sexual Concerns
Self-gratification
Homosexuality
Promiscuous Sex
ADOLESCENT NUTRITION
SPECIAL HEALTH, MEDICAL AND PSYCHOSOCIAL PROBLEMS
Anorexia Nervosa and Bulimia
Malnutrition
Iron Deficiency Anemia (IDA)
Obesity
Puberty Goiter
Depression
Suicide
Substance Abuse
Juvenile Delinquency
Adolescent Violence
Teenage Pregnancy
Sexually Transmitted Diseases (STD) and HIV/AIDS
Menstrual Problems
Breast Disorders
Penile Problems
Scrotal Problems
Urologic Problems
Dermatological Problems
Sleep Disorders
Orthopedic Problems
PROMOTION OF ADOLESCENT HEALTH
Health Education
Life Skills Education (LSE)/ Skills-based Education (SBE)
Family Life Education (FLE)
Counseling for Managing Stress and Emotions
Nutritional Care and Counseling
Early Diagnosis and Management of Medical and Behavioral Conditions
Legislation
FURTHER READING
Books/Monographs
CHAPTER 8:
Pediatric Biostatistics and Informatics
BIOSTATISTICS
The Concept of Normal
Data, Information and Intelligence
Types of Studies
Statistical Averages
Arithmetic Mean
The Median
The Mode
Measures of Variation (Dispersion)
The Range
The Mean Deviation
The Standard Deviation
Percentile
Significant Value
Probability
MEDICAL INFORMATICS, TELEMEDICINE, CYBERMEDICINE AND INTERNET
Applications of Medical Informatics
Telemedicine
Uses of Telemedicine
Distance Communication by Video Conferencing (Fig. 8.1)
Cybermedicine and Cyberhealth Services
Illustrations
Limitations and Key Issues of Telehealth Medicine
The Internet
World Wide Web
Electronic Mail
Future Developments
FURTHER READING
Books/Monographs
CHAPTER 9:
Community Pediatrics
HEALTH
COMMUNITY PEDIATRICS
Basic Principles
Advantages
PREVENTIVE PEDIATRICS
SOCIAL PEDIATRICS
FAMILY HEALTH
Factors Influencing Family Health
Family Health Program
UNDER-FIVES CLINICS
BABY-FRIENDLY HOSPITAL INITIATIVE (BFHI)
SCHOOL HEALTH SERVICE
Priority Health Problems
Aims and Objectives
Salient Components/Features
JUVENILE DELINQUENCY
MATERNAL AND CHILD HEALTH (MCH)
Objectives
Delivery
Mortality Indicators of MCH Care
INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) SCHEME
Objectives
Package of Services
Beneficiaries of Services
Delivery of Services
Community Participation
CHILD LABOR
Magnitude of the Problem
Major Patterns of Child Labor (Figs 9.3 to 9.5)
Background Factors
Health Hazards
The Way-out
STREET CHILDREN
THE HANDICAPPED CHILD
Etiologic Classification
Management
Disability Intervention/Limitation
Disability Prevention
Rehabilitation
Available Welfare Services at National Level
THE GIRL CHILD
Issues and Problems (Female Feticide / Infanticide)
Nutritional Status
Morbidity and Mortality
Educational Status
Girl Child Abuse and Neglect
Girl Child Laborer
Girl Street Child
The Solution/Practical Action Plan
PREVENTION OF ACCIDENTS
Magnitude of the Problem
Major Types
Preventive Measures
Education
Strict Implementation of Rules
Elimination of Causative Factors
Medical Care of the Victim
Survey and Research
CHILD ABUSE AND NEGLECT
INDIA'S NATIONAL HEALTH PROGRAMS
Reproductive and Child Health (RCH) Program
INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS (IMNCI) STRATEGY
Principles of IMNCI Guidelines
Steps of Management
INDIA's NATIONAL NUTRITION PROGRAMS
INDIA's NATIONAL NUTRITION POLICY
ADOPTION
ACUTE FLACCID PARALYSIS (AFP) SURVEILLANCE
TELEVISION AND THE CHILD
A Boon
Agewise TV Viewing
Adverse Effects
The Way-out
DISPOSAL OF HOSPITAL WASTE
FURTHER READING
Books/Monographs
CHAPTER 10:
Immunization
INTRODUCTION
BASICS OF IMMUNIZATION
CATEGORIES OF VACCINES
COLD CHAIN
SOME ADDITIONAL IMMUNIZATION-RELATED MATTERS
Vaccine Vial Monitoring (VVM)
Route of Administration
RECOMMENDED IMMUNIZATION SCHEDULE
BCG VACCINATION
At What Age(s) to Vaccinate?
Site
Method
Normal Reactions Following Vaccination (Immunogenicity)
Contraindication
Adeverse Reactions (Complications) and their Management
POLIO VACCINATION (Fig. 10.2)
At What Age(s) to Vaccinate?
Administration
How OPV Behaves in the Body?
Contraindications
Adverse Reactions
ENHANCED INACTIVATED POLIO VACCINE (EIPV) (SALK VACCINE)
Dosage Schedule
Side-effects
Storage
Availability
DPT VACCINATION
At What Age(s) Vaccinate?
Administration
Contraindications
Adverse Reactions
TYPHOID VACCINATION
CHOLERA VACCINATION
MEASLES VACCINATION
At What Age(s) to Vaccinate?
Dosage
Contraindications
Adverse Reactions/Complications
Precaution
MUMPS VACCINATION
RUBELLA VACCINATION
Indication
Dose
Contraindication
Adverse Reaction
MMR VACCINE
Indication
Dose
Contraindications
Adverse Reactions
H. INFLUENZAE TYPE B VACCINE
Indications
Dose
Contraindication
Adverse Reactions
HEPATITIS B VACCINE
Indications
Dose
Contraindications
Adverse Reactions
Storage
HEPATITIS A VACCINE
Indication
Dose
Side-effects
Storage
VARICELLA VIRUS (CHICKENPOX) VACCINE
Indication
Dose
Contraindications
Adverse Reactions
Protection
COMBINATION VACCINES
POLYVALENT PNEUMOCOCCAL VACCINE
Indications
Dose
Adverse reactions
Special Remarks
INFLUENZA VACCINE
Dose
Protection
Adverse Reactions
Contraindications
Storage
MENINGOCOCCAL VACCINE
Indications
Dose
Side-effects
JAPANESE ENCEPHALITIS (JE) VACCINE
Indication
Dose
Contraindication
Adverse Reactions
VACCINATION AGAINST RABIES
FURTHER READING
Books/Monographs
CHAPTER 11:
Pediatric Nutritional Requirements
INTRODUCTION
WATER
ENERGY
PROTEINS
CARBOHYDRATES
FATS
VITAMINS
MINERALS AND TRACE ELEMENTS
ANTIOXIDANTS
INDIAN SCENARIO
FURTHER READING
Books/Monographs
CHAPTER 12:
Infant Feeding
INTRODUCTION
ANATOMICAL ASPECTS OF LACTATION
PHYSIOLOGY OF LACTATION
In Relation to Mother
In Relation to the Infant
BREASTFEEDING
Advantages/Benefits of Human Milk
For the Infant
For the Mother
For the Community
Contraindications
Breastfeeding Schedule
Breastfeeding Technique and Some Basic Principles
COMMON BREASTFEEDING PROBLEMS
Inverted or Retracted Nipples
Sore Nipple
Breast Engorgement
Breast Abcess
“Not Enough Milk”
LACTATION FAILURE
Definition
Etiology
Prevention
Treatment
Relactation in Partial Lactation Failure
Relactation in Complete Lactation Failure
Evidence of Successful Relactation
COMPLEMENTARY FEEDING
Definition
Recommended Age
Prerequisites/ Attributes of an Ideal Complementary Food
Types of Complementary Foods
Complementary Feeding Regimen
ARTIFICIAL (FORMULA) FEEDING
FEEDING THE LOW BIRTHWEIGHT (LBW) INFANT
Feeding Problems of the LBW Infant
Nutritional Needs of the LBW Infant
Method of Feeding/Providing Nutrition
Breastfeeding
Alternative Methods of Milk Feeding
Gavage (Tube) Feeding
“Palady”/”Katori-spoon” Feeding
Expressed Breast Milk (EBM)
Nutritional Supplements
Intravenous (Central) Feeding
Parenteral Nutrition
Nonnutritive Suckling
Characteristics
Advantages
Procedure
COMMON FEEDING PROBLEMS
Regurgitation
Vomiting
Suckling and Swallowing Difficulties
Dehydration Fever
Excessive Crying
Colic
Change in Bowel Habit
Underfeeding
Bottle Addiction
Overfeeding
Inexperienced Mothers
FURTHER READING
CHAPTER 13:
Protein-energy Malnutrition
ECOLOGY OF MALNUTRITION
Bad Economy
Ignorance, Faulty Food Habits and Feeding
Medical Reasons
Large Families
Closely-spaced Families
Working Mother
Bad Start
Secondary Malnutrition
ASSESSMENT OF NUTRITIONAL STATUS
Dietary History
Clinical Signs
Anthropometry
Age-dependent Indices
Age-independent Indices
Investigations
Associated Disorders
Vital Statistics
PROTEIN-ENERGY MALNUTRITION (PEM): A SPECTRUM
EVOLUTION OF PEM
Dietary Hypothesis
Adaptation Hypothesis
Aflatoxin Contamination Hypothesis
Golden's Hypothesis of Free Radicals
Jellife's Hypothesis of Interactions and Sequelae
PEM AND DISTURBANCES OF METABOLISM
Water, Electrolytes and Minerals
Protein and Amino Acids
Lipids
Carbohydrates and Energy
PEM AND INFECTION
PEM AND FAMILY PLANNING
PEM AND ENDOCRINAL STATUS
PEM AND DIARRHEA
PEM AND CARDIAC FUNCTION
PEM AND RENAL FUNCTION
PEM AND DRUG DISPOSITION
CLASSIFICATION OF PEM
I. Syndromal Classification
II. Gomez Classification
III. Wellcome or International Classification
IV. Classification of the Indian Academy of Pediatrics (IAP)
V. Jellife Classification
VI. McLaren Classification
VII. Waterlow Classification
VIII. WHO Classification (Table 13.1)
IX. Arnold Classification
X. Classification Based on Skinfold Thickness
SPECIAL FEATURES OF CLINCAL SYNDROMES
Kwashiorkor
Clinical Features
Biochemical Changes
Diagnosis
A. Essential Features (Minimal Diagnostic Criteria)
B. Nonessential Features
Nutritional Marasmus
Clinical Features (Figs 13.15 and 13.16)
Biochemical Changes
Diagnosis
MARASMIC KWASHIORKOR
PREKWASHIORKOR
NUTRITIONAL DWARFING (STUNTING)
COMPLICATIONS OF PEM
MANAGEMENT OF PEM
Domiciliary (Home) Management
A. Mild-moderate Malnutrition
B. Uncomplicated Severe Acute Malnutrition (SAMN)
Management in Nutrition Rehabilitation Center (NRC)
Hospital Management
Beginning of Feeding
Energy-dense Feeding
Stimulation
Transfer to Home-based Diet
Results of Nutritional Rehabilitation
Discharge
Poor Response to Nutritional Rehabilitation
PHENOMENA ENCOUNTERED DURING NUTRITIONAL REHABILITATION
Favorable
Unfavorable
1. Pseudotumor Cerebri
2. Nutritional Recovery Syndrome (Gomez Syndrome)
3. Encephalitis-like Syndrome
4. Rickets
5. Anemia/Micronutrient Deficiency
PROGNOSIS IN PEM
LONG-TERM SEQUELAE OF PEM
Growth Retardation
Mental Impairment
Malnutrition and Liver
PREVENTION OF MALNUTRITION
Prevention at Family Level
Prevention at Community Level
Prevention at National Level
Prevention at World Level
NATIONAL NUTRITION PROGRAMS
Applied Nutrition Program
Special Nutrition Program (SNP)
Midday Meal Program
Balwadi Nutrition Program
Anemia Control Program
Nutritional Blindness Prevention Program
Iodine Deficiency Control Program (Goiter Control Program)
Integrated Child Development Services (ICDS) Scheme
NATIONAL NUTRITION POLICY
Aims and Objectives
National Plan of Action on Nutrition (NPAN)
Short-term Measures
Long-term Measures
FURTHER READING
Books/Monographs
CHAPTER 14:
Vitamin Deficiencies
CLASSIFICATION
VITAMIN A DEFICIENCY (VAD)
Etiology
Prevalence
Clinical Features (Figs 14.1 to 14.7)
Diagnosis
Treatment
Prevention
THIAMINE DEFICIENCY
Etiology
Clinical Features
Diagnosis
Treatment
Prevention
RIBOFLAVIN DEFICIENCY
Etiology
Clinical Features
Diagnosis
Treatment
Prevention
NICOTINIC ACID DEFICIENCY
Etiology
Clinical Features
Diagnosis
Treatment
Prevention
PYRIDOXINE DEFICIENCY
Etiology
Clinical Features
Diagnosis
Treatment
VITAMIN B12 DEFICIENCY
FOLIC ACID DEFICIENCY
VITAMIN C DEFICIENCY
Etiopathogenesis
Clinical Features
Differential Diagnosis
Diagnosis
Treatment
Prevention
VITAMIN D DEFICIENCY
Etiology
Prevalence
Clinical Features
Differential Diagnosis
Diagnosis
Treatment
Prevention
REFRACTORY RICKETS
VITAMIN E DEFICIENCY
VITAMIN K DEFICIENCY
FURTHER READING
CHAPTER 15:
Micronutrients/Minerals
CLASSIFICATION
IRON DEFICIENCY DISORDERS
ZINC DEFICIENCY
Etiology
Clinical Features
Diagnosis
Treatment
COPPER DEFICIENCY
COBALT
SELENIUM
CHROMIUM
MANGANESE
FLUORINE
MOLYBDENUM
NICKEL
VANADIUM
SILICON
ARSENIC
IODINE DEFICIENCY (ENDEMIC GOITER)
CALCIUM DEFICIENCY
Clinical Features
MAGNESIUM DEFICIENCY
Causes
Clinical Features
SODIUM DEFICIENCY
POTASSIUM DEFICIENCY
INFANTILE TREMOR SYNDROME (ITS)
LOW BIRTHWEIGHT (LBW) INFANTS
IMMUNONUTRITION
FURTHER READING
CHAPTER 16:
Fluids, Electrolytes and Acid-base Balance and its Disturbances
PHYSIOLOGIC CONSIDERATIONS
Total Body Water
Electrolytes
Sodium
Potassium
Acid-base Balance
DISORDERS OF FLUID AND ELECTROLYTE BALANCE
Dehydration
Hyponatremia
Etiology
Clinical Features
Treatment
Hypernatremia
Etiology
Clinical Features
Treatment
Hypokalemia
Etiology
Clinical Features
Treatment
Hyperkalemia
Etiology
Clinical Features
Treatment
DISTURBANCES OF ACID-BASE BALANCE
Metabolic Acidosis/Acidemia
Etiology
Clinical Features
Treatment
Metabolic Alkalosis/Alkalemia
Etiology
Clinical Features
Treatment
Respiratory Acidosis/Acidemia
Etiology
Treatment
Respiratory Alkalosis/Alkalemia
Etiology
Clinical Features
Treatment
Mixed Acid-base Disturbances
PRINCIPLES OF FLUID AND ELECTROLYTE THERAPY
Deficit Therapy
Maintenance Therapy
Replacement of Ongoing Losses
FLUID THERAPY IN SPECIAL SITUATIONS
Diarrheal Dehydration
Malnutrition
Acute Renal Failure (ARF)
Congestive Cardiac Failure (CCF)
Intestinal Obstruction
FURTHER READING
PART TWO: NEONATOLOGY
CHAPTER 17:
Neonatology
INTRODUCTION
IMPORTANCE OF THE NEONATAL CARE
NOMENCLATURE/DEFINITIONS RELATED TO PERINATAL/NEONATAL PERIOD
HIGH-RISK PREGNANCY
NEONATAL AND PERINATAL MORTALITY IN INDIA
Etiology
Strategy to Reduce Perinatal Mortality
Prevention of Birth Hypoxia/Trauma
Prevention of Low Birth Weight
Prevention of Neonatal Infections
Prevention of Congenital Malformations
Prevention of Rh Incompatibility
BIRTH TRAUMA
CONGENITAL AND OTHER DEFECTS
NEONATAL RESUSCITATION
High-risk Situation
Resuscitation Equipment
Adequate Preparation for Resuscitation
ABC of Resuscitation
Opening the Airway
Initiating Breathing
Maintaining Circulation
Resuscitation Steps
Don'ts in Neonatal Resuscitation
APGAR SCORE
THE FULLTERM NEWBORN (Box 17.6)
Physical Characteristics
Physiologic Characteristics
Neurodevelopment
Psychosocial Development
PRIMITIVE NEONATAL REFLEXES
Moro Reflex
Startle Response
Rooting and Suckling Reflexes
Glabellar Reflex/Tap
Grasp Reflex
Crossed Extension Reflex
Tonic Neck Reflex
Traction Reflex
Plantar (Babinski) Reflex
Chvostek Sign
Parachute Reflex
Landau Reflex
SOME MINOR PROBLEMS OF THE NEWBORN THAT MAY CAUSE PARENTAL ANXIETY
Physiologic Jaundice
Vomiting
Transitional Stools
Constipation
Toxic Erythema (Erythema Toxicum)
Milia
Mongolian Spots
Salmon Patches (Macular Hemangioma, Nevus Simplex, Stork Bites)
Benign Neonatal Hemangiomatosis (BNH)
Harlequin Color Change
Epstein Pearls
Sucking Callosities
Subconjunctival Hemorrhage
Physiologic Mastitis
Vaginal Bleeding
Natal Teeth
Cephalhematoma
Caput Succedaneum
Hiccup (Hiccough)
Nasolacrimal Duct Blockade
Umbilical Hernia (Fig. 17.34)
Hydrocele
Physiologic Phimosis
Hymenal Tags
THE PRETERM INFANT
Predisposing Causes
Characteristic Features
Handicaps/Risks
LOW BIRTH WEIGHT (LBW) INFANTS
Classification
Etiology
Handicaps/Risks
Management
Prognosis
Prevention
Feeding
STAGES OF NEWBORN CARE
First Stage: Care of the Girl Child
Second Stage: Care of the Adolescent Girls
Third Stage: Care during Pregnancy
Fourth Stage: Immediate Care at the Time of Delivery
Fifth Stage: Routine Care of Newborn and Subsequent Fellow up
BASIC PRINCIPLES OF ESSENTIAL NEWBORN CARE
THE 3-TIER SYSTEM OF NEONATAL CARE
DETERMINATION OF GESTATIONAL AGE
DANGER SIGNS
NEONATAL HYPOTHERMIA
Etiology
Clinical Features
Treatment
Prognosis
Prevention (Measures for Warming The Baby)
Warm chain
KANGAROO MOTHER CARE (KMC)
Benefits
Method
Prerequisites
INCUBATOR CARE
OPEN CARE SYSTEM
BREASTFEEDING
FEEDING THE LOW BIRTHWEIGHT (LBW) INFANT
HYPOXIC-ISCHEMIC ENCEPHALOPATHY (Perinatal Asphyxia)
Etiopathogenesis
Clinical Features
Differential Diagnosis
Diagnosis
Treatment
Prevention
Prognosis
Long-term Sequelae
RESPIRATORY DISTRESS SYNDROME
HYALINE MEMBRANE DISEASE (HMD)
Etiopathogenesis
Clinical Features
Diagnosis
Prevention
Differential Diagnosis
Treatment
Prevention
Prognosis
MECONIUM ASPIRATION SYNDROME (MAS)
Clinical Features
Complications
Diagnosis
Treatment
Prevention
PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (PPHN)
TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)
NEONATAL SHOCK
Etiopathogenesis
Classifications
Clinical Features
Complications
Diagnosis
Treatment
Prognosis
RECURRENT NEONATAL APNEA (Apneic Spells)
Etiopathogenesis
Diagnosis
Treatment
Prognosis
STRIDOR
INFECTIONS IN THE NEWBORN
CONGENITAL SYPHILIS
Clinical Features
Diagnosis
Treatment
CONGENITAL TOXOPLASMOSIS
Clinical Features
Diagnosis
Treatment
Prevention
CONGENITAL RUBELLA
Clinical Features
Diagnosis
Prevention
CYTOMEGALOVIRUS DISEASE
Diagnosis
Treatment
Prevention
HERPES SIMPLEX
Clinical Features
Diagnosis
Treatment
Prevention
Prognosis
PERINATAL AIDS
SEPTIC UMBILICUS (Omphalitis)
SEPTICEMIA
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
CONJUNCTIVITIS
PYODERMA
ORAL THRUSH (Moniliasis, Candidiazsis)
NOMA NEONATORUM
NEONATAL MALARIA
Etiology
Clinical Features
Diagnosis
Treatment
Prophylaxis
TETANUS NEONATORUM
HEMORRHAGIC DISEASE OF THE NEWBORN
NEONATAL JAUNDICE
Etiologic Considerations
A. Classification Based on Time of Onset
B. Classification Based on Conjugation of Bilirubin
Frequently Encountered Types of Jaundice
Physiologic Jaundice (Fig. 17.43)
Pathologic Jaundice (Unconjugated Hyperbilirubinemia)
Breastfeeding Jaundice
Breastmilk Jaundice
An Evidences-based Diagnostic Approach
History
Clinical Examination
Laboratory Investigations
Principles of Management
Phototherapy
Indications
Mode of Action
Length of Phototherapy
Special Precaution
Contraindication
Side Effects
Fiberoptic Phototherapy (Bili Blankets)
Exchange Blood Transfusion
Aims and Objectives
Indications
Technique (Fig. 17.46)
Exchange by Alternative Routes
Warning Signs during Exchange
Delayed Complications
Pharmacotherapy and Other Therapies
NEONATAL CHOLESTASIS SYNDROME
G-6-PD Deficiency
NEONATAL HEPATITIS SYNDROME
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
HEMOLYTIC DISEASE OF THE NEWBORN
RHESUS HEMOLYTIC DISEASE (Rh Isoimmunization)
Clinical Features
Diagnosis
Treatment
Prevention
ABO-HEMOLYTIC DISEASE
KERNICTERUS (Bilirubin Toxicity, Bilirubin Encephalopathy)
Etiology
Clinical Features
Investigations
Treatment
Prognosis
NEONATAL SEIZURES
Etiology
Clinical Features
Investigations
Treatment
Prognosis
NEONATAL HYPOGLYCEMIA
Etiology/Predisposing Factors
Clinical Features
Treatment
Prevention
Prognosis
NEONATAL HYPOCALCEMIA (Neonatal Tetany)
Etiology
Clinical Features
Investigations
Treatment
NEONATAL HYPOMAGNESEMIA
INFANTS OF DIABETIC MOTHERS (IDM)
Etiopathogenesis
Clinical Features
Treatment
Prognosis
NEONATAL COLD INJURY (Hypothermia)
NEONATAL HYPERTHERMIA
SCLEREMA
Etiopathology
Clinical Features
Treatment
Prognosis
NEONATAL NECROTIZING ENTEROCOLITIS
Etiology
Investigations
Treatment
TRACHEOESOPHAGEAL FISTULA
CONGENITAL DIAPHRAGMATIC HERNIA
IMPERFORATE ANUS
TRANSPORT OF SICK NEONATES
Types of Neonatal Transport
Indications for Transport
A. In Utero Transport
B. Postnatal Transport
Major Principles of Transport
MATERNAL MEDICATION AND ADVERSE EFFECTS ON THE FETUS
MATERNAL MEDICATION AND ADVERSE EFFECTS ON BREASTFED INFANT
FOOD AND ENVIRONMENTAL AGENTS AND ADVERSE EFFECTS ON THE INFANT
FURTHER READING
PART THREE: PEDIATRIC INFECTIONS
CHAPTER 18:
Pediatric Viral Infections
SMALLPOX (VARIOLA)
MONKEYPOX: A NEW CHALLENGE
CHICKENPOX (VARICELLA)
Etiopathogenesis
Epidemiology
Clinical Features
Diagnosis
Complications
Treatment
Prophylaxis
Prognosis
MEASLES (RUBEOLA)
Etiopathogenesis
Epidemiology
Clinical Features
Diagnosis
Differential Diagnosis
Complications
Treatment
Prophylaxis
GERMAN MEASLES* (RUBELLA, THREE-DAY MEASLES)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prophylaxis
MUMPS (EPIDEMIC PAROTITIS)
Epidemiology
Clinical Features
Differential Diagnosis
Diagnosis
Complications
Treatment
Prophylaxis
Prognosis
POLIOMYELITIS
Etiopathogenesis
Epidemiology
Clinical Features
Paralytic Polio
Complications
Diagnosis
Treatment
Prophylaxis
Prognosis
GUILLAIN-BARRÉ SYNDROME (GBS)
ACUTE FLACCID PARALYSIS (AFP) SURVEILLANCE
Special Features
Indicators of Quality
Role
INFECTIOUS MONONUCLEOSIS
Etiopathogenesis
Clinical Features
Complications
Diagnosis
Differential Diagnosis
Treatment
Prognosis
DENGUE FEVER
Etiopathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Complications
Treatment
Prevention
Prognosis
CHIKUNGUNYA FEVER
Etiology
Epidemiology
Clinical Features
Treatment
Prevention and Control
Vector control
Vaccination
JAPANESE ENCEPHALITIS
Etiology
Clinical Features
Management
Prognosis
Prevention/Control
VIRAL HEPATITIS
SLOW VIRUS INFECTION
HYDROPHOBIA (RABIES)
PEDIATRIC ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
Etiology
Pathogenesis
Clinical Features
Diagnosis
Prevention
Immunization of HIV Positive Children
RESPIRATORY SYNCYTIAL VIRUS (RSV) INFECTION
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
BIRD (AVIAN) FLU
FURTHER READING
CHAPTER 19:
Pediatric Bacterial Infections
HEMOPHILUS INFLUENZAE B (HIB) DISEASE
Epidemiology
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prevention
PERTUSSIS (Whooping Cough)
Etiopathogenesis
Clinical Features
Diagnosis
Complications
Treatment
Prophylaxis
Prognosis
DIPHTHERIA*
Etiopathogenesis
Epidemiology
Clinical Features
Diagnosis
Complications (Table 19.3)
Treatment
Prophylaxis
Prognosis
EPIDEMIC TYPHUS
Clinical Features
Diagnosis
Treatment
Prevention
TYPHOID FEVER (Enteric Fever)
Etiopathogenesis
Epidemiology
Clinical Features
Diagnoses
Complications
Treatment
Specific
General Measures
Prophylaxis
Prognosis
BRUCELLOSIS
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
TETANUS
Etiopathogenesis
Epidemiology
Clinical Features
Diagnosis
Complications
Treatment
Prophylaxis
Prognosis
LEPROSY (Hansen Disease)
Etiopathogenesis
Clinical Classification/Features
Diagnosis
Treatment
Prevention
SYPHILIS
Clinical Features
Diagnosis
Treatment
Prevention
Prognosis
LEPTOSPIROSIS
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prevention
TUBERCULOSIS
MENINGOCOCCAL INFECTIONS
Pathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
Prevention
HELICOBACTER PYLORI (H. PYLORI) INFECTION
ANAEROBIC INFECTIONS
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
OPPORTUNISTIC INFECTIONS
In Normal Host
In Susceptible Host
NOSOCOMIAL INFECTIONS
Etiologic Considerations
Mode of Transmission
Common Nosocomial Infections
Investigations
Preventive and Control Measures
NOMA (Cancrum Oris, Gangrenous Stomatitis)
TOXIC SHOCK SYNDROME (TSS)
FURTHER READING
CHAPTER 20:
Pediatric Parasitosis
MALARIA
Epidemiology
Host Response
Pathogenesis
Clinical Features
Complications
Cerebral Malaria
Hypoglycemia
Noncardiogenic Pulmonary Edema
Coagulation Abnormalities
Black Water Fever
Algid Malaria
Quartan Malarial/Nephropathy
Tropical Splenomegaly
Diagnosis
Treatment
Malaria Control/Prophylaxis
TROPICAL SPLENOMEGALY
Prognosis
Prophylaxis
KALA-AZAR (Black-Sickness*)
Etiopathogenesis
Epidemiology
Clinical Features
Complications
Diagnosis
Laboratory Diagnosis
Serological Test
Polymerase Chain Reaction
Treatment
Monitoring of Therapy
Prophylaxis
Prognosis
FILARIASIS
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prevention
TROPICAL EOSINOPHILIA
Clinical Features
Diagnosis
Treatment
Prognosis
TROPICAL SPLENOMEGALY
Pathology
Treatment
COMMON PARASITIC INFESTATIONS OF GUT
GIARDIASIS
Etiopathogenesis
Clinical Features
Diagnosis
Chemotherapy
AMEBIASIS
Etiopathogenesis
Clinical Features
Diagnosis
Chemotherapy
ACANTHAMOEBA
Epidemiology
Pathophysiology
Clinical Features
Diagnosis
Treatment
CRYPTOSPORIDIOSIS
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
ASCARIASIS
Etiopathogenesis
Clinical Features
Chemotherapy
OXYURIASIS
Etiopathogenesis
Clinical Features
Chemotherapy
ANCYLOSTOMIASIS
Etiopathogenesis
Clinical Features
Chemotherapy
STRONGYLOIDIASIS
Etiopathogenesis
Clinical Features
Chemotherapy
TRICHURIASIS
Etiopathogenesis
Clinical Features
Chemotherapy
TAPEWORMS
Clinical Features
Chemotherapy
NEUROCYSTICERCOSIS (NCC)
Clinical Features
Treatment
Medical Therapy
Prevention
HYDATID DISEASE (Echinococcosis)
FURTHER READING
PART FOUR: PEDIATRIC SUBSPECIALTIES
CHAPTER 21:
Pediatric Pulmonology
INTRODUCTION
CLNICAL EVALUATION OF A RESPIRATORY CASE
SPECIAL DIAGNOSTIC PROCEDURES
Radiology/Imaing
Serology
Microbiologic Examination of Body Secretions
Skin Tests
Pilocarpine Iontophoresis for Sweat Chloride
Pulmonary Function Tests
Arterial Blood Gas (ABG) Analysis
Transillumination
Direct Laryngoscopy
Bronchoscopy
Thoracoscopy
Thoracocentesis
Lung Tap
Lung Biopsy
Polygraphic Monitoring
UPPER RESPIRATORY TRACT INFECTION (URTI) (Upper Respiratory Catarrh; Common Cold; Rhinopharyngitis, Acute Nasopharyngitis)
FOREIGN BODY IN LOWER RESPIRATORY TRACT
ADULT RESPIRATORY DISTRESS SYNDROME (ARDS)
Etiopathogenesis
Clinical Manifestations
Laboratory Diagnosis
Treatment
Complications
Prognosis
RESPIRATORY SYNCYTIAL VIRUS (RSV) INFECTION
ACUTE BRONCHITIS
ACUTE BRONCHIOLITIS
Etiopathogenesis
Epidemiology
Clinical Features
Differential Diagnosis
Diagnosis
Complications
Treatment
Prophylaxis
Prognosis
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
Etiology
Clinical Features
Treatment
Prevention and Infection Control
PNEUMONIAS
Classification
I. Etiologic Classification
II. Anatomic Classification
III. Classification Based on Acquisition
IV. Classification Based on Chronicity
Clinical Features
Complications
Diagnosis
Treatment
Antibitics in Community-acquired Pneumonia
Antibitics in Hospital-acquired Pneumonia
General Measures
Prognosis
BRONCHIECTASIS
Definition
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
DRY PLEURISY (Plastic Pleurisy)
Etiology
Clinical Features
Diagnosis
Treatment
PLEURAL EFFUSION
Etiology
Clinical Features
Diagnosis
Treatment
EMPYEMA THORACIS
Etiology
Clinical Features
Complications
Diagnosis
Treatment
Prognosis
LUNG ABSCESS
Etiology
Clinical Features
Diagnosis
Treatment
BRONCHIAL ASTHMA (Reactive Airway Disease)
Definition
Etiopathogenesis
Triggers/Excitatory Factors
Predisposing Factors
Pathophysiology
Pathology
Clinical Features
Diagnosis
Complications
Management of Acute Exacerbation of Asthma A. Specific Measures (Tables 21.9 and 21.10)
Acute Mild Exacerbation
Acute Moderate Exacerbation
Acute Severe (Life-threatening) Exacerbation
B. Additional Measures
Management of Status Asthmaticus
Management of Asthma in between Acute Exacerbations
TUBERCULOSIS
Etiopathogenesis
Fate of Primary Complex
Clinical Types and Salient Features
Diagnosis
Antituberculous Treatment
Indications for ATT
Categorization of Antituberculous Drugs
Group I: First Line Drugs
Group II: Second Line Drugs
Group III: Reserve Drugs
Currently Recommended Antituberculous Regimens
World Health Organization (WHO) ATT Regimens
Directly Observed Therapy (DOT)
Indian Academy of Pediatrics (IAP) ATT Regimens
Comments
Daily vs Intermittent Therapy
Single Drug or Fixed-drug Combinations
Indications of Prednisolone
Baby Born to Mother with Tuberculosis (Diagnosed in 3rd Trimester or during Delivery)
Hepatotoxicity
Drug Resistance
Relapse
Contact
BCG Adenitis
Problems during ATT
Recommendations for Babies of Tuberculosis Mothers
Newer Antituberculous Drugs
Surgery
Prevention
RECURRENT RESPIRATORY INFECTION (Recurrent Chest Infection)
THE CHILD WITH WHEEZY CHEST
CYSTIC FIBROSIS
LEGIONELLOSIS (Leigonnaires' Disease, Pontiac Fever)
DROWNING AND NEAR DROWNING
FURTHER READING
CHAPTER 22:
Pediatric Cardiology
EVALUATION OF A CARDIOVASCULAR CASE
Clinical Work-up
Investigative Work-up
FETAL CIRCULATION
CIRCULATORY CHANGES AT BIRTH AND NEONATAL BLOOD CIRCULATION
CONGESTIVE CARDIAC FAILURE (CCF)
Etiology*
Clinical Features/Diagnosis
Investigations
Management
Goals
CONGENITAL HEART DISEASE
Incidence
Etiology
Maternal Infections
Maternal Medication
Heredity
Genetic Factors
Environmental Factors
Genetic Counseling
Classification
Characteristic Features of Three Groups of CHD
VENTRICULAR SEPTAL DEFECT (VSD)
Classification
Hemodynamics/Pathophysiology
Clinical Features
Diagnosis
Natural History/Course
Complications
Treatment
ATRIAL SEPTAL DEFECT (ASD)*
Hemodynamics/Pathophysiology
Clinical Features
Diagnosis
Complications
Treatment
PATENT DUCTUS ARTERIOSUS (PDA)
Hemodynamics/Pathophysiology
Clinical Features
Complications
Diagnosis
Treatment
TETRALOGY OF FALLOT (TOF)
Hemodynamics/Pathophysiology
Clinical Features
Diagnosis
Complications
Associated Cardiovascular Anomalies
Treatment
I. Palliative Surgery
II. Total Correction
FALLOT'S PHYSIOLOGY
TRICUSPID ATRESIA
Hemodynamics/Pathophysiology
Clinical Features
Diagnosis
Treatment
EBSTEIN ANOMALY
Hemodynamics/Pathophysiology
Clinical Features
Diagnosis
Treatment
Prognosis
EISENMENGER SYNDROME OR COMPLEX
TRANSPOSITION OF GREAT ARTERIES (TGA)
Hemodynamics
Clinical Features
Diagnosis
Treatment
TOTAL ANOMALOUS PULMONARY VENOUS RETURN (TAPVR)
HYPOPLASTIC LEFT HEART SYNDROME
Hemodynamics
Clinical Features
Diagnosis
Treatment and Prognosis
AORTIC STENOSIS
Hemodynamics
Clinical Features
Diagnosis
Treatment
COARCTATION OF AORTA SYNDROME
Hemodynamics
Clinical Features
Diagnosis
Treatment
Prognosis
CONGENITAL HEART DISEASE (CHD) AND NEUROLOGIC COMPLICATIONS
RHEUMATIC FEVER
Epidemiology
Etiopathogenesis
Clinical Features
Major Criteria
Minor Criteria
Essential Criteria
Other Investigations
New Diagnostic Modalities
Differential Diagnosis
Complications
Treatment
Rheumatic Prophylaxis
Prognosis
RHEUMATIC HEART DISEASE
Mitral Regurgitation
Mitral Stenosis
Rheumatic Aortic Valve Disease
Aortic Regurgitation
RHEUMATIC TRICUSPID VALVE DISEASE
TRICUSPID REGURGITATION
INFECTIVE ENDOCARDITIS
Etiology
Pathogenesis and Pathology
Clinical Features
Investigations
Complications
Diagnosis
Treatment
Prognosis
Prophylaxis and Prevention
MITRAL VALVE PROLAPSE SYNDROME (BARLOW SYNDROME, FLOPPY OR BILLOWING MITRAL VALVE SYNDROME, LATE MITRAL SYSTOLIC MURMUR-SYSTOLIC CLICK SYNDROME)
PAROXYSMAL ATRIAL TACHYCARDIA (PAT)
Etiology
Clinical Features
Diagnosis
Treatment
SICK SINUS SYNDROME (SSS)
LONG QT SYNDROME
TAKAYASU ARTERITIS (Pulseless Disease)
CARDIOMYOPATHY
Clinical Categories
PERICARDITIS
Etiology
Clinical Features
Diagnosis
Treatment
DEXTROCARDIA
MYOCARDITIS
SYSTEMIC HYPERTENSION
Blood Pressure Measurement in Children
Etiology
Clinical Features
Diagnosis
Management
Pharmacological Therapy
Course and Prognosis
Prevention
INTERVENTIONAL CARDIAC PROCEDURES
BIBLIOGRAPHY
CHAPTER 23:
Pediatric Neurology
DEVELOPMENTAL ASPECTS
NEUROLOGIC EVALUATION
NEURAL TUBE DEFECTS (Myelodysplasia, Dysraphism)
Types
Prenatal Diagnosis
Prevention
PSEUDOTUMOR CEREBRI (Benign Intracranial Hypertension, Otitic Hydrocephalus)
Clinical Features
Etiopathogenesis
Treatment
ACUTE STROKE SYNDROMES (Acute Hemiplegia of Childhood Acute Infantile Hemiplegia, Stroke)
Types
Arterial Thrombosis and Embolism
Venous Thrombosis
Intracranial Hemorrhasge
Differential Diagnosis
Diagnosis
Treatment
BELL PALSY
GUILLAIN-BARRÉ SYNDROME (Postinfectious Polyneuritis, Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP), Infective Polyneuritis, Infectious Polyradiculitis)
Etiopathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Prognosis
MENTAL RETARDATION
Epidemiology
Etiology
Clinical Features
Diagnosis
Assessment of Mental Age
Differential Diagnosis
Management
Prevention
DOWN SYNDROME (Mongolism)
Clinical Features
Diagnosis
Radiologic Findings
Dermatoglyphic Findings
Management
AUTISM
CEREBRAL PALSY (Little Disease*)
Epidemiology
Etiology
Pathology
Clinical Features
Handicaps/Comorbidity
Diagnosis
Treatment
Prevention
MENINGITIS
BACTERIAL MENINGITIS
Clinical Features
Diagnosis
Treatment
Prognosis
CNS TUBERCULOSIS (NEUROTUBERCULOSIS)
TUBERCULOUS MENINGITIS (TBM)
Epidemiology
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
Sequelae
TUBERCULOUS ENCEPHALOPATHY
TUBERCULOMA
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
ENCEPHALITIS
Etiologic Considerations
Clinical Features
Diagnosis
Treatment
Prognosis
HYDROCEPHALUS
Etiology
I. Congenital Hydrocephalus
II. Acquired Hydrocephalus
Clinical Features
Diagnosis
Treatment
Prognosis
INTRACRANIAL SPACE-OCCUPYING LESIONS (ICSOL)
BRAIN ABSCESS
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
SUBDURAL EFFUSION
SUBDURAL HEMATOMA
NEUROCYSTICERCOSIS
Etiopathogenesis
Clinical Features
Diagnostic Investigations
Treatment
INTRACRANIAL TUMORS
CAVERNOUS SINUS THROMBOSIS
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
CRANIOSYNOSTOSIS (Craniostenosis)
Classification
Clinical Features
Diagnosis
Treatment
CONVULSIVE DISORDERS
FEBRILE SEIZURES
Incidence
A. Typical (Simple) Febrile Seizures
B. Atypical (Complex) Febrile Seizures
Treatment
Prophylaxis
Prognosis
CHRONIC/RECURRENT CONVULSIONS
STATUS EPILEPTICUS
DIAGNOSIS OF CONVULSIVE DISORDERS
DRUG THERAPY OF AN ACUTE CONVULSIVE EPISODE/STATUS EPILEPTICUS
LONG-TERM DRUG THERAPY
INTRACTABLE SEIZURES
INFANTILE TREMOR SYNDROME (ITS)
REYE SYNDROME
PHAKOMATOSES (Neurocutaneous Syndromes)
THE CHILD WITH ATAXIA
SPASMUS NUTANS
THE CHILD WITH COMA
Emergency Measures
Clues to Diagnosis
A. Pattern of Respiration
B. Pattern of Pupil Responses
C. Head and Body
D. Fever
E. Neck Rigidity
F. Limbs
G. Reflexes
H. Fundoscopy
I. Focal Signs in Relation to RIP
Investigations (Table 23.17)
Urine Examinations
Blood Picture
Lumbar Puncture
Management
DEGENERATIVE BRAIN DISORDERS
PARAPLEGIA
Etiopathogenesis
Clinical Features
Diagnosis
Management
FURTHER READING
CHAPTER 24:
Pediatric Gastroenterology
BASICS OF GASTROINTESTINAL TRACT (GIT)
SPECIAL INVESTIGATIVE WORK-UP FOR GASTROINTESTINAL DISORDERS
DIARRHEAL DISEASES: AN OVERVIEW
ACUTE DIARRHEA
Etiology
Pathogenesis
Clinical Features
Clinical Assessment of Diarrheal Dehydration
Treatment
A. Conventional Rehydration Therapy
B. WHO Guidelines on Management of Diarrheal Dehydration
Plan A for “No dehydration”
Plan B for Some Dehydration
Plan C for Severe Dehydration
C. Chemotherapy (Table 24.9)
D. Symptomatic Control
E. Diet
F. Ancillary Measures
Prognosis
Prevention
Complications/Sequelae
CHOLERA
Etiology
Epidemiology
Clinical Features
Complications
Management
Prophylaxis
ACUTE BACILLARY DYSENTERY (Shigellosis)
Etiopathogenesis
Epidemiology
Clinical Features
Differential Diagnosis
Diagnosis
Treatment
Prognosis
Prevention
PSEUDOMEMBRANOUS COLITIS (Clostridium difficile-associated Diarrhea)
Etiopathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Prognosis
ORAL REHYDRATION THERAPY (ORT)
Indications
Standard Formulation
Low Osmolarity ORS
ResoMal (ORS in Severely Malnourished Children)
Home-made Preparations of ORS
Administration
Limitations
ORT as a Community-based Program
PERSISTENT DIARRHEA
Definition
Etiology
Clinical Features
Diagnosis
Treatment
Prevention
Prognosis
CHRONIC DIARRHEA
Definition
Evaluation Protocol
Pathophysiologic Mechanisms
Etiologic Considerations
Chronic Diarrhea/ Malabsorption: A Practical Approach
CELIAC DISEASE
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
CYSTIC FIBROSIS (Mucoviscidosis)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Complications
ENDEMIC TROPICAL SPRUE
PROTEIN-LOSING ENTEROPATHY
Etiology
Clinical Features
Diagnosis
Treatment
CARBOHYDRATE MALABSORPTION
COW MILK ALLERGY (Cow Milk Hypersensitivity or Intolerance)
ACRODERMATITIS ENTEROPATHICA (Brandt Syndrome)
Etiology
Clinical Features
Differential Diagnosis
Diagnosis
Treatment
INFLAMMATORY BOWEL DISEASE (IBD)
Ulcerative Colitis
Etiology
Manifestations
Diagnostic Investigations
Differential Diagnosis
Treatment
Complications
Crohn's Disease
Manifestations
Diagnostic Investigations
Treatment
Prognosis
Food Allergic Colitis
CONSTIPATION
VOMITING
RECURRENT APHTHOUS STOMATITIS
THRUSH (Oral Moniliasis)
GEOGRAPHIC TONGUE (Glossitis Areata Migrans)
STRESS (SECONDARY) ULCER DISEASE
Clinical Features
Etiopathogenesis
Treatment
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Diagnosis
Management
GASTROINTESTINAL BLEEDING
Etiology
A. Upper GIT Bleeding
B. Lower GIT Bleeding
Diagnosis
Management
Prognosis
RECURRENT ABDOMINAL PAIN (RAP)
H. PYLORI INFECTIONS
Epidemiology
Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
FOOD ALLERGY
Causative Foods
Operational Mechanisms
Clinical Feaures
Diagnosis
Treatment
Bezoars
TRACHEOESOPHAGEAL FISTULA
HYPERTROPHIC PYLORIC STENOSIS
INTUSSUSCEPTION
ANORECTAL MALFORMATIONS
HIATAL HERNIA
INGUINAL HERNIA
UMBILICAL HERNIA
FURTHER READING
CHAPTER 25:
Pediatric Hepatology
BASICS OF HEPATOBILIARY SYSTEM
FUNCTIONS OF LIVER
MANIFESTATIONS OF LIVER DISEASE
DIAGNOSTIC WORK-UP FOR SUSPECTED LIVER DISORDER
Clinical Evaluation
Investigative Evaluation
INDIAN CHILDHOOD CIRRHOSIS
Epidemiology
Etiologic Considerations
Pathology
Clinical Features
Diagnosis
Treatment
Prognosis
Prevention (Table 25.2)
REYE's SYNDROME (Including “Reye-like” Diseases)
Etiopathogenesis
Clinical Features
Complications
Differential Diagnosis
Laboratory Diagnosis
Treatment
Prognosis
VIRAL HEPATITIS
Etiologic Viruses
Mode of Infectivity
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Prevention
Prognosis
FULMINANT HEPATITIS (Including Subfulminant Hepatitis)
Etiology
Clinical Features
Treatment
Prognosis
FULMINANT/ACUTE HEPATIC FAILURE (Hepatic Encephalopathy)
Etiopathogenesis
Clinical Grading
Investigations
Management
Prognosis
CHRONI LIVER DISEASE (CLD)
CHRONIC HEPATITIS (CH)
Major Types
Old Classification
New Staging/Grading
Clinical Features
Diagnosis
Management
Prognosis
AUSTRALIA ANTIGEN
PORTAL HYPERTENSION
INTRAHEPATIC PORTAL HYPERTENSION (IHPH)
Etiology
Clinical Features
Diagnosis
Treatment
Prognosis
EXTRAHEPATIC PORTAL HYPERTENSION
Etiology
Clinical Features
Diagnosis
Treatment
NEONATAL CHOLESTASIS SYNDROME (NCS)
Etiology
Clinical Features
Diagnosis
Management
Prognosis
EXTRAHEPATIC BILIARY ATRESIA
CHOLEDOCHAL CYST
CHOLECYSTITIS
Cholecystitis with Cholelithiasis
Acute Acalculous Cholecystitis
DRUG-INDUCED LIVER INJURY
HEPATOMEGALY: DIFFERENTIAL DIAGNOSIS
LIVER ABSCESS
PYOGENIC LIVER ABSCESS
Etiology
Clinical Features
Diagnosis
Management
Prognosis
Complications
AMEBIC LIVER ABSCESS
WILSON DISEASE (Hepatolenticular Degeneration)
APPROACH TO THE CHILD WITH ASCITES
Etiology
Special Diagnostic Investigations
Management
ORTHOTOPIC LIVER TRANSPLANTATION (OLT)
Indications
Contraindication
Complications
Immunosuppression to Prevent “Rejection”
Results
FURTHER READING
CHAPTER 26:
Pediatric Nephrology
BASICS OF THE RENAL SYSTEM
DIAGNOSTIC WORK-UP FOR RENAL DISORDERS
Clinical Evaluation
Investigative Evaluation
CONGENITAL MALFORMATIONS OF KIDNEY AND URINARY TRACT
Renal Agenesis
Horse-shoe Kidneys
Polycystic Disease of Kidneys
Duplex Renal System
Pelviureteric Junction (PUJ) Stenosis
Posterior Urethral Valves
Meatal Stenosis
Phimosis and Paraphimosis
Antenatal Diagnosis of Developmental Anomalies
NEUROGENIC BLADDER
OBSTRUCTIVE UROPATHY
Predisposing Factors
Manifestations
Diagnosis
Treatment
PROTEINURIA
HEMATURIA
Etiology
Diagnosis
Treatment
URINARY TRACT INFECTION (UTI) (Pyelonephritis)
Etiologic Considerations
Clinical Features
Diagnosis
Treatment
ACUTE GLOMERULONEPHRITIS
Etiopathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Complications
Treatment
Prognosis
RENAL TUBULAR DISEASES
Renal Tubular Acidosis (RTA)
Nephrogenic Diabetes Insipidus (NDI)
Bartter Syndrome
ACUTE RENAL FAILURE (ARF)
Etiology
Investigations
Management
Prognosis
CHRONIC RENAL FAILURE (CRF)
Etiology
Clinical Features
Treatment
HEMOLYTIC-UREMIC SYNDROME (HUS)
Etiology
Pathogenesis
Pathology
Clinical Features
Diagnosis
Complications
Treatment
NEPHROTIC SYNDROME
Etiopathogenesis
Pathology
Clinical Features
Diagnosis
Treatment
Complications
Prognosis
HYPERTENSION
RENAL STONE
PRIMARY BLADDER STONE
PHIMOSIS AND PARAPHIMOSIS
END-STAGE RENAL DISEASE (ESRD)
RENAL OSTEODYSTROPHY (Renal or Uremic Rickets, Renal Dwarfism)
Clinical Features
Diagnosis
Treatment
FURTHER READING
CHAPTER 27:
Pediatric Hematology
DEVELOPMENTAL ASPECTS OF HEMATOPOIETIC SYSTEM
ANEMIAS
Grading
CLASSIFICATION OF ANEMIAS
NUTRITIONAL ANEMIAS
Iron-Deficiency Anemia (IDA)
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Control Measures
ANEMIA OF PROTEIN-ENERGY MALNUTRITION
PHYSIOLOGIC ANEMIA OF PREMATURITY
HYPOCHROMIC ANEMIAS REFRACTORY TO IRON
Pyridoxine (Vitamin B6) Dependency Anemia
Sideroblastic Anemia
Anemia of Infection
Anemia of Lead Poisoning
Anemia of Thalassemia
MEGALOBLASTIC ANEMIA
Etiology
Deficiency of B12
Folate Deficiency
Clinical Features
Diagnosis
Treatment
HEMOLYTIC ANEMIAS
CHARACTERISTICS OF HEMOLYSIS
Classification
HEREDITARY SPHEROCYTOSIS (Congenital Hemolytic Anemia, Congenital Acholuric Jaundice)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
THALASSEMIA (Cooley Anemia, Mediterranean Anemia)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
Prevention and Counseling
SICKLE CELL ANEMIA
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G-6-PD) DEFICIENCY
Clinical Features
Diagnosis
Treatment
Prevention
PYRUVATE KINASE DEFICIENCY
Clinical Features
Treatment
AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)
AIHA Associated with Warm Antibodies
AIHA Associated with Cold Antibodies
METHEMOGLOBINEMIA
APLASTIC ANEMIA
Types
Treatment
MECHANISM OF COAGULATION (HEMOSTASIS)
APPROACH TO A CHILD WITH BLEEDING/ HEMOSTATIC DISORDER
History and Physical Examination
Investigations
DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
HEMORRHAGIC DISEASE OF THE NEWBORN (HDN) [VITAMIN K DEFICIENCY BLEEDING (VKDB)]
Definition, Incidence and Inclusion Criteria
Clinical Features
Diagnosis
Treatment
Prevention
HEMOPHILIA
Classification
Clinical Features
Diagnosis
Treatment
Preventive Care
VON WILLEBRAND DISEASE (VWD)
IMMUNE THROMBOCYTOPENIC PURPURA (ITP)
Etiopathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
1. Acute ITP
2. Chronic ITP
Prognosis
WISKOTT-ALDRICH SYNDROME
DRUG-INDUCED THROMBOCYTOPENIA
ANAPHYLACTOID (HENOCH-SCHOENLEIN) PURPURA
Clinical Features
Diagnosis
Treatment
Prognosis
PURPURA FULMINANS
LEUKOCYTE DYSFUNCTION
NEUTROPENIA
Etiology
Febrile Neutropenia
Clinical Features
Diagnosis
Management
Prevention
VENOUS THROMBOEMBOLISM
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
POLYCYTHEMIA (Erythrocytosis)
HEMOPOIETIC STEM CELL (HSC) TRANSPLANTATION
Principle Indications
Complications
Future Direction
BLOOD COMPONENT THERAPY
Classification
Unmodified Components Packed RBCs
Indications
Platelets
Indications
Granulocytes
Indications
Fresh Frozen Plasma
Indications
Cryoprecipitate
Indications
Modified Components Gamma-irradiated Blood Products
Indications
Saline Washed RBCs
Indications
Saline Washed Platelets
FURTHER READING
CHAPTER 28:
Pediatric Oncology
INTRODUCTION
LEUKEMIA
Etiology
Clinical Features
Diagnosis
Treatment
Prognosis
LYMPHOMAS
HODGKIN's DISEASE
Etiopathology
Clinical Features
Diagnosis
Treatment
Prognosis
NON-HODGKIN LYMPHOMA
Etiopathology
Clinical Features
Diagnosis
Treatment
Prognosis
WILMS' TUMOR (Nephroblastoma)
Clinical Features
Diagnosis
Treatment
Prognosis
NEUROBLASTOMA
Clinical Features
Diagnosis
Treatment
Prognosis
HEPATOBLASTOMA
BRAIN TUMORS
Infratentorial
Cerebellar Tumors
Brainstem Tumors
Fourth Ventricle Tumor
Supratentorial
BONE TUMORS
Osteosarcoma
Ewing Sarcoma
SOFT TISSUE SARCOMAS
RETINOBLASTOMA
THYMOMA
TERATOMAS
ONCOLOGIC EMERGENCIES
BONE MARROW TRANSPLANTATION
Indications
Procedure
Complications
FURTHER READING
CHAPTER 29:
Pediatric Immunology
INTRODUCTION
IMMUNOLOGIC SYSTEM: FUNDAMENTALS
IMMUNODEFICIENCY STATES
I. PRIMARY IMMUNODEFICIENCY STATES
B-Cell Defects
T-Cell Defects
Combined B and T Cell Defects (Combined Immunodeficiency)
Neutrophils Defects
Complement Defects
II. SECONDARY IMMUNODEFICIENCY
DIAGNOSTIC APPROACH IN IMMUNODEFICIENCY
Clinical Clues
Investigations
Treatment
IMMUNOLOGIC BASIS OF AUTOIMMUNE DISEASE
IMMUNOLOGIC BASIS OF ALLERGY (ATOPY)
IMMUNOLOGIC ASPECTS OF MALIGNANCY
IMMUNODEFICIENCY AND SPECIAL RISKS
INTRAVENOUS IMMUNOGLOBULINS (IVIG)
Composition
Essential Prerequisites/Requirements
Indications
Abuse
Contraindications
Advantages of Intravenous over Intramuscular Immunoglobulin
Hazards
BONE MARROW TRANSPLANTATION (BMT)
FURTHER READING
CHAPTER 30:
Pediatric Collagenosis
INTRODUCTION
RHEUMATIC FEVER
JUVENILE RHEUMATOID ARTHRITIS (JRA)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Pathology
Clinical Features
Diagnosis
Treatment
Prognosis
DERMATOMYOSITIS
POLYARTERITIS NODOSA (Periarteritis)
SCLERODERMA
MIXED CONNECTIVE TISSUE DISEASE (MCTD)
GOODPASTURE SYNDROME
FASCITIS
BENIGN RHEUMATOID NODULES
VASCULITIS SYNDROMES (Vasculitides)
KAWASAKI DISEASE (Mucocutaneous Lymph Node Syndrome, Infantile Polyarteritis)
Clinical Features
Diagnosis
Treatment
Prognosis
POLYARTERITIS NODOSA
ANAPHYLACTOID PURPURA (Henoch-Schoenlein Purpura)
BEHCET DISEASE
TAKAYASU ARTERITIS
WEGENER'S GRANULOMATOSIS
MARFAN SYNDROME
EHLER-DANLOS SYNDROME
FURTHER READING
CHAPTER 31:
Pediatric Dermatology
INTRODUCTION
ATOPIC DERMATITIS
Clinical Features
Treatment
INSECT BITE HYPERSENSITIVITY
DRUG ERUPTION
SCABIES (Seven-year Itch)
Clinical Features
Diagnosis
Treatment
PEDICULOSIS
RINGWORM INFECTIONS (Dermatophytosis, Dermatophycosis)
MONILIASIS (Candidiasis)
DIAPER RASH (Nappie or Napkin Flash, Intertrigo)
Clinical Features
Treatment
PRICKLY HEAT (Sudamina)
SEBORRHEA
Clinical Features
Treatment
URTICARIA (Nettle Rash)
PYODERMAS
Classification
Treatment
ERYSIPELAS
SCALDED SKIN SYNDROME (SSS)
ICHTHYOSIS*
CAFE-AU-LAIT SPOTS
ALBINISM
VITILIGO (Leukoderma)
LEPROSY
HEMANGIOMA
TELANGIECTATIC ANGIOMA (Spider Nevus)
EPIDERMOLYSIS BULLOSA (EB)
ERYTHEMA MULTIFORME
PEMPHIGUS
EHLER-DANLOS SYNDROME
MOLLUSCUM CONTAGIOSUM
WARTS
ERYTHEMA NODOSUM
SKIN TUBERCULOSIS
ECTODERMAL DYSPLASIAS
ACNE
PSORIASIS
FURTHER READING
CHAPTER 32:
Pediatric Accidental Poisoning
ACCIDENTAL POISONING: AN OVERVIEW
Approach
Laboratory Evaluation
Gastrointestinal Decontamination
Gastric Lavage
Activated Charcoal
Whole Bowel Irrigation (WBI)
Toxin Elimination (Enhancement of Excretion)
Administration of Antidotes
Prevention
KEROSENE OIL POISONING
Clinical Features
Treatment
ORGANIC PHOSPHATE POISONING
Clinical Features
Treatment
DDT POISONING
Clinical Features
Treatment
BARBITURATE POISONING
Clinical Features
Treatment
PARACETAMOL TOXICITY
IBUPROFEN TOXICITY
Clinical Features
Treatment
ASPIRIN POISONING (Salicylism)
Clinical Features
Treatment
PHENOTHIAZINE TOXICITY
Clinical Features
Treatment
CHLOROQUINE-INDUCED PSYCHOSIS
CYPROHEPTADINE POISONING
IRON (IRON SALTS) POISONING
Clinical Features
Treatment
MORPHINE AND OTHER OPIATES POISONING
Clinical Features
Treatment
DATURA (ATROPINE) POISONING
Clinical Features
Treatment
LEAD POISONING (Plumbism)
Clinical Features
Diagnosis
Treatment
MERCURY POISONING
LATHYRISM
FURTHER READING
CHAPTER 33:
Pediatric Envenomations
SNAKE BITE
Clinical Features
Laboratory Investigations
Grading of Envenomation
Treatment
Immediate Measures
Specific Measures
Desensitization
Supportive Measures
Prevention
Complications
SCORPION STING
Clinical Features
Potentially Dangerous Sting
Fatal Sting
Treatment
FURTHER READING
CHAPTER 34:
Pediatric Endocrinology
THE ENDOCRINE ORCHESTRA
HYPOTHALAMUS AND ITS DISORDERS
PITUITARY AND ITS DISORDERS
SHORT STATURE
GROWTH HORMONE DEFICIENCY (GHD)
Etiology
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
THYROID AND ITS DISORDERS
CONGENITAL HYPOTHYROIDISM (Cretinism)
Etiology
Clinical Features
Diagnostic Investigations
Differential Diagnosis
Treatment
Prognosis
ACQUIRED HYPOTHYROIDISM
HYPERTHYROIDISM (Juvenile Graves Disease)
Etiology
Clinical Features
Diagnosis
Treatment
GOITER (Thyromegaly)
PARATHYROID AND ITS DISORDERS
ADRENAL AND ITS DISORDERS
GONADS AND THEIR DEFICIENCY
UNDESCENDED TESTES (Cryptorchidism)
PRECOCIOUS PUBERTY
Types
Diagnosis
Treatment
DELAYED PUBERTY
Etiology
Diagnosis
Management
THE CHILD WITH AMBIGUOUS GENITALIA
Types of Hermaphroditism
Diagnosis
Clinical
Radiologic
Laboratory
Treatment
DIABETES MELLITUS
Childhood Diabetes vs Adult Diabetes
Current Classification
Etiologic Considerations
Clinical Features
Diagnosis
Management
Routine Diabetes
Diabetic Ketoacidosis (DKA)
Complications
Prognosis
THE OBESE CHILD
Definition and Screening
Etiopathogenesis
Clinical Features
Diagnosis
Management
SHORT STATURE
FURTHER READING
CHAPTER 35:
Genetics in Pediatric Practice
DEFINITION
GENETICS IN HUMAN WELLBEING
HUMAN CELL DIVISION
THE GENES
TYPES OF INHERITANCE
VARIATIONS IN EXPRESSION OF GENETIC TRAITS
TYPES OF GENETIC DISORDERS
THE HUMAN GENOME PROJECT (HGP)
THE CHROMOSOMES
Number
Size, Shape and Structure
Types
Denver Classification (Modified)
Sex Chromatin
Chromosomal Studies
CHROMOSOMAL DISORDERS
INBORN ERRORS OF METABOLISM (IEM)
PHENYLKETONURIA (PKU)
Clinical Features
Diagnosis
Treatment
ALBINISM
ALKAPTONURIA
HOMOCYSTINURIA
MAPLE SYRUP URINE DISEASE (MSUD)
HARTNUP DISEASE
TYROSINEMIA
GALACTOSEMIA
Clinical Features
Diagnosis
Treatment
GLYCOGEN STORAGE DISEASE (GSD)
GAUCHER DISEASE
NIEMANN-PICK DISEASE
MUCOPOLYSACCHARIDOSIS (MPS)
PRENATAL DIAGNOSIS
Situations for Which Prenatal Diagnosis is Available
Indications
Techniques
DERMATOGLYPHICS
GENE THERAPY
GENETIC COUNSELING
FURTHER READING
CHAPTER 36:
Pediatric Neuromuscular Disorders
INTRODUCTION
NEUROMUSCULAR TRANSMISSION DISORDERS
Myasthenia Gravis
MOTOR NEURON DISORDERS
SPINAL MUSCULAR ATROPHIES (SMA)
Classification
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
DEVELOPMENTAL (CONGENITAL) DISORDERS OF MUSCLES
MYOTUBULAR MYOPATHY (Centronuclear Myopathy)
BENIGN CONGENITAL HYPOTONIA
MUSCULAR DYSTROPHIES
PSEUDOHYPERTROPHIC MUSCULAR DYSTROPHY
Duchenne Muscular Dystrophy (DMD)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
Prevention
Becker Muscular Dystrophy
Scapuloperoneal or Scapulohumeral Muscular Dystrophy
Myotonic Muscular Dystrophy
Limb-Girdle Muscular Dystrophy
Facioscapulohumeral Muscular Dystrophy
Congenital Muscular Dystrophy
ENDOCRINAL MYOPATHIES
Steroid-induced Myopathy
Thyroid Myopathy
Parathyroid Myopathy
METABOLIC MYOPATHIES
Potassium-related Periodic Paralysis
OTHER MYOPATHIES
HEREDITARY MOTOR-SENSORY NEUROPATHIES (HMSN)
AUTONOMIC NEUROPATHIES
GUILLAIN-BARRÉ SYNDROME
BELL's PALSY
FLOPPY BABY SYNDROME
FURTHER READING
PART FIVE: PEDIATRIC SUPERSPECIALTIES
CHAPTER 37:
Pediatric Ophthalmology
DEVELOPMENTAL ASPECTS
ORBITAL DISEASES
Hypertelorism
Hypotelorism
Exophthalmos (Proptosis)
Enophthalmos
Microphthalmia
Orbital Cellulitis
Periorbital (Preseptal) Cellulitis
Tumors
DISEASES OF THE EYELIDS
Ptosis
Lagophthalmos
Lid Retraction
Entropion
Ectropion
Blepharospasm
Blepharitis
Hordeolum
Chalazion
Coloboma
Tumors
DISEASES OF THE LACRIMAL SYSTEM
Congenital Nasolacrimal Duct Obstruction (CNLDO)
Dacryocystitis
Alacrima (Dry Eye)
CONJUNCTIVAL DISEASES
Conjunctivitis
Subconjunctival Hemorrhage
Chemosis
Pingueculum
Pterygium
Dermoid Cyst/Dermolipoma
Conjunctival Nevus
Symblepharon
CORNEAL DISEASES
Megalocornea
Microcornea (Anterior Microphthalmia)
Keratoconus
Sclerocornea
Dendritic Keratitis
Interstitial Keratitis
Phlyctenules (Phlyctenular Keratoconjunctivitis)
Corneal Ulcers
Peter's Anomaly
PUPILLARY AND IRIS ABNORMALITIES
DISEASE OF LENS
Cataracts
Ectopia Lentis
DISEASE OF THE UVEAL TRACT
EYE MOVEMENT AND ALIGNMENT DISEASES
Strabismus (Squint)
Clinical Types
Diagnostic Tests
Treatment
REFRACTIVE ERRORS
Hypermetropia (Hyperopia)
Myopia
Astigmatism
Anisometropia
Impairment/Paralysis of Accommodation
VISUAL DISORDERS
DISEASES OF THE RETINA AND VITREOUS
Retinopathy of Prematurity (Retrolental Fibroplasia)
Etiopathogenesis
Classification
Treatment
Prevention
RETINOBLASTOMA
Retinitis Pigmentosa
Retinal Detachment
Hypertensive Retinopathy
Diabetic Retinopathy
OPTIC NERVE DISEASES (Figs 37.5 to 37.9)
Papilledema (Choked Disk)
Optic Neuritis
Optic Atrophy
SYSTEMIC MEDICATION AND OCULAR DAMAGE
OCULAR TRAUMA
FURTHER READING
CHAPTER 38:
Pediatric Ear, Nose and Throat (ENT) Problems
INTRODUCTION
THE EAR DISORDERS
Foreign Bodies in the Ear
Acute Otitis Media
Etiology
Clinical Features
Treatment
Prognosis
Complications
Deafness (Hearing Impairment)
Types
Etiology
Clinical Effects
Evaluation
Assessment of Hearing through Special Techniques
Treatment
THE NOSE DISORDERS
Foreign Body in Nose
Epistaxis (Nosebleeds)
Etiology
Treatment
Sinusitis
Nasal Polyps
THE THROAT DISORDERS
Acute Pharyngitis
Etiology
Clinical Features
Diagnosis
Complications
Treatment
Tonsillitis
Adenoids (Adenoidal Hypertrophy; Hypertrophy of Pharyngeal Tonsils)
Clinical Features
Diagnosis
Treatment
Stridor
Croup (Acute Laryngotracheobronchitis)
Acute Epiglottitis
DIPHTHERIA
INTUBATION AND TRACHEOSTOMY
FURTHER READING
CHAPTER 39:
Pediatric Dental Problems
NORMAL DENTITION
DENTAL MALOCCLUSION
DENTAL CARIES
Etiopathogenesis
Clinical Features
Treatment
Prevention
FLUOROSIS
GUIDELINES FOR PREVENTION OF DENTAL DISEASE
Dental/Oral Hygiene
Diet
Fluoride and Fluoridation
Regular Dental Check-ups
CLEFT LIP AND PALATE (Figs 39.3 to 39.6)
FURTHER READING
CHAPTER 40:
Pediatric Surgery
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS
Clinical Features
Diagnosis
Treatment
HIATAL HERNIA (Partial Thoracic Stomach)
ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA
Clinical Features
Diagnosis
Treatment
CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
DUODENAL AND OTHER INTESTINAL ATRESIAS
INTESTINAL MALROTATION
INTUSSUSCEPTION
Clinical Features
Diagnosis
Treatment
Prognosis
HIRSCHSPRUNG's DISEASE
Treatment
Prognosis
MECONIUM PLUG SYNDROME
MECONIUM ILEUS
MECKEL's DIVERTICULUM
NECROTIZING ENTEROCOLITIS (NEC)
APPENDICITIS
IMPERFORATE ANUS AND OTHER MALFORMATIONS
ANAL FISSURE (Fissure-in-ano)
PERIANAL ABSCESS AND FISTULA
PILONOIDAL SINUS AND ABSCESS
VITELLOINTESTINAL FISTULA
UMBILICAL POLYP
UMBILICAL HERNIA
EXOMPHALOS (OMPHALOCELE) AND GASTROSCHISIS
EXTRAHEPATIC BILIARY ATRESIA (EHBA)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
CHOLEDOCHAL CYSTS
Varieties
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
CHOLECYSTITIS (CALCULUS TYPE)
OBSTRUCTIVE UROPATHY
Congenital Ureteropelvic Junction (UPJ) Obstruction
Posterior Urethral Valve (PUV)
RENAL STONE
Etiology
Clinical Features
Diagnosis
Treatment
PRIMARY BLADDER STONE DISEASE
Etiology
Clinical Features
Treatment
PRIAPISM
Etiology
Treatment
TIGHT EXTERNAL URETHRAL MEATUS (Meatal Stenosis)
PHIMOSIS AND PARAPHIMOSIS
HYPOSPADIAS AND EPISPADIAS
AMBIGUOUS GENITALIA
INGUINAL HERNIA
HYDROCELE
UNDESCENDED TESTES (Cryptorchidism)
EPIDIDYMO-ORCHITIS
ACUTE SCROTUM
CLEFT LIP AND CLEFT PALATE
CYSTIC HYGROMA (Lymphangioma)
THYROGLOSSAL CYST
BRACHIAL CYST
BRACHIAL SINUS AND FISTULA
STERNOMASTOID TUMOR (Sternocleidomastoid Tumor)
ABSCESS
FURTHER READING
CHAPTER 41:
Pediatric Orthopedics
CONGENITAL DEFICIENCY OF LONG BONES
CLUB FOOT
FLAT FOOT
RADIAL CLUB HAND
TRIGGER THUMB
POLYDACTYLY
SYNDACTYLY
CONGENITAL CONSTRICTION BANDS/ RINGS
CONGENITAL PSEUDOARTHROSIS OF THE TIBIA
DISLOCATION OF PATELLA
KNOCK KNEE (Genu Valgum)
BOW LEG (Genu Varum)
CLEIDOCRANIAL DYSOSTOSIS
HEMIHYPERTROPHY
SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)
Etiology
Clinical Features
Diagnosis
Treatment
Prognosis
SCOLIOSIS
KYPHOSIS
OSTEOGENESIS IMPERFECTA (OI)
MARFAN SYNDROME
ARTHROGRYPOSIS MULTIPLEX CONGENITA (AMC)
ACHONDROPLASIA
PSEUDOACHONDROPLASIA
OSTEOPETROSIS (Marble Bone Disease)
OSTEOCHONDRITIS
LIMB LENGTH DISCREPANCY
Etiology
Evaluation
Treatment
CHILD ABUSE AND NEGLECT (CAN)
ACUTE SEPTIC (PYOGENIC) ARTHRITIS
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
OSTEOMYELITIS
Etiopathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
TUBERCULOSIS OF BONES AND JOINTS
TRANSIENT SYNOVITIS OF THE HIP (Observation Hip)
RHEUMATOID ARTHRITIS
BONE TUMORS
PEDIATRIC SPORTS MEDICINE
Indications for Restriction
Categorization of Sports
Areas of Concern
Disqualifications and Limitations
Pediatric Evaluation
The Pediatric Sports Medicine Program and the Pediatrician's Responsibilities
PEDIATRIC FRACTURES
Special Features
Patterns
Management Highlights
FURTHER READING
PART SIX: MISCELLANEOUS AND UNCLASSIFIED ISSUES
CHAPTER 42:
Miscellaneous and Unclassified Pediatric Issues
CHILD ADOPTION
Why Adoption?
Source of Adoption: A Relative or An Agency?
Adoption Laws
Adoption and the Pediatrician
CHILD ABUSE AND NEGLECT (CAN) (Nonaccidental Injury Battered Baby Syndrome)
Etiology
Clinical Features
Diagnosis
Treatment
INFANTILE TREMOR SYNDROME (ITS)
Epidemiologic Considerations
Etiology
Clinical Features
Course
Diagnosis
Treatment
Prognosis
SUDDEN INFANT DEATH SYNDROME (SIDS)
Etiopathogenesis
Diagnosis
Treatment
PROGERIA (Hutchinson-Gilford Syndrome, Plucked Bird Disease, Premature Senility)
CHRONIC FATIGUE SYNDROME (Chronic Mononucleosis, Chronic Epstein-Barr Virus Infection, Immune Dysfunction Syndrome)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Prognosis
GROWING PAINS
HISTIOCYTOSIS
SARCOIDOSIS
Etiopathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Prognosis
SOME MINOR PROBLEMS OF THE NEWBORN, THE INFANT AND THE YOUNG CHILD
Neonatal Period
Later Infancy and Childhood
Tongue-tie (Ankyloglossia)
Delayed Speech
Eating Problem
Bedwetting
Umbilical Hernia
Protuberant Abdomen
Irregular/Asymmetrical Skull
Bowlegs (Genu Varum)/Knock Knees (Genu Valgum)
Flat Feet (Pes Planovalgus)
MODERN IMAGING TECHNIQUES
Ultrasonography
CT Scan
Magnetic Resonance Imaging (MRI)
Nuclear Medicine (Radionuclide Scintography)
COMPUTERS: APPLICATIONS IN PEDIATRICS
HEAT INJURY
SHOCK
Types
Clinical Manifestations
Diagnosis
Treatment
EMERGING AND RE-EMERGING INFECTIONS
Definitions
Classification
Noteworthy Emerging and Re-emerging Infections
Contributing Factors
Control Measures
EVIDENCE BASED MEDICINE (EBM)
Need for the EBM
Essential Steps in EBM
Sources of EBM
Limitations of EBM
FURTHER READING
PART SEVEN: PEDIATRIC PROCEDURES
CHAPTER 43:
Pediatric Practical Procedures
INTRODUCTION
GENERAL RULES/PRECAUTIONS
RESTRAINT AND POSITIONING
INTRAMUSCULAR INJECTION
Usual Sites
Method
Special Note
SUBCUTANEOUS INJECTION
Method
Special Note
INTRADERMAL INJECTION
Method
Special Note
VENIPUNCTURE
INTRAVENOUS INFUSION
Scalp Vein Infusion
Venesection (Cutdown or Cutopen)
Umbilical Vein Catheterization
ARTERIAL PUNCTURE
INTRAOSSEOUS INFUSION
SUBCUTANEOUS INFUSION
INTRAPERITONEAL INFUSION
RECTAL INFUSION
BONE MARROW ASPIRATION
BONE MARROW TREPHINE
LUMBAR PUNCTURE (LP)
SUBDURAL PUNCTURE OR TAP
VENTRICULAR TAP
THORACENTESIS
PERICARDIAL PUNCTURE
ABDOMINAL PARACENTESIS
SUPRAPUBIC BLADDER ASPIRATION
Method
HEEL PUNCTURE
Method
Special Note
LIVER BIOPSY
KIDNEY BIOPSY
INTUBATION
ENDOTRACHEAL INTUBATION
PHOTOTHERAPY
EXCHANGE TRANSFUSION
LYMPH NODE BIOPSY
FINE NEEDLE ASPIRATION
Requirements
Method
Special Role
Caution
GASTRIC LAVAGE
Method
Special Note
MANUAL REMOVAL OF FOREIGN BODY FROM AIRWAY
Removal in an Infant
Back Blow Chest Thrust
Removal in a Child Older than 1 Year
Helmich's Maneuver in Conscious Child
Helmich's Maneuver in Unconscious Child
CARDIAC RESUSCITATION
ASSISTED VENTILATION
A. Bag and Mask Ventilation
B. Continuous Positive Airway Pressure (CPAP)
Mechanical Ventilation
FURTHER READING
CHAPTER 44:
Pediatric Laboratory Procedures
BLOOD EXAMINATION
Collection
Hemoglobin
Hematocrit
Red Cell Count
Peripheral Blood Film
Total Leukocyte Count (TLC)
Differential Leukocyte Count (DLC)
Erythrocyte Sedimentation Rate (ESR)
Reticulocyte Count
Platelet Count
URINE EXAMINATION
Collection
Physical Examination
Chemical Examination
Urine Microscopy
STOOL EXAMINATION
Collection
Microscopy
Occult Blood
Fat Globules
Reducing Substances
Stool pH
CSF EXAMINATION
Collection
Examination
FURTHER READING
PART EIGHT: PEDIATRIC SYNDROMES
CHAPTER 45:
Pediatric Syndromes
FURTHER READING
PART NINE: PEDIATRIC DRUG DOSAGES
CHAPTER 46:
Pediatric Drug Dosages
Appendices
BLOOD
URINE
CEREBROSPINAL FLUID (CSF)
Milliequivalents
Data for Conversion of Milligrams per 100 ml to Milliequivalents per Liter of Plasma
Factors for Rapid Conversion of Milligrams per 100 ml to Milliequivalents per Liter
Temperature
Inches to Centimeter
Minim to Millilit (ml)
Equivalent Imperial and Metric Quantities
SI Unit Conversion
Example
Results Previously Expressed as mg/100 ml
1. Introduction to Pediatrics
2. Growth and Development
3. Nutrition and Its Disorders
4. Immunizations
5. Fluid and Electrolytes
6. Neonatology
7. Infectious Diseases (I)
8. Infectious Diseases/Parasitic Disorders (II)
9. Gastrointestinal System
10. Respiratory System
11. Cardiovascular System
12. Genitourinary System
13. Hemato-oncology
14. Central Nervous System and Neuromuscular Disorders
15. Endocrine System
Break-up
Guidelines/Classifications
INDEX
TOC
Index
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