IAP Textbook of Pediatrics A Parthasarathy, MKC Nair, Rohit Agrawal, TU Sukumaran, PSN Menon, Piyush Gupta
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1IAP Textbook of PEDIATRICS
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IAP Textbook of PEDIATRICS
Fifth Edition
Editor-in-Chief A Parthasarathy MD(Ped) DCH FIAP President Indian Academy of Pediatrics 1997 Distinguished Professor of Pediatrics The Tamil Nadu Dr MGR Medical University Senior Clinical Professor of Pediatrics (Retd) Madras Medical College Deputy Superintendent, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu Chief Academic Editor PSN Menon MD MNAMS FIAP President Indian Society for Pediatric and Adolescent Endocrinology 2011–12 Consultant and Head, Department of Pediatrics, Jaber Al-Ahmed Armed Forces Hospital, Kuwait Former Professor of Pediatrics, All India Institute of Medical Sciences, New Delhi Academic Editors Piyush Gupta MD FAMS FIAP Editor-in-Chief Indian Academy of Pediatrics 2008–13 Professor Department of Pediatrics University College of Medical Sciences, Delhi MKC Nair PhD MD M Med Sc MBA, FIAP President Indian Academy of Pediatrics 2004 Professor of Pediatrics and Clinical Epidemiology Director, Child Development Centre Government Medical College Thiruvananthapuram, Kerala Editorial Advisers Rohit Agrawal MD FIAP President Indian Academy of Pediatrics 2012 Consultant Pediatrician Kohinoor Hospital and Chandra-Jyoti Children Hospital Mumbai, Maharashtra TU Sukumaran MD DCH MNAMS MPhil FIAP President Indian Academy of Pediatrics 2011 Professor Department of Pediatrics Pushpagiri Institute of Medical Sciences Thiruvalla, Kerala ForewordsCP Bansal, Rohit Agrawal, TU Sukumaran IAP, National Publication House, Gwalior
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This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
IAP Textbook of Pediatrics
First Edition: 1999, 2000
Second Edition: 2002,2003
Third Edition: 2006
Revised Reprint: 2007
Fourth Edition: 2009
Fifth Edition: 2013
9789350259450
Printed at
5Dedicated to
The future citizens of India whose Care and Nurture are our Goal, Concern and Commitment
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7Contributors 17Foreword
It gives me great pleasure to write the foreword for IAP Textbook of Pediatrics (Fifth Edition), a prestigious publication of Indian Academy of Pediatrics.
We, as Pediatricians, are dealing with the health of more than 50 percent of the population. Infant and childhood morbidity continue to be very high and adolescent health problems are still not adequately addressed by medical profession. Thus, it is imperative that all of us need to have sound training to look after the children from birth to 18 years. The book has fulfilled this void very well. All previous editions of this book have been very popular amongst undergraduate and postgraduate students. The book has been well received in many developing countries having similar health scenario.
Contributors of this book are renowned experts in their respective fields. An invariable problem with multiauthored texts is the diversity of presentations adopted by a multitude of contributors. Since inception, Dr A Parthasarathy, Editor-in-Chief, an accomplished academician with tremendous zeal, managed this issue by carefully crafting a common editorial style. In this venture, he has been aptly assisted by other very well-known academicians, Dr PSN Menon, Dr Piyush Gupta and Dr MKC Nair, along with many highly reputed chapter editors. Keeping with time, the text of the book has been aptly modified and all the chapters have been thoroughly revised.
The book is designed to be relevant to the need of the developing countries. Emphasis has been on common prevalent conditions though allied subjects seen in children have also received due attention. Section on Community Pediatrics deserves special mention as most textbooks with Western approach hardly provide any information in this respect.
The book certainly will continue to remain as a very prestigious publication of Indian Academy of Pediatrics.
CP Bansal
President
Indian Academy of Pediatrics 2013
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19Foreword
It indeed is a proud privilege and great honor for me to write the foreword for IAP Textbook of Pediatrics, an ultimate academic publication of the Indian Academy of Pediatrics, which is nothing less of an international class. If “Nelson” is considered as the “Bible of Pediatrics”, this creation should surely be taken as “Gita/Quran of Pediatrics”, at least for the pediatric health professionals of South Asia.
The Indian Academy of Pediatrics is always been a front runner in dissemination of knowledge and academics being its citadel. The revolutionary concept, envisaged way back in the late 1990s, has undergone many revisions, and, today; the Fifth Edition is getting released on the 50th Golden Jubilee Year of Indian Academy of Pediatrics; will imprint itself in the golden letters in the golden history of Indian Academy of Pediatrics at the golden hands of His Excellency Dr APJ Abdul Kalam.
This mission of Indian Academy of Pediatrics is a vision towards the cause of every pediatrician, a student, a practitioner or an academician alike, which may translate into better child health care services and reduction in child mortality… a humble attempt to achieve MDG-4. In its Fifth Edition, this textbook slowly but surely inching towards the “Nelson's” textbook. Almost the entire gambit of pediatrics is being brilliantly and aesthetically crafted in this reader-friendly textbook by the editors. Latest and updated information is encompassed and compiled in their respective subspecialty sections by a team of learned section editors. The authors who contributed are Key Academic Opinion Leaders in their respective fields.
A dedicated team of astute academicians, such as Dr A Parthasarathy, Editor-in-Chief, Dr PSN Menon, Chief Academic Editor, Dr Piyush Gupta and Dr MKC Nair, Academic Editors, have probably put in the best of their academic life for the last 2 years to bring out this “immortal” Fifth Edition of IAP Textbook of Pediatrics. My heartfelt gratitude, tributes and innumerable salutes to this “Immortal quartet”.
Rohit Agrawal
President
Indian Academy of Pediatrics 2012
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21Foreword
It is my pleasure and privilege to write the foreword for the Fifth Edition of the IAP Textbook of Pediatrics. This textbook was published as an action plan of Dr A Parthasarathy who continues to excel as the Editor-in-Chief for the Fifth Edition of this remarkable book. The book is not only an accepted reference book of Pediatrics in India but is also widely accepted by all the academicians, postgraduates and practitioners around the country. There are a lot of unique features included in the Fifth Edition. Every chapter has been updated and rewritten by experts in their respective fields with a great acumen.
I congratulate the dynamic editors Dr PSN Menon, Dr Piyush Gupta and Dr MKC Nair for their hard work to release the book during the Golden Jubilee Year of Indian Academy of Pediatrics in Pedicon (Kolkata, West Bengal, India). I also congratulate Dr Rohit Agrawal, President, IAP 2012, and Dr CP Bansal, President, IAP 2013, and all the contributors who have made this wonderful book possible.
TU Sukumaran
President
Indian Academy of Pediatrics 2011
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23Preface to the Fifth Edition
The Editorial Board dedicates this new revised and updated Fifth Edition of the IAP Textbook of Pediatrics to children and adolescents—the future citizens of India whose Care and Nurture are our goal, concern and commitment. In a way, it is also our humble homage to the Indian Academy of Pediatrics, which has been in the forefront for the care of children of all hues and colors, at all ages and without barriers; and had trained and nurtured us as responsible professionals to care them with love and compassion. It is our honor and privilege that this dedication coincides with the time when the Indian Academy of Pediatrics is celebrating 50 years of its existence and active service.
The last decade has witnessed rapid strides in medicine and technological advances in biological sciences. The specialty of Pediatrics has made substantial advances in preventive and therapeutic care. New vistas for care of children have been opened and many fresh thrust areas requiring our immediate or continued attention to decrease both morbidity and mortality have been delineated. These have provided fresh impetus to revise knowledge, harvest new information and thus continue the process of learning. The opportunities are limitless and it is for us to take advantage of these new frontiers. There was a felt need for publication of an updated Fifth Edition of this book after a gap of 4 years. This was also prompted by the enthusiastic response to the previous editions from practicing pediatricians, postgraduates, undergraduates as well as faculty of Departments of Pediatrics throughout India and other SAARC countries.
It has been our endeavor to present this subject in a simplified and practical manner to provide adequate clinical guidance to pediatricians so that children derive the benefits of early diagnosis and optimal treatment. The basic simple and practical outline of the book is retained. We have tried our best to oversee that the “art and science” of Clinical Pediatrics maintains its central position without being overshadowed by newer technical advances.
The main focus of the new edition has now shifted to practicing pediatricians as against the original concept of undergraduates. The Indian Academy of Pediatrics now has a membership of nearly 20,000 pediatricians and there is a felt need to continuously update our members—young and old—with the rapid advances in the field and the new national initiatives in the care of children. The previous editions were very popular amongst practitioners of pediatrics as well as family medicine. This is not a watered down version; efforts have also been made to keep a balance with incorporation of the curricular needs of the undergraduates and postgraduates and teachers in Pediatrics.
The book represents a substantial revision and reorganization of the text based on a complete review of the field of Pediatrics. A major change in this edition is the concerted effort to condense the contents of the Fifth Edition in a single volume instead of the 1,565 pages of the Fourth Edition in two volumes. The number of chapters has been brought down to 21 from the original 36 in the previous edition. These changes are in accordance with the wishes expressed by several readers and also suggestions received from the publisher. The entire contents of this textbook were formulated to provide relevant clinical information and national priorities at one site. The text of the new edition was written afresh or revised and edited accordingly by selected reputed experts in respective fields. A judicious balance of old and young authors was made by retaining most authors as far as possible and at the same time inducting new experts in chosen fields. Almost all the chapters have been thoroughly revised and updated in a lucid and readable style. The Editorial Board and the Indian Academy of Pediatrics are indebted to these experts who made their valuable contributions without any remuneration or honorarium for their services to the Indian Academy of Pediatrics.
Some of the thrust areas in this edition refer to felt needs of our country. It is our constant endeavor to inform, educate and update the reader about the current status of national community-oriented initiatives for children. We are justifiably proud of our achievements in preventive care with attainment of the status of polio-free nation among others, early this year. Strategies for incorporating newer technology and better coverage of immunization to contain communicable diseases and further reduction in disease burden, especially in the underprivileged areas of our society hence find a better thrust in this book. While we are able to combat infections at a better footing than before, the continued onslaught of newer infections and pandemics, especially from resistant microorganisms is our national priority. As pediatricians, our major commitment is to ensure a decrease in mortality and morbidity, especially among the under-fives. The use of simple strategies to improve health status (e.g. uniform growth charts and low cost food supplements); more complex issues such as the increasing disease burden of new epidemics of non-infectious chronic 24diseases like obesity, especially in the urban India; and screening for congenital disorders in the newborns thus find adequate mention in this book. Several new chapters have been added keeping in mind the changing concepts of Pediatric care in the global scenario.
The Indian Academy of Pediatrics would like to place on record its appreciation to all the authors who have taken great pains to contribute and/or edit reader-friendly sections with practical guidelines amidst their busy professional and academic schedules. We are proud to inform you that we have about 75 new authors in this edition of the textbook with valuable contributions. We welcome the new section editors of this edition and gratefully acknowledge the efforts and time spent by Senior Editors and Chapter Editors who have devoted great deal of their time reviewing and editing the manuscripts. We do sincerely hope their efforts have made the book look more concise and precise.
It is our earnest hope that this book will help in early diagnosis and efficient management leading to optimal outcome and improving the quality of patient care. Your valuable suggestions and comments are most welcome for improving the contents and quality of future editions.
A Parthasarathy
PSN Menon
Piyush Gupta
MKC Nair
25Preface to the First Edition
Pediatrics has grown and developed with significant milestones in preventive and therapeutic care over the past few decades. The WHO and UNICEF in their Primary Health Care (PHC) approach have given due importance for effective child survival programs. So the medical students need to be well oriented towards these approaches in Pediatrics as the future middle level managers in Primary Health Care.
Several luminaries in the Indian pediatric scenario have contributed their might in bringing out books for the undergraduate medical students. However, the rapid advances made in the various pediatric subspecialties have necessitated the updating of these books from time to time. Nevertheless, the need for a full-fledged textbook was felt for long. The Indian Academy of Pediatrics thought it fit to shoulder the responsibility of bringing out such a need-based Textbook in Pediatrics for medical students. Our erudite and enthusiastic editors and contributors made it possible at a record time. The Indian Academy of Pediatrics owes its gratitude to all these experts for their worthy contribution.
The book has been divided into several sections. A few chapters included in this book are entirely newer concepts, which are not usually found in the conventional pediatric textbooks. It has also worthy annexures to the main contents. However, editing the text to suit the needs of medical students was a Himalayan task. The idea is to equip the medical students with adequate knowledge in Pediatrics in order to make them confident to shoulder the responsibilities concerned with preventive and curative Pediatrics. Thus, it is hoped that the practitioners of Pediatric Medicine will benefit from this book.
We are confident that this book will serve the needs of medical students, especially at a time when the Medical Council of India has made Pediatrics as a major examination subject. Thus, the publication of the book is not only timely but also out of necessity.
The Indian Academy of Pediatrics would like to place on record its appreciation to the senior editors, chapter editors, contributors, and staff members of Indian Academy of Pediatrics Central Secretariat for help rendered in the creation of this book and M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, for their excellent cooperation in bringing out the First Edition at record time.
A Parthasarathy
PSN Menon
MKC Nair
26Acknowledgments
We are indebted to the President and Members of the Executive Board 1997 of the Indian Academy of Pediatrics for the initiation and completion of the project of bringing out the first ever IAP Textbook of Pediatrics for the medical students and practitioners. We are also thankful to the successive Presidents and Members of the Executive Boards 1998–2012 for their encouragement in sustaining the project toward the publication of the Fifth Edition.
Our grateful thanks go to the various contributors and chapter editors, past and present teachers of Pediatrics who have contributed to the Fifth Edition and made the “Himalayan task” of production of the current edition a reality by their precise and updated text. We are indebted to the faculty and residents of All India Institute of Medical Sciences, New Delhi, for shaping the contents of the First Edition which has made the production of the subsequent editions an easy task and to Ms Manju, Ms Chitra and Ms Suman for their assistance in typing and drafting the text of the book for the First Edition.
The secretarial and organizational skills of Mr Joseph A Gonzalves and his supportive staff of Indian Academy of Pediatrics Central Office, Mumbai, the meticulous guidance and cooperation and coordination provided by Dr Rohit Agrawal, IAP President 2012, Dr TU Sukumaran, IAP President 2011, Dr CP Bansal, IAP President 2013, Dr Sailesh Gupta, IAP Honorary Secretary General 2012–13, Dr Pravin J Mehta, IAP Honorary Treasurer 2012–13, are gratefully acknowledged.
Our grateful thanks to Mrs Nirmala, Mr R Janardhanan, Dr Pratibha, Ms Shruthi Pavana, Ms Swathi Pavana, Mr P Balaji, Ms Kavya and Ms Mahiya for secretarial assistance and to Mr D Prakash, Mr Ajay Kumar, Mr Shukla, Mr Sathiyathasan and Mrs Umadevi Sathish for help rendered in scrutiny and formatting of manuscripts, typesetting the editorial corrections, correspondence assistance, etc. to the Editor-in-Chief at Chennai need special mention for their untiring assistance in correspondence and formatting of the book with updated contents.
Our grateful thanks are due to Mr Shaji Jacob Ninan and Dr Nazeer Ahmed at Kuwait for the assistance rendered to the Chief Academic Editor in editing, scrutinizing and proofreading of the individual chapter files. Our special thanks to Ms Anju Kumari and Mr RG Bhardwaj for assisting Dr Piyush Gupta, Academic Editor, at New Delhi and Mr N Asokan and Ms S Suja for assisting Dr MKC Nair, Academic Editor, at Thiruvananthapuram.
Our sincere and grateful thanks go to M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, especially Shri Jitendar P Vij (Group Chairman); Mr Ankit Vij (Managing Director); Mr Tarun Duneja (Director-Publishing); Mr Tarun Vij (Director-Pharma); Mr KK Raman (Production Manager); Mrs Samina Khan (PA to the Director-Publishing); Dr Richa Saxena (Editor-in-Chief); Mr Syed Amir Haider and Mr Amit Rai (Medical Editors); Ms Kamlesh Rawat (Proofreader); Mr Hemant Kumar (Typesetter); Mr Santosh Kumar Pandit (Graphic Designer) and other members of Jaypee Head Office, New Delhi, for their untiring coordination efforts in the production of the Fifth Edition.
We also place on record our sincere appreciation of the help rendered by the local branch managers of the Jaypee Brothers—Mr Mukherjee (Branch Manager) and Mr Jayanandan (Senior Commissioning Editor), Chennai Branch Office, for the help rendered to the Editor-in-Chief and Academic Editors.
All attempts have been made to acknowledge the sources of information and illustrations. Inadvertent omission, if any, is regretted.