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Algorithms in Pediatrics
Nitin K Shah, Anand S Vasudev
SECTION 1: NEONATOLOGY
CHAPTER 1:
Neonatal Resuscitation
INTRODUCTION
STANDARD PRECAUTIONS
PREPARATION PRIOR TO BIRTH
Equipment Check
Personnel
Identifying High Risk Delivery
ASSESSMENT AT BIRTH
CORD CLAMPING
STEPS IN NEONATAL RESUSCITATION
Initial Steps
Positive Pressure Ventilation
Intubation
Chest Compression
Medications
PRETERM RESUSCITATION
SPECIAL CIRCUMSTANCES
Meconium Stained Liquor
Role of Oxygen
Pneumothorax
Therapeutic Hypothermia
Resuscitation of Babies Outside Hospital/Home Delivery
To Resuscitate or Not
POSTRESUSCITATION CARE
HARMFUL PRACTICES IN NEWBORN RESUSCITATION
CHAPTER 2:
Apnea
INTRODUCTION
CLINICAL EVALUATION
COMMON CAUSES OF APNEA
DIFFERENTIAL DIAGNOSIS
INVESTIGATIONS
MANAGEMENT (ALGORITHM 1)
AREAS OF UNCERTAINTY IN CLINICAL PRACTICE
CHAPTER 3:
Respiratory Distress in Newborn
INTRODUCTION
COMMON CAUSES OF RESPIRATORY DISTRESS IN NEWBORN
Preterm Baby
Term Baby
APPROACH TO A NEONATE WITH RESPIRATORY DISTRESS
History
Clinical Examination
Investigations
MANAGEMENT (ALGORITHM 1)
General Management
Specific Management
CHAPTER 4:
Respiratory Support in Newborns
INTRODUCTION
Oxygen Therapy
Noninvasive Modes of Respiratory Support
Invasive Ventilation
Respiratory Adjuncts
COMMON CLINICAL INDICATIONS FOR RESPIRATORY SUPPORT IN NEONATAL INTENSIVE CARE UNIT
Pulmonary Disorders
Surgical Respiratory Disorders
Cardiopulmonary Disorders
Central Nervous System Disorders
OXYGEN THERAPY
Indications
NONINVASIVE RESPIRATORY SUPPORT
Continuous Positive Airway Pressure
Mechanism of Action
Indications
Contraindications
Types of Continuous Positive Airway Pressure Delivery Systems
Interface Used for Delivery of Continuous Positive Airway Pressure
Initiating Continuous Positive Airway Pressure
Continuous Positive Airway Pressure Failure
Complications
Heated Humidified High Flow Nasal Cannula
Noninvasive Positive Pressure Ventilation
Mechanism of Action
Indications for Use
MECHANICAL VENTILATION
Conventional Ventilation
Indications
Modes of Ventilation
Controls in Ventilation
Ventilation Strategies
Management after Initiating Ventilation
Ventilator Adjustments
Sudden Deterioration
Weaning
Extubation Criteria
High Frequency Oscillatory Ventilation
Indications
Initial Settings on High Frequency Oscillatory Ventilation
Ventilator Setting Adjustments on High Frequency Oscillatory Ventilation
Chest X-ray
Suctioning
Weaning
CHAPTER 5:
Persistent Pulmonary Hypertension of the Newborn
INTRODUCTION
MECHANISMS LEADING TO PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (TABLE 1)
CLINICAL MANIFESTATIONS OF PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN
Profound Hypoxemia and Labile Oxygenation
DIFFERENTIAL DIAGNOSIS
Clinical Signs Favoring Cyanotic Congenital Cardiac Disease over Persistent Pulmonary Hypertension of the Newborn
INVESTIGATIONS AND DIAGNOSIS
MANAGEMENT
CHAPTER 6:
Bronchopulmonary Dysplasia
INTRODUCTION
DEFINITION
Old and New Bronchopulmonary Dysplasia
PATHOGENESIS
Predisposing Factors
CLINICAL FEATURES
Chest X-ray
Pulmonary Functions
Echocardiography
DIFFERENTIAL DIAGNOSIS
TREATMENT STRATEGIES FOR SUSPECTED BRONCHOPULMONARY DYSPLASIA
Preventive Strategies
INFANT STIMULATION AND PARENTAL SUPPORT
DISCHARGE PLANNING
OUTCOME
CHAPTER 7:
Patent Ductus Arteriosus
INTRODUCTION
INCIDENCE
PATHOPHYSIOLOGY
Predisposing Factors
CLINICAL PRESENTATION
INVESTIGATIONS
MANAGEMENT (ALGORITHM 2)
Prophylactic Treatment
Conservative Treatment
Symptomatic Treatment
Supportive Treatment
Agents Used for Pharmacotherapy
Indomethacin
Ibuprofen
Paracetamol
Surgical Ligation
CHAPTER 8:
Neonatal Shock
INTRODUCTION
INCIDENCE
PATHOPHYSIOLOGY OF SHOCK
ETIOLOGY OF SHOCK
Clues on History Suggesting Etiology
DIAGNOSIS
INVESTIGATIONS IN NEONATAL SHOCK
MANAGEMENT OF NEONATAL SHOCK
Vasoactive Agents Used in Neonatal Shock
CHAPTER 9:
Anemia in Neonate
INTRODUCTION
ETIOLOGY
CLINICAL FINDINGS
CLINICAL APPROACH
History
Physical Examination
INVESTIGATIONS (ALGORITHM 1)
MANAGEMENT
Red Blood Cell Transfusion Guidelines for Premature Infants
Complications Associated with Blood Transfusions
Prevention of Anemia of Prematurity
AREAS OF UNCERTAINTY
CHAPTER 10:
Bleeding Neonate
INTRODUCTION
HEMOSTASIS IN NEONATE
CAUSES OF BLEEDING IN NEONATES
APPROACH TO A BLEEDING NEONATE
History and Physical Examination
Laboratory Investigations
MANAGEMENT
Thrombocytopenia
Coagulopathy
CHAPTER 11:
Neonatal Hyperbilirubinemia (Unconjugated)
INTRODUCTION
EXAGGERATED PHYSIOLOGICAL JAUNDICE
Risk Factors For Pathological Neonatal Hyperbilirubinemia
Risk Factors for Neurotoxicity
INVESTIGATIONS
MANAGEMENT PLAN FOR A JAUNDICED NEONATE
TREATMENT
CHAPTER 12:
Hypoglycemia
INTRODUCTION
SCREENING OF BABIES (WHO ARE AT RISK)
SCREENING SCHEDULE
METHODS OF GLUCOSE ESTIMATION
MANAGEMENT OF SYMPTOMATIC HYPOGLYCEMIA
MANAGEMENT OF ASYMPTOMATIC HYPOGLYCEMIA
MANAGEMENT OF REFRACTORY HYPOGLYCEMIA
Definitions
Critical Sample in Management of Refractory Hypoglycemia
Drugs for the Treatment of Refractory Hypoglycemia
CHAPTER 13:
Neonatal Seizures
INTRODUCTION
RISK FACTORS FOR NEONATAL SEIZURES
Maternal
Infant
ETIOLOGY OF NEONATAL SEIZURES (TABLE 1)
TYPES OF SEIZURES
DIFFERENTIAL DIAGNOSIS OF MOVEMENT DISORDERS IN NEONATES
INVESTIGATIONS
ANTIEPILEPTICS AND THEIR DOSES
PROGNOSIS
Predictive Variables
CHAPTER 14:
Neonatal Sepsis
INTRODUCTION
CLASSIFICATION
RISK FACTORS FOR SEPSIS
ORGANISMS IN NEONATAL SEPSIS
SIGNS AND SYMPTOMS ASSOCIATED WITH NEONATAL SEPSIS
Early Signs
Late Signs
DIAGNOSTIC WORKUP
TREATMENT
Supportive Care
Specific Treatment
Antibiotics
Management of Early Onset Sepsis
Management of Late Onset Sepsis
Stopping Antibiotics
Adjunctive Therapies in Sepsis
CHAPTER 15:
Approach to Congenital Heart Disease
INTRODUCTION
ANTENATAL DIAGNOSIS
Pathologic Murmurs
Cyanosis
Heart Failure
Congenital Heart Disease: Presenting as Cardiac Failure
Shock
SYSTEMATIC ASSESSMENT OF THE INFANT WITH SUSPECTED CONGENITAL HEART DISEASE
History
Symptoms in Baby
Examination
Diagnosis
Specific Treatment
CHAPTER 16:
First Golden Hour Management of Preterm
INTRODUCTION
SPECIAL CONSIDERATIONS IN PRETERM NEONATES
AIM OF GOLDEN HOUR
BASIC PRINCIPLES
PRINCIPLES OF GOLDEN HOUR CARE (FIGURE 1 AND ALGORITHM 1)
Thermoregulation
Delivery Room Practices
Neonatal Intensive Care Unit (NICU) Practices
Respiratory Support (Algorithm 2)
Fluids and Nutrition
Developmentally Supportive Care
Family Involvement
INVESTIGATION
CHAPTER 17:
Perinatal Hypoxia
INTRODUCTION
DEFINITIONS
CLINICAL EVALUATION
MONITORING
MANAGEMENT
Delivery Room Management
Management in Neonatal Intensive Care Unit
Supportive Therapy
Specific Therapy
Therapeutic Hypothermia
SECTION 2: ADOLESCENCE
CHAPTER 18:
Teen Pregnancy and Contraception
INTRODUCTION
CONTRACEPTION
Nonhormonal Methods
Barrier Method
Spermicides
Combination Methods
Hormonal Methods
Contraindications of Combined Hormonal Contraceptives
Emergency Contraception
Potential Indications for Use of Emergency Contraception
INTRAUTERINE DEVICES
ADOLESCENT PREGNANCY
CHAPTER 19:
HEEADSSS Assessment of the Adolescent Child
INTRODUCTION
BUILD A RELATIONSHIP
INTERVIEWING THE ADOLESCENT
Home
Education and Employment
Eating and Exercise
Activities and Hobbies
Drugs, Alcohol, and Tobacco
Sex and Relationships
Suicide and Depression
Safety and Abuse
WRAPPING UP THE SESSION
PRINCIPLES OF INTERVENTION
CHAPTER 20:
Adolescent Anemia
INTRODUCTION
PREVALENCE
DEFINITION
Severe Anemia
Mechanism of Anemia of Chronic Diseases
Etiology of Anemia (Algorithm 1)
Nutritional Anemia
Other Causes of Anemia in Adolescents
SPECIAL FEATURES OF ANEMIA IN ADOLESCENTS
Clinical Effects of Anemia
INVESTIGATIONS (ALGORITHM 2)
MANAGEMENT
Treatment Program (Algorithm 3)
Indications for Blood Transfusion
Prevention (Fig. 1)
CONCLUSION
CHAPTER 21:
Academics and Career Choices in Adolescents: Approach in the Pediatric Office Setting
INTRODUCTION
SCHOOL AND PERFORMANCE
COLLEGE AND CAREERS
Websites for Parents
CHAPTER 22:
Polycystic Ovarian Syndrome and Menstrual Problems in Adolescents
POLYCYSTIC OVARIAN SYNDROME
DIAGNOSIS IS BY CLINICAL EXAMINATION, ULTRASOUND, and LABORATORY
Hyperandrogenism
Chronic Anovulation
POLYCYSTIC OVARIAN SYNDROME DIAGNOSTIC CRITERIA
DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS (TABLE 2)
RADIOGRAPHIC FEATURES
PATHOPHYSIOLOGY OF POLYCYSTIC OVARIAN SYNDROME
POLYCYSTIC OVARIAN SYNDROME
MANAGEMENT OF POLYCYSTIC OVARIAN SYNDROME
HIRSUTISM
Mechanical
Testosterone Production (Algorithm 3)
Medical Management of Hirsutism (Algorithm 6)
Testosterone Action
Management of Infertility
DIABETES RISK AND LONG-TERM MANAGEMENT OF INSULIN RESISTANCE IN POLYCYSTIC OVARIAN SYNDROME
Cardiovascular Risk Factors and Disease in Polycystic Ovarian Syndrome
Assessment of Cardiometabolic Risk (Fig. 3 and Table 5)
LIFESTYLE MANAGEMENT FOR WOMEN WITH POLYCYSTIC OVARY SYNDROME
CHAPTER 23:
Approach to a Case of Sexual Abuse in Children/Adolescent
WHAT IS CHILD/ADOLESCENT SEXUAL ABUSE
SEXUAL ABUSE BEHAVIOR DEFINITION
AGE OF CONSENSUAL SEX
PEDOPHILE
INCEST (INTRAFAMILIAL CHILD ABUSE/CHILD INCESTUOUS ABUSE)
COMMERCIAL SEXUAL EXPLOITATION OF CHILDREN
VULNERABLE SITUATIONS (RISK FACTORS)
PROFILE OF THE ADULT SEX OFFENDER
TYPES OF OFFENDERS
STATISTICS OF CHILD SEXUAL ABUSE IN INDIA
EFFECTS
Psychological Effects
Physical Effects
DIAGNOSIS/DISCLOSURE
EXAMINATION OF A CASE OF SEXUAL ABUSE
History
Physical Examination
Age Determination
Collection of Forensic Samples
TREATMENT
PHARMACOLOGICAL MANAGEMENT
Prophylaxis of Sexually Transmitted Diseases
Gonorrhea and Chlamydia
Syphilis
Human Papillomavirus
Human Immunodeficiency Virus
Herpes Simplex Virus
Trichomonas
Pregnancy Prophylaxis
FOLLOW-UP AND REHABILITATION
PREVENTION
HOW TO HELP THE SURVIVOR
SEXUAL ABUSE AND EXISTING LEGAL SYSTEM
International Law
CHAPTER 24:
Adolescent Depression/Suicidal Tendency and Its Management
INTRODUCTION
PREDISPOSING FACTORS
CLINICAL FEATURES
IDENTIFY RISK STATUS
ASSESS FOR DEPRESSION
DIAGNOSE AND RATE SEVERITY
EDUCATE
INITIAL MANAGEMENT
Primary Care
CONSIDER CONSULTATION
TREATMENT PLAN
FOLLOW-UP MANAGEMENT (AT 6–8 WEEK VISIT)
FINAL THOUGHTS
INDICATIONS FOR PHARMACOTHERAPY
Medication Dosing and Follow-up for Anxiety and Depression
General Dosing Suggestions
Antidepressants Commonly Used in Treatment of Major Depressive Disorders (Table 1)
SUICIDE
Predisposing Factors
Approach to an Adolescent with Suicide Behavior
Risk Factors for Suicide
Rating Scales for Suicide Behavior and Related Mental Health Conditions
The Search for Biological Markers for Suicide
What are the Most Effective Secondary Suicide Prevention Strategies?
CHAPTER 25:
Teen Aggression: Steps in Management
INTRODUCTION
DEFINITION, SUBTYPES, AND RELATED TERM ANGER
Proactive and Reactive/Affective Aggression
Disruptive Behavior Disorders
Intermittent Explosive Disorder
NORMATIVE DEVELOPMENT
RISK AND PROTECTIVE FACTORS
PREVENTION OF AGGRESSION
ASSESSMENT
INTERVENTION
SECTION 3: IMMUNIZATION
CHAPTER 26:
Immunization in Childhood
INTRODUCTION
COMBINATION VACCINES AND DRUG CONTROLLER GENERAL OF INDIA LICENSURE
INTERCHANGEABILITY OF FORMULATIONS
VACCINATION ALGORITHM
Bacillus Calmette-Guérin Vaccine
Hepatitis B Vaccine
Catch-up Vaccination
Poliovirus Vaccines: Oral Polio Vaccine/Inactivated Polio Vaccine
Catch-up Vaccination
Diphtheria, Tetanus Toxoids, and Pertussis Vaccine
Routine Vaccination
Catch-up Vaccination
Haemophilus influenzae Type B Conjugate Vaccine
Catch-up
Pneumococcal Vaccines
Routine Vaccination
Catch-up Vaccination
Pneumococcal Polysaccharide Vaccine (PPSV23)
Rotavirus Vaccines
Catch-up Vaccination
Measles, Mumps, and Rubella Vaccine
Routine Vaccination
Catch-up Vaccination
Varicella Vaccine
Catch-up Vaccination
Hepatitis A Vaccine
Routine Vaccination
Catch-up Vaccination
Typhoid Vaccine
Routine Vaccination
Catch-up Vaccination
Human Papilloma Virus Vaccine
Routine Vaccination
Catch-up Vaccination
Influenza Vaccine
Meningococcal Vaccine
Cholera Vaccine
Japanese Encephalitis Vaccine
Routine Vaccination
Catch-up Vaccination
Rabies Vaccine
INDIAN ACADEMY OF PEDIATRICS RECOMMENDED VACCINES FOR HIGH RISK CHILDREN (VACCINES UNDER SPECIAL CIRCUMSTANCES)
CHAPTER 27:
Missed Immunization
INTRODUCTION
CHAPTER 28:
Animal Bites
INTRODUCTION
PROBLEMS OF RABIES INFECTION IN CHILDREN
POSTEXPOSURE PROPHYLAXIS
Approach to Postexposure Prophylaxis
Management of Animal Bite Wound
Rabies Immunoglobulin
Antirabies Vaccines
Postexposure Therapy for Previously Vaccinated Children
Preexposure Vaccination of Children
Schedule of Preexposure Vaccination
CHAPTER 29:
Adverse Event Following Immunization
INTRODUCTION
WHY REPORT ADVERSE EVENT FOLLOWING IMMUNIZATION?
NATIONAL ADVERSE EVENT FOLLOWING IMMUNIZATION PROGRAM
WHAT TO REPORT
REPORTING FROM PRIVATE SECTOR
THE WAY FORWARD
SECTION 4: OFFICE EMERGENCIES
CHAPTER 30:
Approach to Respiratory Distress in Children
INTRODUCTION
APPROACH
Initial Impression
Primary Assessment
Airway
Breathing
Circulation
Disability
Exposure
Secondary Assessment
Diagnostic Tests
GENERAL APPROACH TO A CHILD IN RESPIRATORY DISTRESS
Respiratory Distress
Respiratory Failure
CHAPTER 31:
Recognition of Child in Shock
INTRODUCTION
DEFINITION
RECOGNITION OF SHOCK
Recognizing Shock
TYPES
SEVERITY
Compensated and Hypotensive Shock
CHAPTER 32:
Croup
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
CLINICAL FEATURES
SEVERITY OF CROUP
DIFFERENTIAL DIAGNOSIS
INVESTIGATIONS
TREATMENT
COMPLICATIONS
PROGNOSIS
SPASMODIC CROUP
CHAPTER 33:
Approach to a Child with Acute Febrile Encephalopathy
INTRODUCTION
SOME DEFINITIONS
Encephalopathy
Acute Febrile Encephalopathy
Encephalitis
Acute Encephalitis Syndrome
PATHOPHYSIOLOGY
ETIOLOGY
EVALUATION
APPROACH TO ACUTE FEBRILE ENCEPHALOPATHY (ALGORITHM 1)
Step 1: Initiate Resuscitation and Assess Neurological Status
Step 2: Take History and Perform Focused Examination
History (Table 3)
Examination
Step 3: Send Basic Investigations
Basic Investigations
Lumbar Puncture
Neuroimaging
Step 4: Initiate Empiric Therapy
Step 5: Send Specific Investigations and Treat the Cause
Other Tests
Step 6: Supportive Care
Maintenance Intravenous Fluids
Other Drugs
Step 7: Prevention/Treatment of Complications and Rehabilitation
PROGNOSIS
CONCLUSION
CHAPTER 34:
Management of a Child with Respiratory Distress
INTRODUCTION
DEFINITIONS
PATHOPHYSIOLOGY
INITIAL EVALUATION AND STABILIZATION
Airway
Clear Airway
Breathing
Oxygen Delivery
Assisted Ventilation
ASSESSMENT TO DETERMINE THE SEVERITY AND TYPE OF RESPIRATORY PROBLEM
Severity
Type
TARGETED INTERVENTIONS
UPPER AIRWAY OBSTRUCTION
General Management
Specific Management
Foreign Body Aspiration
Angioneurotic Edema
Acute Laryngotracheobronchitis
LOWER AIRWAY OBSTRUCTION
General Management
Specific Management
Management of Bronchiolitis
LUNG TISSUE DISEASE
General Management
Specific Management
Acute Infectious Pneumonia
Cardiogenic Pulmonary Edema
Acute Respiratory Distress Syndrome
DISORDERED CONTROL OF BREATHING
Important Aspects of Treatment
CHAPTER 35:
Hypovolemic Shock
INTRODUCTION
CAUSES (BOX 1)
CLINICAL FEATURES
INVESTIGATIONS
TREATMENT AND MANAGEMENT
Prehospital Care
Prevention of Further Injury
General Shock Management
Position of Child
Airway
Breathing
Circulation
Monitor
Fluid Therapy
Additional/Special Considerations during Management of Hypovolemic Shock in Trauma Patients (Table 2)
During Primary Assessment
During Tertiary Assessment
CHAPTER 36:
Approach to Fever in Children
INTRODUCTION
RECOGNIZING FEVER
Identifying “High Risk” for Serious Illness
ASSESSMENT OF FEVER
EXAMINATION
ASSESSMENT FOR LOCALIZING SIGNS
INVESTIGATIONS
INDICATIONS FOR HOSPITALIZATION
MANAGEMENT OF FEBRILE CHILD (ALGORITHM 1)
SPECIAL CIRCUMSTANCES: FEVER IN NEWBORN (<30 DAYS)
PARENT EDUCATION: FEVER PHOBIA
CHAPTER 37:
Approach to Poisoning in Children
INTRODUCTION
ETIOPATHOGENESIS
CLINICAL PRESENTATION
MANAGEMENT OF POISONING
Initial Assessment and Emergency Management
Airway
Breathing
Circulation
Disability
Exposure
Monitoring and Investigations
Poison Elimination
Toxin Elimination
Activated Charcoal
Emesis
Gastric Lavage
Whole-Bowel Irrigation
Cathartics
Other Methods of Elimination
Specific Antitoxins
Acknowledgement
CHAPTER 38:
Approach to Burns in Children
INTRODUCTION
MODERN BURNS CLASSIFICATION
ESTIMATION OF BURNT BODY SURFACE AREA
FIRST AID MEASURES
INITIAL TRIAGE AND MANAGEMENT STRATEGIES
Airway and Breathing
Circulation
Associated Injuries
Extent and the Depth of Burns
Nil by Mouth
Catheterization
Wound Care
FURTHER TREATMENT
Outpatient Management of Minor Burns
INPATIENT MANAGEMENT OF BURNS (BOX 1)
Fluid Resuscitation
Assessment and Monitoring
Electrolytes
Subsequent Fluids and Feeding
Blood Products: Indications
Prevention of Infection/Role of Antibiotics
Wound Care and Surgical Management
Pain Relief
Nutritional Support
INHALATIONAL INJURY
Treatment
RECONSTRUCTION AND REHABILITATION
PREVENTION OF BURNS
CHAPTER 39:
Approach to Envenomation
INTRODUCTION
APPROACH TO SNAKE BITE
How to Identify Venomous Snake
CLINICAL FEATURES (ALGORITHM 1)
MANAGEMENT OF SNAKE ENVENOMATION (ALGORITHM 2)
APPROACH TO SCORPION STING
Clinical Features (Fig. 5 and Algorithm 3)
Local Manifestations
Systemic Manifestations
Investigations
Management (Algorithm 3)
APPROACH TO ENVENOMATION BY BEES and WASPS
Allergic Reactions and Anaphylaxis
Mass Stinging Events
Management (Algorithm 4)
SECTION 5: INTENSIVE CARE
CHAPTER 40:
Recognition and Assessment of Critically III Child
INTRODUCTION
EVALUATE, IDENTIFY, AND INTERVENE
Initial Impression
Consciousness
Work of Breathing
Coloration of Skin
Primary Assessment
Airway
Breathing
Circulation
Disability (Mental Status)
Exposure
Secondary Assessment
Laboratory and Radiological Diagnostic Testing
Ongoing Assessment
Categorization by Severity
Respiratory Distress
Respiratory Failure
Shock
Initial Stabilization
Common Initial Interventions
Foreign Body Obstruction
Shock
Other Supportive Therapy
Transport
CHAPTER 41:
Septic Shock
INTRODUCTION
MANAGEMENT
Airway, Breathing, and Circulation
Fluid Refractory Shock
Antibiotics and Source Control
Steroid Therapy
Glycemic Control
Blood Products and Plasma Therapies
Nutrition
Protein C and Activated Protein Concentrate
Deep Vein Thrombosis and Stress Ulcer Prophylaxis
Diuretics and Renal Replacement Therapy
Extracorporeal Membrane Oxygenation
CONCLUSION
CHAPTER 42:
Status Epilepticus
INTRODUCTION
DEFINITION
MANAGEMENT OF STATUS EPILEPTICUS
CHAPTER 43:
Cardiogenic Shock
INTRODUCTION
DEFINITION
PATHOPHYSIOLOGY
Diastolic Dysfunction
Recognition of Cardiogenic Shock
Causes of Cardiogenic Shock
Investigations
Chest Radiography
Electrocardiography
Echocardiography
Management
General Measures
CARDIOGENIC SHOCK IN A NEWBORN
Preload
Myocardial Contractility, Inotropic Agents
Vasoactive Drugs
Diastolic Blood Pressure
Afterload Reduction
SPECIFIC THERAPY
Surgical Correction
Extracorporeal Cardiac Support
CARDIAC TRANSPLANT
CHAPTER 44:
Head Injury in Infants and Children
INTRODUCTION
MANAGEMENT
Glasgow Coma Scale
Care upon Admission
Radiological Investigations
Intracranial Pressure
Cerebral Perfusion Pressure
Monitoring Devices
CHAPTER 45:
Trauma in Children
INTRODUCTION
UNIQUE ANATOMY OF PEDIATRIC PATIENTS
PRIMARY SURVEY (ALGORITHM 1)
Airway
Breathing Assessment
Circulation/Hemodynamics
Circulation with Hemorrhage Control
Disability Assessment
Exposure with Environmental Control
SECONDARY SURVEY
Head Trauma
Spinal Cord Injury without Radiological Abnormality
Chest and Abdomen
INDICATIONS FOR SURGERY
CHAPTER 46:
Poisoning in Children
INTRODUCTION
EVALUATION OF CHILDREN WITH SUSPECTED TOXIN INGESTION
HISTORY
PHYSICAL EXAMINATION
SYSTEMIC EXAMINATION
LABORATORY EVALUATION
RADIOLOGIC IMAGING
MANAGEMENT
Emergency Stabilization
Decontamination
Gastric Lavage
Syrup of Ipecac
Activated Charcoal
Whole-bowel Irrigation
Surgical Decontamination
Enhanced Elimination
Diuresis
Toxin-specific Treatments
CONCLUSION
CHAPTER 47:
Snakebite Envenomation
INTRODUCTION
TYPE AND SEVERITY OF THE BITE
Neurotoxic Effects
Hemorrhagic Effects
TREATMENT
Supportive Therapy
Specific Therapy
CHAPTER 48:
Initial Approach to a Comatose Child
INTRODUCTION
BEWARE HYPOGLYCEMIA
Worsening Glasgow Coma Scale despite correction of Airway, Breathing, and Circulation (Box 2)
INVESTIGATIONS
IMMEDIATE TREATMENT
SECTION 6: INFECTIOUS DISEASES
CHAPTER 49:
Fever without Focus in Infants Less than 3 Months of Age
INTRODUCTION
DEFINITION
EPIDEMIOLOGY
LABORATORY DIAGNOSIS
MANAGEMENT
PITFALLS AND PEARLS IN ASSESSMENT AND DIAGNOSIS
CHAPTER 50:
Acute Viral Encephalitis
INTRODUCTION
CLINICAL MANIFESTATIONS
MANAGEMENT
Step I: Rapid Assessment and Stabilization
Step II: Clinical Evaluation: History and Examination
Step III: Investigation/Samples to Be Collected
Step IV: Empirical Treatment
Step V: Supportive Care and Treatment
Step VI: Prevention/Treatment of Complications and Rehabilitation
PREVENTION OF ACUTE ENCEPHALITIS SYNDROME
CHAPTER 51:
Acute Osteomyelitis
INTRODUCTION
PATHOGENESIS
ETIOLOGY
CLINICAL MANIFESTATIONS
LABORATORY INVESTIGATIONS (BOX 2)
RADIO IMAGING STUDIES (BOX 3)
Plain Radiographs
Ultrasonography
Computed Tomography Scan
Magnetic Resonance Imaging
Radionuclide Bone Scanning
DIFFERENT DIAGNOSIS
TREATMENT
Antibiotic Therapy (Box 4)
Surgical Therapy
Physiotherapy for Prevention of Contractures and Early Mobility
Prognosis
Complications
CONCLUSION
CHAPTER 52:
Algorithmic Approach to Short Duration Fever without Focus in Older Infants and Children
INTRODUCTION
CAUSES
APPROACH
CHAPTER 53:
Fever with Rash
INTRODUCTION
CLASSIFICATION OF RASH WITH FEVER
Centrally Distributed Maculopapular Rash
Peripheral Rash (Table 2)
Confluent Desquamative Rash (Table 3)
Vesiculobullous Rash (Table 4)
Urticarial Rash
Purpuric Rash (Table 6)
Nodular Rash
CHAPTER 54:
Approach to Managing New Onset Fever in the Intensive Care Unit
INTRODUCTION
GENERAL PRINCIPLES IN DIAGNOSIS
Distinguishing Infectious from Noninfectious Causes of Fever
Determining the Site of Infection
Distinguishing Infection from Colonization in the Nosocomial Setting
INVESTIGATIVE APPROACH
TREATMENT
Factors Determining Choice of Antimicrobial Therapy
Initial Empirical Antimicrobial Regimes
Dosing of Antibiotics
De-escalation
Duration of Therapy
CONCLUSION
CHAPTER 55:
Infant Born to Human Immunodeficiency Virus Infected Mother
INTRODUCTION
Prevention Modalities
ELECTIVE CAESAREAN SECTION
ANTIRETROVIRAL PROPHYLAXIS
CHOICE OF FEEDING
WORLD HEALTH ORGANIZATION (WHO) 2013 GUIDELINES
DIAGNOSIS OF HUMAN IMMUNODEFICIENCY VIRUS IN INFANTS BORN TO HUMAN IMMUNODEFICIENCY VIRUS INFECTED MOTHERS
TIMING OF TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS AND ROLE OF POLYMERASE CHAIN REACTION
DIAGNOSIS OF HUMAN IMMUNODEFICIENCY VIRUS IN CHILDREN ABOVE 18 MONTHS OF AGE
COTRIMOXAZOLE PROPHYLAXIS
CONCLUSION
CHAPTER 56:
Fever of Unknown Origin
DEFINITION
CAUSES
APPROACH TO FEVER OF UNKNOWN ORIGIN
INVESTIGATIONS AND MANAGEMENT
SECTION 7: HEMATOLOGY/ONCOLOGY
CHAPTER 57:
A Mass in the Abdomen: The Way to Diagnosis
INTRODUCTION
PRESENTATION
HISTORY
Age
EXAMINATION
INVESTIGATIONS
IMAGING
CHAPTER 58:
Approach to a Child with Persistent Anemia
INTRODUCTION
DEFINITION OF ANEMIA
HISTORY IN THE DIAGNOSIS OF ANEMIA
Age
Gender/Family History/Inheritance
Community
Dietary History
History of Drug Ingestion
Infections and Infestations
Diarrhea
EXAMINATION FINDINGS AS A CLUE TO THE DIAGNOSIS OF ANEMIA
Skin
Facies
Eyes
Hands and Nails
Mouth
Lymphadenopathy
Hepatosplenomegaly
LABORATORY APPROACH TO ANEMIA
Screening Tests
Complete Blood Counts
Reticulocyte Count
Peripheral Smear Examination
Confirmatory Tests
ALGORITHMS TO DIAGNOSE ANEMIA BASED ON VARIOUS INVESTIGATIONS
CONCLUSION
CHAPTER 59:
Algorithmic Approach to Thrombocytopenia in Children
INTRODUCTION
CLINICAL FEATURES
CAUSES
Decreased Platelet Production
Increased Destruction
Platelet Sequestration
CLINICAL APPROACH TO THE PATIENT WITH THROMBOCYTOPENIA
Detailed History
Physical Examination
Investigations
TREATMENT
CONCLUSION
CHAPTER 60:
Algorithmic Laboratory Approach to a Child with Anemia
INTRODUCTION
DIAGNOSIS OF ANEMIA
CLASSIFICATION OF ANEMIA
USE OF AUTOMATED BLOOD COUNTING INSTRUMENTS IN ANEMIA
EXAMINATION OF THE PERIPHERAL SMEAR
APPROACH TO MICROCYTIC HYPOCHROMIC ANEMIA
APPROACH TO MACROCYTIC ANEMIA
NORMOCYTIC NORMOCHROMIC ANEMIA
ANEMIA IN THE NEWBORN
CHAPTER 61:
Recurrent Unusual Infections in a Child: The Way Forward
INTRODUCTION
DEFINITIONS
Recurrent or Repeated Infections: Common Causes
Unusual Infections: Causes
Key Features of Unusual Recurrent Infections
WARNING SIGNS OF IMMUNE-DEFICIENCY
GENERAL EXAMINATION
LABORATORY EVALUATION
General Screening Tests
Diagnostic Tests
CHAPTER 62:
Approach to Persistent Fever with Hepatosplenomegaly in a Child
INTRODUCTION
HEPATOMEGALY
SPLENOMEGALY
HISTORY
PHYSICAL EXAMINATION
INVESTIGATIONS
Initial Investigations
Imaging of Abdomen
Other Investigations
TREATMENT
CHAPTER 63:
Approach to a Bleeding Child
INTERPRETATION OF ALGORITHM
CLINICAL HISTORY
Local versus Generalized Bleeding
Platelet/Vascular Type versus Coagulation Type of Bleeding
Inherited versus Acquired Causes
Inherited Causes
Acquired Causes
Associated Underlying Disorders
EXAMINATION
Well versus Sick Child
Pallor and Organomegaly
Site of Bleeding
Associated Syndromes
INVESTIGATIONS
Screening Tests
Others
Bleeding Disorders with Normal Screening Tests
MANAGEMENT OF BLEEDING CHILD
CHAPTER 64:
Clinic Pathological Approach to Coagulation Disorder
INTRODUCTION
SCREENING TESTS
Complete Blood Count
Prothrombin Time/International Normalized Ratio
Activated Partial Thromboplastin Time
Mixing Study
Thrombin Time and Fibrinogen Measurement
Reptilase Time
Urea Clot Lysis Test
Fibrinogen
Fibrinogen Degradation Products or D-dimer
Fibrinolysis Inhibitors
Genetic Testing
Specific Coagulation Factors
Euglobulin Clot Lysis Test
Bleeding Time (Using a Device Appropriate for Size of Child)
Platelet Function Analyzer
Testing for Defects in Primary Hemostasis von Willebrand Factor Antigen and Activity
Platelet Function Testing
Platelet Aggregometry
Thromboelastography
CHAPTER 65:
Algorithmic Approach to Eosinophilia in Children
INTRODUCTION
ETIOLOGY
RARE SYNDROMES WITH EOSINOPHILIA
PULMONARY INFILTRATES WITH EOSINOPHILIA SYNDROME
APPROACH TO A PATIENT WITH EOSINOPHILIA (Algorithm 1)
SECTION 8: PULMONOLOGY
CHAPTER 66:
Approach to a Child with Respiratory Distress
INTRODUCTION
DEFINITION
ETIOLOGY OF RESPIRATORY DISTRESS
CLINICAL FEATURES
INVESTIGATIONS
TREATMENT
CONCLUSION
CHAPTER 67:
Assessing and Managing a Child with Stridor
INTRODUCTION
PATHOPHYSIOLOGY
HISTORY AND CLINICAL EXAMINATION
INVESTIGATIONS
MANAGEMENT
Laryngotracheobronchitis/Croup
Epiglottitis
Diphtheria
Retropharyngeal Abscess
Allergic Reactions/Angioneurotic Edema
Laryngomalacia
Subglottic Stenosis
Vocal Cord Paralysis
CONCLUSION
CHAPTER 68:
Recurrent Wheezing in Infants and Preschool Children
INTRODUCTION
PHENOTYPES OF PRESCHOOL WHEEZE
Causes
HISTORY AND EXAMINATION
INVESTIGATIONS: HOW AND HOW FAR?
TREATMENT
Acute Episode
Regular Prophylaxis
What Does all this Mean in and What are the Implications for Clinical Practice?
CHAPTER 69:
Managing Acute Severe Asthma
INTRODUCTION
EPIDEMIOLOGY
CLINICAL FEATURES
TREATMENT
First Line Treatment
Oxygen
Short-acting β-2 Agonists
Anticholinergics
Corticosteroids
Second Line Treatment
Intravenous or Nebulized Magnesium Sulfate
Intravenous Aminophylline
Intravenous Terbutaline
Other Modalities
CHAPTER 70:
Management of Bronchiolitis
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
CLINICAL FEATURES AND COURSE
DIAGNOSIS
MANAGEMENT
Supportive Care
Fluid and Hydration Management
Oxygen Supplementation
Nasal Decongestion
Bronchodilators
Corticosteroids
Mucolytics
Antibiotics
Mechanical Ventilation and Continuous Positive Airway Pressure
Antiviral
Others
PREVENTION
CHAPTER 71:
Management of Bronchiectasis
INTRODUCTION
CAUSES OF BRONCHIECTASIS
PATHOPHYSIOLOGY OF BRONCHIECTASIS
CLINICAL FEATURES
DIAGNOSIS
TREATMENT
Rational Use of Antibiotics
Airway Hydration and Mucoactive Drugs
Chest Physiotherapy (Airway Clearance Methods)
Anti-inflammatory Agents
Bronchodilators
SURGICAL TREATMENT
PREVENTION
CONCLUSION
SECTION 9: CARDIOLOGY
CHAPTER 72:
Management of Congestive Heart Failure in Infants and Children: An Algorithmic Approach
INTRODUCTION
Type I Congestive Heart Failure
Type II Congestive Heart Failure
CAUSES
Fetal Causes
Day One Causes (0–24 h)
First Week Causes (1–7 Days)
1–4 Weeks Causes
1 Months–1 Year Causes
1–6 Years Causes
6–12 Years Causes
RECOGNITION OF CONGESTIVE HEART FAILURE IN INFANTS
EVALUATION
Investigations
Chest X-ray
Electrocardiography
Echocardiography
Others
TREATMENT
Management of Chronic/Subacute Congestive Heart Failure
Management of Acute Congestive Heart Failure
Management of Refractory Congestive Heart Failure
Specific Situations
DRUGS AND DOSES
CHAPTER 73:
Approach to a Child with Chest Pain
INTRODUCTION
CAUSES OF CHEST PAIN
Chest Wall
Pulmonary
Gastrointestinal
Cardiac
Psychiatric
APPROACH
INVESTIGATIONS
CONCLUSION
CHAPTER 74:
Systemic Hypertension
INTRODUCTION
GRADATION
CAUSES
Primary
Secondary
TRANSIENT HYPERTENSION
CLINICAL PRESENTATION
INVESTIGATIONS
First Line
Second Line
Confirmatory Test
Special Tests for Endocrine Function
When Primary Hypertension Suspected
Document Target Organ Damage
PRIMARY HYPERTENSION EVALUATION
How Will You Approach a Child with Hypertension?
Indications for Measurement of Blood Pressure in Children
NONPHARMACOLOGICAL MANAGEMENT OF HYPERTENSION
Hypertension
Therapeutic Lifestyle Modification
Pharmacological Therapy
Other Forms of Therapy
Indications for Antihypertensive Drug Therapy in Children
HYPERTENSIVE EMERGENCIES
CHAPTER 75:
Pediatrician's Perspective for Postoperative Follow-up of a Child
INTRODUCTION
GENERAL CARE
General Hygiene and Isolation
Fever and Cough
Feeding
WOUND CARE
Dressing
Discharge
Sutures
Scar
PAIN RELIEF
INITIAL FOLLOW-UP
FOLLOW-UPS
Corrective Surgeries
Palliative Surgeries
MEDICATIONS
Antibiotics
Diuretics and Vasodilators
Aspirin and International Normalized Ratio Drugs
VACCINATIONS
Rearranging the Vaccination Schedule
Additional Vaccine
DENTAL PROCEDURE
ACTIVITY
Infants
Children
Young Adults
AIR TRAVEL
INFECTIVE ENDOCARDITIS PROPHYLAXIS
CARE OF SPECIAL CHILD
NEXT CHILD
SECTION 10: GASTROENTEROLOGY
CHAPTER 76:
Chronic Diarrhea in Children Less than 3 Years of Age
INTRODUCTION
DEFINITIONS
Chronic Diarrhea
Persistent Diarrhea
Protracted Diarrhea
Intractable Diarrhea
Secretory Diarrhea
Osmotic Diarrhea
BOVINE OR COW'S MILK PROTEIN ALLERGY
Symptoms
Diagnosis
Treatment
Child less than 4 Months of Age
Child more than 4 Months of Age
SECONDARY LACTOSE INTOLERANCE
IMMUNODEFICIENCY STATES
X-linked Agammaglobulinemia
Severe Combined Immunodeficiency
NONSPECIFIC OR TODDLER'S DIARRHEA
INTRACTABLE DIARRHEA OF INFANCY
Setting to Suspect Intractable Diarrhea of Infancy
CHAPTER 77:
Chronic Diarrhea in Children More than 3 Years of Age
INTRODUCTION
APPROACH TO CHRONIC DIARRHEA
WHAT SHOULD YOU LOOK FOR IN HISTORY?
WHAT SHOULD YOU LOOK FOR IN PHYSICAL EXAMINATION?
CELIAC DISEASE
INTESTINAL LYMPHANGIECTASIA
IMMUNODEFICIENCY
INFLAMMATORY BOWEL DISEASE
Clinical Features
Diagnosis
Treatment
ABDOMINAL TUBERCULOSIS
Diagnosis
Treatment
CHAPTER 78:
Approach to Upper Gastrointestinal Bleed in Children
INTRODUCTION
DEFINITIONS
MANAGEMENT
INVESTIGATIONS
TREATMENT
Variceal Bleeding
Endoscopic Therapy
Surgical Management
Nonvariceal Bleeding
Pharmacological Therapy
Endoscopic Therapy
PREVENTION
CONCLUSION
CHAPTER 79:
Management of Lower Gastrointestinal Bleed
DEFINITION
TYPES OF BLEED
INCIDENCE
ETIOLOGY
MANAGEMENT OF LOWER GASTROINTESTINAL BLEED
Clinical Evaluation
History
Examination
Investigations
Additional Procedures
Triple Arteriography
Double Balloon Enteroscopy
Capsule Endoscopy
Intraoperative Enteroscopy
Diagnostic Laparoscopy/Laparotomy
Management
Diet
Medications
Endotherapy
Interventional Radiology
Surgery
CONCLUSION
CHAPTER 80:
Acute Liver Failure
INTRODUCTION
DEFINITION AND DIAGNOSIS
ETIOLOGY OF ACUTE LIVER FAILURE IN INDIA
DIAGNOSTIC WORK-UP
TRANSPORT AND INITIAL MANAGEMENT
SUPPORTIVE MANAGEMENT
MANAGEMENT OF RAISED INTRACRANIAL PRESSURE
COAGULOPATHY
SEPSIS
LIVER ASSIST DEVICES
HEPATOCYTE TRANSPLANTATION
CRITERIA FOR LIVER TRANSPLANTATION
PROGNOSIS AND OUTCOME
CHAPTER 81:
Corrosive Injury in Children
INTRODUCTION
TYPES OF CORROSIVES
PATHOGENESIS OF CORROSIVE INJURY
CLINICAL MANIFESTATIONS
INVESTIGATIONS IN THE ACUTE PHASE
Chest and Abdominal Radiographs
Laboratory Investigations
Early Endoscopic Evaluation
Computed Tomography
MANAGEMENT (ALGORITHM 2)
Management in the Acute Phase
Management of Strictures
Long-term Complications of Corrosive Injury
CONCLUSION
CHAPTER 82:
Chronic Abdominal Pain
INTRODUCTION
CLASSIFICATION
Red Flag Signs
Functional Dyspepsia
Diagnostic Criteria
Evaluation
Treatment
Irritable Bowel Syndrome
Diagnostic Criteria
Evaluation
Treatment
Abdominal Migraine
Diagnostic Criteria
Evaluation
Treatment
Childhood Functional Abdominal Pain
Diagnostic Criteria
Evaluation
Treatment
Childhood Functional Abdominal Pain Syndrome
Diagnostic Criteria
Evaluation
Treatment
APPROACH TO A CASE OF CHRONIC ABDOMINAL PAIN
MANAGEMENT OF FUNCTIONAL PAIN
SECTION 11: NEUROLOGY
CHAPTER 83:
Approach to Global Developmental Delay
DEFINITION
APPROACH TO DIAGNOSIS
CLINICAL ASSESSMENT
History
Examination
DEVELOPMENTAL ASSESSMENT
INVESTIGATIONS
Genetic Testing
Cytogenetic Studies
Fluorescent in situ Hybridization Testing (FISH)
Array Comparative Genomic Hybridization Techniques (aCGH)
Metabolic Testing (Box 2)
CHAPTER 84:
Approach to Psychomotor Regression in Children
INTRODUCTION
DEFINITION
CLINICAL APPROACH
Step 1: Inheritance
Step 2: Age of Onset
Age-related Presentations
Step 3: Neuroanatomical Localization
Step 4: Identifying Associated System/Organ Involvement
INVESTIGATIONS
MANAGEMENT
ANTENATAL TESTING AND COUNSELING
CHAPTER 85:
Approach to a Child with First Seizure
INTRODUCTION
NEWER DEFINITIONS
STATISTICS
Risk of Recurrence after First Status Epilepticus
High Risk Factors Associated with Recurrence after First Unprovoked Seizure
Fctors Known to Provocate Seizures and Epilepsy
Clinical Evaluation after a First Seizure in a Child
HISTORY
EXAMINATION
DIFFERENTIAL DIAGNOSIS
Syncope with Secondary Jerking Movements
Nonepileptic Attack Disorder
Breath Holding Spells
Sleep Disorders
Primary Cardiac or Respiratory Abnormalities Presenting with Secondary Anoxic Seizures
Involuntary Movement Disorders and Other Neurological Conditions
Hyperekplexia
ROLE OF INVESTIGATIONS
TREATMENT RECOMMENDATIONS
COUNSELING AND EMERGENCY HOME MANAGEMENT
CHAPTER 86:
Medical Management of Epilepsy
INTRODUCTION
DEFINITIONS
STATISTICS
MANAGEMENT OF THE FIRST SEIZURE
Indications of Electroencephalogram
Neuroimaging
WHEN TO LOOK BEYOND ANTIEPILEPTICS
DRUG TREATMENT OF EPILEPSY
How to Start Treatment
How to Choose the First Drug?
Do I Use an Established Antiepileptic Drug or Try a Newer Antiepileptic Drug?
What are the Common Side Effects of Each Drug I Should Know?
Specific side effects
What do I do if there is no Response to First-line Antiepileptic Drug?
DISCONTINUATION OF ANTIEPILEPTIC THERAPY
DRUG MONITORING
PARENTAL COUNSELLING
Explain the Disease
Drug Therapy
Lifestyle
FOLLOW-UP
CHAPTER 87:
Approach to Refractory Epilepsies
INTRODUCTION
DEFINITION
International League against Epilepsy Definition of Drug Refractory Epilepsy
EPIDEMIOLOGY
WHAT ARE THE CONSEQUENCES OF Drug-refractory epilepsy?
COMPLICATIONS OF Drug-refractory epilepsy
RISK FACTORS OF Drug-refractory epilepsy
PREDICTORS OF TRUE DRUG-REFRACTORY EPILEPSY
DIFFERENTIAL DIAGNOSIS
Pseudorefractory Epilepsy
MANAGEMENT OF DRUG-REFRACTORY EPILEPSY
Antiepileptic Drugs
Seizure Diary
Epilepsy Surgery
Ketogenic Diet
Vagus Nerve Stimulation
CHAPTER 88:
Acute Flaccid Paralysis
INTRODUCTION
CAUSES OF ACUTE FLACCID PARALYSIS
Peripheral Neuropathy
Anterior Horn Cell Disease
Acute Myelopathies
Systemic Disease
Metabolic Neuropathy
Muscle Disorders
Disorders of Neuromuscular Transmission
Others
CLUES IN HISTORY AND EXAMINATION
Preceding Infectious Prodrome/Vaccination
Precipitating Factors
Prominent Autonomic Signs/Symptom
Prominent and Early Ptosis
Muscle Stretch Reflexes
Spinal Tenderness, Painful Spine Movement
Clinical Approach
ACUTE INFLAMMATORY POLYRADICULO NEUROPATHY (GUILLAIN-BARRE SYNDROME)
ACKNOWLEDGMENTS
CHAPTER 89:
Approach to Floppy Infant
INTRODUCTION
DEFINITION
EXAMINATION OF A HYPOTONIC INFANT
CEREBRAL HYPOTONIA
SYNDROMIC HYPOTONIA
Prader-Willi Syndrome (PWS)
Joubert Syndrome
NONSYNDROMIC CENTRAL HYPOTONIA
Systemic Disease
Craniocervical Junction Lesions
BENIGN CONGENITAL HYPOTONIA
MOTOR UNIT DISORDERS
Differential Diagnosis (Table 1)
Spinal Muscular Atrophy
Congenital Muscular Dystrophy
Congenital Myotonic Dystrophy
Pompe's Disease
Myasthenic Syndromes
NEONATAL HYPOTONIA
CHAPTER 90:
Approach to Ataxia
INTRODUCTION
SENSORY ATAXIA
VESTIBULAR ATAXIA
CEREBELLAR ATAXIA
Clinical Approach to Cerebellar Ataxia
Acute Cerebellar Ataxias
Chronic Ataxias
CHAPTER 91:
Acute Hemiplegia in Children: An Algorithm for Diagnosis and Treatment
INTRODUCTION
HEMIPLEGIA IN INFANTS
Perinatal Stroke
Hemiconvulsion-hemiplegia-epilepsy Syndrome
HEMIPLEGIA IN OLDER CHILDREN
Childhood Stroke
Treatment
Demyelination in Children
Recurrent Hemiplegia in Children
CHAPTER 92:
Approach to a Child with Spastic Paraplegia
INTRODUCTION
CLINICAL FEATURES OF UPPER MOTOR AND LOWER MOTOR NEURON LESIONS
TYPES OF SPINAL CORD DISORDERS
Spinal Cord Syndromes (Table 4)
CAUSES OF SPASTIC PARAPLEGIA
Pott's Spine
Acute Transverse Myelitis
Intramedullary Spinal Arteriovenous Malformations
Adrenomyeloneuropathy
Hereditary Spastic Paraplegia
Spinal Cord Tumors
Deficiency of Vitamin B12
Tethered Cord Syndrome
CHAPTER 93:
Acute Febrile Encephalopathy
INTRODUCTION
CAUSES
WORKUP
Encephalopathies versus Meningoencephalitis
TREATMENT (BOX 6)
CHAPTER 94:
Approach to Pediatric Movement Disorders
INTRODUCTION
How They Differ in Children
CATEGORIZATION OF MOVEMENT DISORDER
PHENOMENOLOGY OF MOVEMENT DISORDERS
GENERAL APPROACH TO MOVEMENT DISORDERS
CAUSES OF MOVEMENT DISORDERS
Drug-induced Movement Disorders
INVESTIGATIONS
TREATMENT
INDIVIDUAL MOVEMENT DISORDERS
Dystonia
Definition
Pathophysiology
Classification
Distribution
Type of Onset
Treatment
Chorea
Pathophysiology of Chorea
Causes of Chorea
Tremor
Definition
Pathophysiology
Types
Rigidity
Hallmarks of Rigidity
Tics
Definition
Types
Treatment of Tics
Stereotypy
Myoclonus
Definition
Types
Opsoclonus-myoclonus-ataxia Syndrome (“Dancing Eyes, Dancing Feet”)
CHAPTER 95:
Afebrile Encephalopathy: Bedside Approach to Diagnosis and Management
INTRODUCTION
VARIED ETIOLOGIES AND THEIR BRIEF PRESENTATION ALGORITHM 1
Metabolic
Acquired: Hepatic/Uremic/Others
Hepatic Encephalopathy
Electrolyte Disturbances/ Hyperglycemia/Hypoglycemia
Inflammatory/Vasculitis
Parainfectious/Postinfectious Demyelination
Vasculitis/Hypertensive Encephalopathy/ Vascular Etiologies
Autoimmune Pathologies
Acquired Brain Injury
Accidental/nonaccidental injury
MANAGEMENT
SECTION 12: NEPHROLOGY
CHAPTER 96:
Approach to Rickets in Children
INTRODUCTION
CLINICAL EXAMINATION
Head
Thorax
Extremities
General
METAPHYSEAL DYSPLASIA
Clinical Features and Radiological Signs Suggestive of Metaphyseal Dysplasia
Clinical Features and Radiological Signs Suggestive of Hypophosphatasia
NUTRITIONAL RICKETS
NON-NUTRITIONAL RICKETS
ETIOLOGY WITH CLUES
GASTROINTESTINAL CAUSES
Features Indicating Gastrointestinal Etiology (Particularly Malabsorption Disorders Leading to Rickets)
Features Indicating Hepatobiliary Disorder Leading to Rickets
RENAL CAUSES
Clinical and Laboratory Features Indicating Renal Etiology Leading to Rickets
VITAMIN D-DEPENDENT RICKETS TYPE 1
VITAMIN D-DEPENDENT RICKETS TYPE 2
ONCOGENIC RICKETS
INVESTIGATIONS DONE IN ANY CHILD WITH RICKETS
Basic Investigations to Confirm Rickets
Second Level Investigations
Tertiary Level Investigations
MANAGEMENT
CHAPTER 97:
Disorders of Sodium and Potassium
INTRODUCTION
CLINICAL FEATURES
DIAGNOSTIC TESTS
Useful Biochemical Indices in Investigation of Sodium and Potassium Abnormalities
MANAGEMENT
CONCLUSION
CHAPTER 98:
Acute Glomerulonephritis
INTRODUCTION
ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS
EPIDEMIOLOGY
PATHOGENESIS
Nephritogenic Streptococcal Antigens
Immune Complex Deposition and Complement Activation
Cellular Immune Mechanisms
Autoimmune Reactivity
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
INVESTIGATIONS
Renal Biopsy Findings
Light Microscopy
Immunofluorescence
Electron Microscopy
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
PROGNOSIS
Endocarditis Associated Renal Disease
Shunt Nephritis
Henoch-schönlein Purpura and Immunoglobulin A Nephropathy
Hepatitis B and C Virus-related Glomerulonephritis
CHAPTER 99:
Approach to Hematuria in Children
INTRODUCTION
DEFINITION
GROSS HEMATURIA
Glomerular and Extraglomerular Hematuria
History and Physical Examination
Investigations
MICROSCOPIC HEMATURIA
Indications for Renal Biopsy
MANAGEMENT
Postinfective Glomerulonephritis
Immunoglobulin A Nephropathy
Alport Syndrome
Idiopathic Hypercalciuria
Benign Familial Hematuria
CONCLUSION
CHAPTER 100:
Approach to Urinary Tract Infection
INTRODUCTION
DEFINITION
CLINICAL FEATURES: (WHEN TO SUSPECT)
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
COMMON ORGANISMS
TREATMENT
Other/Nonpharmacologic Therapy
FOLLOW UP AND SUBSEQUENT CARE
Radiological Investigations
CONCLUSION
CHAPTER 101:
Antenatal Renal Anomalies: Outcome and Postnatal Management
INTRODUCTION
NORMAL FETAL URINARY TRACT
Grading System for Hydronephrosis
ANTENATAL HYDRONEPHROSIS
Antenatal Hydronephrosis: Postnatal Outcome
Antenatal Renal Anomalies: When to Worry?
Postnatal Evaluation
UNILATERAL OR BILATERAL MILD-TO-MODERATE HYDRONEPHROSIS (ANTEROPOSTERIOR RENAL PELVIS DIAMETER 5–14 MM)
UNILATERAL SEVERE HYDRONEPHROSIS
SEVERE HYDRONEPHROSIS (BILATERAL OR SOLITARY KIDNEY)
ROLE OF PROPHYLACTIC ANTIBIOTICS
ISOLATED ANTENATAL HYDRONEPHROSIS
VESICOURETERAL REFLUX
Diagnosis
PELVIURETERIC JUNCTION OBSTRUCTION
MULTICYSTIC DYSPLASTIC KIDNEY
POSTERIOR URETHRAL VALVES
PRENATAL COUNSELING
CONCLUSION
CHAPTER 102:
Acute Kidney Injury
INTRODUCTION
CLASSIFICATION
CLINICAL FEATURES
DIAGNOSIS
Urinalysis
Other Investigations
Biomarkers
Renal Imaging
TREATMENT
CHAPTER 103:
Enuresis
INTRODUCTION
PATHOGENESIS
EVALUATION (SEE ALGORITHM 1)
History
Physical Examination
Laboratory Testing and Imaging Studies
MANAGEMENT
Behavioral Therapy
Alarm Therapy
Pharmacological Treatment
CONCLUSION
CHAPTER 104:
Approach to Renal Tubular Disorders in Children
INTRODUCTION
PATHOPHYSIOLOGY (TABLE 1)
CLINICAL FEATURES (FIG. 1)
Clinical
Laboratory
EVALUATION OF RENAL TUBULAR DISORDERS (ALGORITHMS 1 AND 2)
Additional Tests for Renal Tubular Acidosis (Table 2)
EVALUATION OF METABOLIC ALKALOSIS (ALGORITHM 3)
TREATMENT GUIDELINES
APPENDIX 1
CHAPTER 105:
Nephrotic Syndrome in Children
INTRODUCTION
EVALUATION
INDICATIONS FOR RENAL BIOPSY
MANAGEMENT OF NEPHROTIC SYNDROME INCLUDES SPECIFIC AND SUPPORTIVE MANAGEMENT
Specific Management
Treatment of the Initial Episode
Management of Relapse
Frequent Relapser and Steroid-dependent
Steroid-resistant Disease
Supportive Management
Diet
Edema
SECTION 13: ENDOCRINOLOGY
CHAPTER 106:
Approach to Short Stature
INTRODUCTION
DEFINITION
ETIOLOGY
Familial Short Stature
Constitutional Delay in Growth and Puberty
Malnutrition and Chronic Illness
Growth Hormone Deficiency
Hypothyroidism
Cushing Syndrome
Turner Syndrome
Psychosocial Short Stature
Small for Gestational Age Sequelae
MANAGEMENT
Measurement of Height/Length
Calculate the Midparental Height (Target Height) and the Target Range
Normal Growth Velocity
Indications for Further Workup
Preliminary Workup
History
Anthropometry
Clinical Examination
Interpretation of Growth Velocity
Low Growth Velocity (Faltering Growth Curve)
Management Strategies
Growth Hormone
Androgens
CONCLUSION
CHAPTER 107:
Childhood Obesity
caintroduction
WHAT IS OBESITY?
Body Mass Index
Weight for Height
Waist Circumference
WHAT CAUSES OBESITY?
Constitutional Obesity
Endocrine Causes
Dysmorphic Syndromes
Hypothalamic Obesity
Monogenic Obesity
Drugs
WHY BOTHER ABOUT OBESITY?
Endocrine
Cardiovascular
Central Nervous System
Orthopedic
Respiratory
Gastrointestinal
Psychological
HOW TO EVALUATE A CHILD WITH OBESITY?
What Is the Cause of Obesity?
Clinical Evaluation
Investigations
What are the Complications of Obesity?
When to Evaluate?
Clinical Evaluation
Investigations
HOW TO MANAGE A CHILD WITH OBESITY?
Lifestyle Measures
Nutritional Therapy
Physical Activity
Specific Management
Treatment of Complications
Medical Treatment for Obesity
Surgical Management
HOW TO PREVENT CHILDHOOD OBESITY?
CHAPTER 108:
An Approach to Hyperglycemia
INTRODUCTION
CHILD OR ADOLESCENT WITH TYPICAL SYMPTOMS OF DIABETES MELLITUS
HYPERGLYCEMIA DETECTED ON SCREENING IN AN OBESE ASYMPTOMATIC ADOLESCENT
NEONATE/INFANT (BELOW 6 MONTHS) WITH SYMPTOMS OF HYPERGLYCEMIA
Transient Neonatal Diabetes Mellitus
Permanent Neonatal Diabetes Mellitus
MANAGEMENT OF NEONATAL DIABETES MELLITUS
STRESS HYPERGLYCEMIA
HYPERGLYCEMIA IN NEONATAL INTENSIVE CARE UNIT
Pathophysiology and Causes
Management
CHAPTER 109:
Gynecomastia in Children
INTRODUCTION
SIGNS AND SYMPTOMS
DIAGNOSIS
Laboratory Tests
Imaging Studies
MANAGEMENT
PATIENT EDUCATION
PROGNOSIS
CHAPTER 110:
Precocious Puberty
INTRODUCTION
PHYSIOLOGY OF PUBERTY
NORMAL PUBERTY
DEFINITION OF PRECOCIOUS PUBERTY
TYPES OF PRECOCIOUS PUBERTY
CAUSES OF PRECOCIOUS PUBERTY
APPROACH TO DIAGNOSIS
History
Physical Examination
Investigations
Gonadotropin-releasing Hormone Agonist Analog Test
Other Hormones
Imaging
Plain X-rays of the Skull
Pelvic Ultrasound
Abdominal Ultrasound
Neuroimaging
MANAGEMENT
CHAPTER 111:
Persistent Hypoglycemia in Newborns and Infants
INTRODUCTION
DEFINITION OF HYPOGLYCEMIA
GLUCOSE HOMEOSTASIS IN FETUS AND NEWBORN
GLUCOSE HOMEOSTASIS IN OLDER CHILDREN
TRANSIENT HYPOGLYCEMIA OF NEWBORN
PERSISTENT HYPOGLYCEMIA IN NEWBORNS, INFANTS, AND CHILDREN
Congenital Hyperinsulinism
Hormone Deficiencies
Disorders of Carbohydrate Metabolism
Fatty Acid Oxidation Disorders
Aminoacidopathies
Insulinoma
Accelerated Hypoglycemia (Ketotic Hypoglycemia)
SYMPTOMS OF HYPOGLYCEMIA
CLINICAL EVALUATION
Diagnostic Algorithm
MANAGEMENT
Specific Treatment for Congenital Hyperinsulinism
Specific Treatment of Other Causes of Persistent Hypoglycemia
PROGNOSIS
CHAPTER 112:
Approach to a Child with Disorder of Sex Development
INTRODUCTION
CAUSES AND CLASSIFICATION
EVALUATION OF A CHILD WITH AMBIGUOUS GENITALIA
History
Physical Examination
Dysmorphic Features
Gonads
Phallic Length
Anogenital Ratio
Urethral Opening
Prader Stages
Laboratory Evaluation
Karyotype
Fluorescence In Situ Hybridization
Adrenal Steroids
Gonadal Steroids
Human Chorionic Gonadotropin Stimulation Test
Imaging
MANAGEMENT
Newborn Gender Assignment
CHAPTER 113:
Approach to Thyroid Disorders in Children
INTRODUCTION
CONGENITAL HYPOTHYROIDISM
HYPOTHYROIDISM IN THE OLDER CHILD
HYPERTHYROIDISM
THYROID NODULE
CHAPTER 114:
Endocrine Hypertension in Children
INTRODUCTION
CLINICAL APPROACH TO ENDOCRINE HYPERTENSION
INVESTIGATIVE APPROACH
TREATMENT
SECTION 14: RHEUMATOLOGY
CHAPTER 115:
Approach to Oligoarthritis
INTRODUCTION
DEFINITION
SOME COMMON SCENARIOS OF ACUTE ARTHRITIS
Scenario 1: Reactive/Postinfectious Arthritis
Scenario 2: Septic Arthritis
Scenario 3: Malignancies
Scenario 4: Mechanical Causes
CHRONIC OLIGOARTICULAR PRESENTATION
History
Examination
Chronic Oligoarticular Juvenile Idiopathic Arthritis
APPROACH TO ACUTE ONSET OLIGOARTICULAR ARTHRITIS
History
Physical Examination
Laboratory Investigations (As Guided by History and Examination)
CHAPTER 116:
Approach to Polyarthritis
INTRODUCTION
SOME DEFINITIONS
ETIOLOGY
IMPORTANT POINTS IN HISTORY
Age
Sex
Onset and Duration
Pattern
Past History
Family History
EXAMINATION
Articular Involvement
Inflammatory Versus Noninflammatory
Pattern of Joint Involvement
Extra-articular Manifestations
Pattern Recognition
LABORATORY TESTS
TREATMENT
PROGNOSIS
CHAPTER 117:
Fever with Arthritis: An Algorithmic Approach
INTRODUCTION
ALGORITHMIC APPROACH TO MONOARTHRITIS (SINGLE JOINT)
History Taking
Physical Examination
Laboratory Investigations
ALGORITHMIC APPROACH TO POLYARTHRITIS (MULTIPLE JOINTS)
CONCLUSION
CHAPTER 118:
Childhood Vasculitis
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
CLASSIFICATION
ALGORITHMIC APPROACH TO CHILDHOOD VASCULITIS
Suspect Childhood Vasculitis
Support from Common Laboratory Findings
Categorize the Involved Vessel Type
Predominantly Large Vessel Vasculitis
Predominantly Medium-sized Vessel Vasculitis
Predominantly Small Vessel Vasculitis
Rule Out Mimickers
Confirm the Diagnosis
Therapeutic Measures
Medical
Surgical
INDIAN SCENARIO
CONCLUSION
CHAPTER 119:
Kawasaki Disease
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
PATHOGENESIS
CLINICAL FEATURES
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
TREATMENT
PROGNOSIS
CONCLUSION
CHAPTER 120:
Henoch-Schönlein Purpura
INTRODUCTION
ETIOPATHOGENESIS
CLINICAL MANIFESTATIONS
INVESTIGATIONS
TREATMENT
COURSE
CHAPTER 121:
Systemic Lupus Erythematosus
INTRODUCTION
EPIDEMIOLOGY
DIAGNOSIS OF SYSTEMIC LUPUS ERYTHEMATOSUS
CLINICAL PRESENTATION
WORKUP
INVESTIGATIONS
Immunological Testing
Antinuclear Antibody Test
Tissue Diagnosis
Renal Biopsy
TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS
General Measures
Specific Measures
Counseling
CHAPTER 122:
Approach to Juvenile Dermatomyositis
INTRODUCTION
DEFINITION
EPIDEMOLOGY
CLINICAL MANIFESTATIONS
COMPLICATIONS
INVESTIGATIONS
Muscle Enzymes
Autoantibodies
Magnetic Resonance Imaging
Electromyography
Muscle Biopsy
TREATMENT
CHAPTER 123:
Acute Osteoarticular Infections
INTRODUCTION
SEPTIC ARTHRITIS AND OSTEOMYELITIS
PATHOGENESIS
EPIDEMIOLOGY
MICROBIOLOGY
CLINICAL MANIFESTATIONS
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS
TREATMENT
PROGNOSIS
CONCLUSION
CHAPTER 124:
Eye Involvement: Beyond Infections
INTRODUCTION
CONJUNCTIVITIS
SCLERITIS
DIAGNOSIS
TREATMENT
INTERSTITIAL KERATITIS
RETINAL VASCULITIS
Therapy
ORBITAL DISEASE
Therapy
UVEITIS
Management
Treatment
SECTION 15: PEDIATRIC SURGERY
CHAPTER 125:
Empyema Thoracis: Management Algorithm
INTRODUCTION
EPIDEMIOLOGY
ETIOPATHOGENESIS
PATHOPHYSIOLOGY
CLINICAL FEATURES
INVESTIGATIONS
Chest Radiograph
Ultrasonography of Chest
Computed Tomography Scan
Hematological Investigations
Pleural Fluid Analysis
MANAGEMENT
Antibiotics
Pleural Cavity Drainage
Timing of Drainage
Options for Drainage
CHAPTER 126:
Evaluation of Acute Abdominal Pain in Children
INTRODUCTION
PATHOPHYSIOLOGY
PAIN HISTORY
CLINICAL EXAMINATION
General Examination
Gait
Vital Signs
Abdominal Examination
INVESTIGATIONS (TABLE 2)
Specific Conditions Causing Acute Abdomen Pain
Infantile Colic
Gastroenteritis
Appendicitis
Abdominal Trauma
Intestinal Obstruction
CHAPTER 127:
Management of Undescended Testis: Cryptorchidism
INTRODUCTION
TERMINOLOGY
PATHOGENESIS
EPIDEMIOLOGY AND RISK FACTORS
Associated Conditions
CLINICAL FEATURES
COMPLICATIONS AND SEQUELS
Inguinal Hernia
Testicular Torsion
Testicular Trauma
Subfertility
Testicular Cancer
MANAGEMENT
Bilateral Undescended Testis
Surgical Treatment
Palpable Testis
Nonpalpable Testis
Retractile Testis
Ascended Testicle
LONG-TERM OUTCOME OF THE ORCHIDOPEXY
Testicular Atrophy
Fertility
Malignancy
CHAPTER 128:
Acute Scrotum
INTRODUCTION
DEFINITION
ETIOLOGY
CLINICAL FEATURES
History
Clinical Examination
Examination of the Scrotum
INVESTIGATIONS
MANAGEMENT
Epididymo-orchitis
Idiopathic Scrotal Edema
Torsion of Testis
Perinatal Torsion
Torsion of the Appendages of Testis
Testicular Trauma
CHAPTER 129:
Per-rectal Bleeding
INTRODUCTION
CLINICAL CLASSIFICATION
ETIOLOGY
ALGORITHM OF CLINICAL APPROACH TO THE DIAGNOSIS
INVESTIGATIONS
FISSURE IN ANO
Pathogenesis
Clinical Presentation
Treatment
INTUSSUSCEPTION
Treatment
RECTAL AND COLONIC POLYPS
Treatment
RECTAL PROLAPSE
CHAPTER 130:
Inguinal Hernia
INTRODUCTION
INGUINAL HERNIA
Definition
Types
Clinical Presentation and Examination
Management
Timing of Surgery
INCARCERATED HERNIA
HYDROCELE
SPECIAL CONSIDERATIONS
Preterm Babies
Hernia with Undescended Testis
Hernia with Ventriculoperitoneal Shunts
Hernia in a Female Child
Bilateral Hernia
LAPAROSCOPIC VERSUS OPEN REPAIR OF HERNIA
CHAPTER 131:
Antenatal Hydronephrosis
INTRODUCTION
MAGNITUDE OF THE PROBLEM
What Is Significant Dilatation?
Information from a Good Antenatal Ultrasound Scan
Current Status of Fetal Intervention
Natural History of Antenatal Hydronephrosis
POSTNATAL EVALUATION OF ANTENATAL HYDRONEPHROSIS
Role of Radionuclide Imaging Studies
Follow-up Evaluation
CHAPTER 132:
Management of Vesicoureteric Reflux
MAINSTAY OF MODERN MANAGEMENT OF VESICOURETERIC REFLUX
Option A (Antibiotic Prophylaxis)
Option B (Endoscopic Injection)
Option C (Open Surgery)
MANAGEMENT OF vesicoureteric reflux
Management of Vesicoureteric Reflux in the Child under 2 Years of Age
Management of Vesicoureteric Reflux in the Child Over 2 Years of Age
Additional Information
CONCLUSION
CHAPTER 133:
Intussusception
INTRODUCTION
INCIDENCE AND CLINCAL FEATURES
DIAGNOSIS
TREATMENT
RECURRENCE
CHAPTER 134:
Neonatal Jaundice: Surgical Perspective
INTRODUCTION
PHYSIOLOGICAL VERSUS PATHOLOGICAL JAUNDICE
CLINICAL FEATURES
EVALUATION OF THE CHOLESTATIC NEONATE
Initial Investigations
Specific Investigations
Ultrasonography
Tc99m-hepatobiliary Iminodiacetic Acid Scintigraphy
Magnetic Resonance Cholangiopancreatography
Liver Biopsy
Intraoperative Cholangiogram
Additional Tests
MANAGEMENT (ALGORITHM 1)
COMPLICATIONS
POSTOPERATIVE MANAGEMENT
OUTCOME
LIVER TRANSPLANTATION
CONCLUSION
SECTION 16: DERMATOLOGY
CHAPTER 135:
Atopic Dermatitis
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
APPROACH TO THE PATIENT (ALGORITHM 1)
MANAGEMENT
CHAPTER 136:
Approach to a Child with Hypopigmented Macules
INTRODUCTION
CHAPTER 137:
Pediatric Acne
INTRODUCTION
NEONATAL ACNE
INFANTILE ACNE
MID-CHILDHOOD ACNE
PREADOLESCENT ACNE
ADOLESCENT ACNE
TREATMENT OF MILD ACNE
TREATMENT OF MODERATE ACNE
TREATMENT OF SEVERE ACNE
CHAPTER 138:
Approach to Congenital Melanocytic Nevus
INTRODUCTION
CHAPTER 139:
Seborrheic Dermatitis
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
CLINICAL PRESENTATION AND APPROACH (Algorithm 1)
Infants
Adolescents
TREATMENT
Infant Seborrheic Dermatitis
Adolescent/Adult Seborrheic Dermatitis
Scalp Seborrheic Dermatitis
Nonscalp Seborrheic Dermatitis
SECTION 17: OPHTHALMOLOGY
CHAPTER 140:
Approach to Red Eye in Children
INTRODUCTION
CAUSES OF RED EYE
HISTORY AND EXAMINATION
Tips for an Effective Patient History and Examination
CONJUNCTIVITIS
Bacterial Conjunctivitis
Viral Conjunctivitis
Allergic Conjunctivitis
BLEPHARITIS
SUBCONJUNCTIVAL HEMORRHAGE
CORNEAL ABRASION
RED EYE IN A NEWBORN
Ophthalmia Neonatorum (Neonatal Conjunctivitis)
CONCLUSION
CHAPTER 141:
Compensatory Head Posture
INTRODUCTION
COMPONENTS OF HEAD POSTURE
INTERPRETATION OF HEAD POSTURE
SENSORY AND MOTOR FUSION
The Association of Sensory and Motor Visual System
CONFUSION, DIPLOPIA, AND SUPPRESSION
CAUSES OF ABNORMAL HEAD POSTURE
Incomitant Squint
Incomitance in Concomitant Squint (A or V Phenomenon)
Nystagmus
Other Causes
HISTORY AND EXAMINATION
INVESTIGATIONS
MANAGEMENT
Nonsurgical Treatment
Surgical Treatment
Paralytic Squint
A and V Phenomenon
Nystagmus
Other Causes
ACKNOWLEDGEMENT
CHAPTER 142:
Pediatric Epiphora
INTRODUCTION
THE OUTFLOW PATHWAY FOR TEARS
DEVELOPMENT OF LACRIMAL DRAINAGE SYSTEM
CAUSES OF WATERING OF EYES IN RELATION TO LACRIMAL SYSTEM
Hyperlacrimation
Epiphora
Infective Causes
Ophthalmia Neonatorum
Allergic Conjunctivitis
Vernal Keratoconjunctivitis
WORKUP
History
Clinical Examination with Torch light
Features of Congenital Obstruction of Nasolacrimal Duct
Tests to Check for Nasolacrimal Duct Block
Sac Syringing
Jones Dye Test
Fluorescein Dye Disappearance Test
Management of Congenital Blockage of Nasolacrimal Duct
CONCLUSION
CHAPTER 143:
Deviation of Eyes
INTRODUCTION
STRABISMUS
CLASSIFICATION
Based on Direction
Based on Latency
Based on Onset
Based on Constancy
Based on Comitance
Based on Etiology
ETIOLOGY
CLINICAL FEATURES
EXAMINATION
MANAGEMENT
PROGNOSIS
CHAPTER 144:
Decreased Vision in Children
INTRODUCTION
NORMAL VISUAL DEVELOPMENT
Visual Milestones
Signs of Poor Visual Development
Approach to an Infant with Decreased Vision
History
Examination
ASSESSMENT OF VISUAL ACUITY
Infants
Toddlers
Preschoolers
School-aged Children
CONCLUSION
SECTION 18: EAR, NOSE, AND THROAT
CHAPTER 145:
Hearing Screening and Management in Newborn
INTRODUCTION
IMPORTANCE OF SCREENING THE NEWBORN
SCREENING TECHNIQUES
Automated Otoacoustic Emission (Kemp, 1978)
Automated Auditory Brainstem Responses
Auditory Brainstem Responses
Auditory Steady State Response
SCREENING PROTOCOLS FOR NEWBORN
CHAPTER 146:
Hoarseness in Pediatric Age Group
INTRODUCTION
ETIOLOGY
Vocal Nodules
Vocal Polyps
Vocal Cord Cysts
Sulcus Vocalis
Juvenile Laryngeal Papillomatosis
Congenital or Acquired Vocal Fold Paresis
Laryngopharyngeal Reflux
Acute or Chronic Laryngitis
Foreign Body Inhalation
Malignant Tumors
Iatrogenic
EVALUATION
History
Examination
TREATMENT
Surgery
CHAPTER 147:
Otitis Media with Effusion
INTRODUCTION
DEFINITION
SYNONYMS
SUBJECTIVE COMPLAINTS
CLINICAL AND FUNCTIONAL ANATOMY
OBJECTIVE FINDINGS
PATHOPHYSIOLOGY
Classic Theory
Newer Theories
ETIOLOGY
Common Pathogens
EPIDEMIOLOGY
PHYSICAL EXAMINATION
DIAGNOSTIC CHALLENGES
Differential Diagnoses
Assessment
Radiologic Studies
Computed Tomography
Magnetic Resonance Imaging
Pneumatic Otoscopy
Video Otoscopy
Free-field Testing
Tympanometry
Language Testing
Tympanocentesis and Myringotomy
OVERVIEW OF MEDICAL AND SURGICAL APPROACHES
Summary of Medical Intervention
Autoinflation
Summary of Surgical Intervention
Medication
Antimicrobial Agents
Steroids
Antihistamines and Decongestants
Mucolytics
Indications for Surgical Intervention
MYRINGOTOMY
Myringotomy and Ventilation Tubes
Complications
Adenoidectomy
Removal because of Enlargement
Removal for Improvement of Eustachian Tube Function
Removal of a Potential Source of Inflammation and Infection at the Eustachian Tube Orifice
Long-term Monitoring
PITFALLS
CHAPTER 148:
Pediatric Sinusitis
INTRODUCTION
SINUSITIS
CLASSIFICATION
BACTERIOLOGY
NATURAL HISTORY
SYMPTOMOLOGY
COMPLICATIONS
PRESEPTAL CELLULITIS
ORBITAL CELLULITIS
SUBPERIOSTEAL ABSCESS
ORBITAL ABSCESS
CAVERNOUS SINUS THROMBOSIS
LOCAL COMPLICATIONS
INTRACRANIAL COMPLICATIONS
EPIDURAL AND SUBDURAL ABSCESS
INTRACEREBRAL ABSCESS
DIAGNOSIS
TREATMENT
CHAPTER 149:
Stridor in Children
INTRODUCTION
CONGENITAL CAUSES
ACQUIRE CAUSES
Laryngo-tracheal Stenosis
Laryngeal Atresia
Laryngomalacia
Diagnosis
Tracheomalacia
Laryngeal Webs
Laryngeal Cysts
ACQUIRED CAUSES
Epiglottitis
Croup
Symptoms
Diagnosis
Management
Foreign Bodies in the Airways
SUBGLOTTIC HEMANGIOMA
HEMANGIOMA IN SUCH CASES
Abnormalities of the Cry
Physical Signs
Nasal Patency Test
Radiology
CHAPTER 150:
Upper Airway Obstruction and Sleep Related Breathing Disorders
INTRODUCTION
CLINICAL PRESENTATION
ADENOID AND TONSIL SURGERY FOR OBSTRUCTIVE SLEEP APNEA
ADENOTONSILLECTOMY
What Are the Signs and Symptoms of Obstructive Sleep Apnea for the Mother to See?
SECTION 19: ORTHOPEDICS
CHAPTER 151:
Septic Arthritis
INTRODUCTION
HOW COMMON IS THE PROBLEM?
MECHANISM/PATHOPHYSIOLOGY OF THE PROBLEM
WHICH ARE THE SUSCEPTIBLE GROUPS IN NEONATES?
When to Suspect (Algorithm 1)?
WHICH ARE THE MOST COMMON JOINTS INVOLVED?
What Are Clinical Clues for Diagnosis in Neonate?
What are Clinical Clues in Infants and Older Children?
CHALLENGES IN DIAGNOSING SEPTIC ARTHRITIS
WHICH ARE OTHER DIFFERENTIAL DIAGNOSES?
WHICH ARE THE MOST COMMON CAUSATIVE ORGANISMS?
WHAT INVESTIGATIONS ARE SUPPORTIVE TO CONFIRM THE DIAGNOSIS?
Radiographs
Ultrasonography
Bone Scan
Magnetic Resonance Imaging
Hematological Investigations
HOW TO PROCEED FOR THE MANAGEMENT ONCE DIAGNOSIS IS MADE (ALGORITHM 1)?
WHICH ANTIBIOTICS NEED TO BE GIVEN?
WHICH IS THE PREFERRED ROUTE OF ANTIBIOTICS?
HOW LONG ANTIBIOTICS NEED TO BE GIVEN?
WHERE AND WHO SHOULD PERFORM THE JOINT ASPIRATION?
Is Simple Joint Aspiration Sufficient or a Joint Wash Need to Be Done?
What is the Role of Plaster Cast/Splints/Traction?
CHAPTER 152:
Angular and Rotational Deformities in Children
INTRODUCTION
ANGULAR DEFORMITIES IN CHILDREN
Normal Variation During Growth
Radiological Assessment of Alignment of Lower Limb
Genu Varum (Algorithm 1)
Physiological Genu Varum
Nutritional Rickets
Blount's Disease
Clinical Features
Radiographic Findings
Skeletal Dysplasia
Focal Fibrocartilaginous Dysplasia
Genu Valgum (Algorithm 2)
Idiopathic Genu Valgum
Metabolic Disorders
Skeletal Dysplasia
Post-traumatic Genu Valgum
ROTATIONAL DEFORMITIES IN CHILDREN
Common Causes of Rotational Deformities in Children
Pathologic Causes for Rotational Deformities
Evaluation of Child with Rotational Deformity
The Three-step Rotational Profile (Algorithm 3)
In-toeing
Investigations
Metatarsus Adductus
Tibial Torsion
Femoral Anteversion
CHAPTER 153:
Approach to a Child with a Limp
INTRODUCTION
DIAGNOSIS
HISTORY
CLINICAL EXAMINATION
Local Examination
DIFFERENTIAL DIAGNOSIS
Transient Synovitis
Septic Arthritis
Osteomyelitis
Fracture
Limb Length Discrepancy
Developmental Dysplasia of Hip
Slipped Capital Femoral Epiphysis
Perthes Disease
Osteoid Osteoma
Juvenile Arthritis
CONCLUSION
CHAPTER 154:
Pulled Elbow, Growing Pains, and Flatfoot
PULLED ELBOW
Incidence
Mechanism of Injury
Pathology
Clinical Features (Algorithm 1)
Investigations
Treatment
Reduction Maneuver
Precautions
GROWING PAINS (ALGORITHM 2)
Incidence
Etiology
Clinical Features
On Examination
Investigations
Differential Diagnosis
Management
FLATFOOT
Incidence
Classification
Differential Diagnosis
Clinical Features
Examination
Investigations
Management
CHAPTER 155:
Clubfoot Treatment: Current Concepts
INTRODUCTION
DEFINITION
ETIOLOGY
PATHOLOGY
HISTORY AND PHYSICAL EXAMINATION
MANAGEMENT
Treatment in the Prewalking Age
Results of the Ponseti Method of Clubfoot Treatment
Treatment after Independent Walking is Achieved
Open Surgery: Soft-tissue Releases
Open Surgery: Tendon Transfer
Bony Surgery
Fixators
ROLE OF EXERCISES AND SPLINTS
CHAPTER 156:
Developmental Dysplasia of the Hip
SPECTRUM OF DEVELOPMENTAL DYSPLASIA OF THE HIP
INCIDENCE OF Developmental dysplasia of the hip
CAUSES AND RISK FACTORS
DIAGNOSING DEVELOPMENTAL DYSPLASIA OF THE HIP
Clinical Examination
Investigations
WHAT ARE THE TREATMENT OPTIONS?
Pavlik Harness
Closed Reduction and Hip Spica Application
Medial Open Reduction
Anterior Open Reduction with Femoral and Pelvic Osteotomy
Neglected Developmental Dysplasia of the Hip in the Older Child (Figure 7)
INDEX
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