Practical Pediatric Digest A Parthasarathy, A Somasundaram, P Sudhakar
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PRACTICAL PEDIATRIC DIGEST
Publication of IAP Chennai City Branch
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PRACTICAL PEDIATRIC DIGEST
Editor-in-ChiefA Parthasarathy Senior Consultant Pediatrician AP Child Care, Chennai Former Distinguished Professor of Pediatrics The Tamil Nadu Dr MGR Medical University, Chennai Retired Senior Clinical Professor of Pediatrics Madras Medical College, Chennai Deputy Superintendent Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu apartha2030@gmail.com Executive EditorA Somasundaram Consultant in Developmental Pediatrics Kanchi Kamakoti CHILDS Trust Hospital Consultant Pediatrician, Sabari Child Care Clinic and Center for Child Development Formerly, Senior Assistant Professor of Pediatrics Institute of Child Health and Hospital for Children Madras Medical College, Chennai, Tamil Nadu drsoma2001@yahoo.com Publication EditorP Sudhakar Senior Assistant Professor of Pediatrics Institute of Child Health and Hospital for Children Madras Medical College, Chennai Consultant Pediatrician and Development Pediatrician BFCC Child Care Center, Chennai, Tamil Nadu drsudhakar2001@gmail.com ForewordsPramod Jog Anupam Sachdeva S Sachidananda Kamath Major K Nagaraju R Somasekar
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Chief Academic EditorsPSN Menon Consultant and Head Department of Pediatrics Jaber Al-Ahmed Armed Forces Hospital, Kuwait Former Professor Department of Pediatrics All India Institute of Medical Sciences New Delhi psnmenon@hotmail.com MKC Nair Vice-Chancellor Kerala University for Health Sciences, Thrissur Founder Director Child Development Center Government Medical College Thiruvananthapuram Kerala cdcmkc@gmail.com K Nedunchelian Senior Consultant and Head (Research and Academics) Dr Mehta’s Children’s Hospital Chennai, Tamil Nadu drknedunchelian@gmail.com P Ramachandran Professor and Head Department of Pediatrics Sri Ramachandra Medical College and Research Institute Chennai, Tamil Nadu ramachandran_dr@rediffmail.com Academic EditorsAlok Gupta Pediatrician and Counselor Pediatric Specialties Clinic, Jaipur Former Assistant Professor Pediatric Medicine Mahatma Gandhi Medical College and Hospital Jaipur, Rajasthan docalok@hotmail.com S Thangavelu Former Reader Department of Pediatrics Institute of Child Health and Hospital for Children Madras Medical College Chennai Senior Consultant and Director Department of Pediatrics Dr Mehta's Children's Hospital Chennai, Tamil Nadu thangavelu.dr@gmail.com Jaydeep Choudhury Associate Professor Department of Pediatrics Institute of Child Health Kolkata, West Bengal drjaydeep_choudhury@yahoo.co.in NC Gowrishankar Pediatric Pulmonologist and Bronchoscopist Head (Pediatrics—Clinical Operations and Quality) Dr Mehta's Children's Hospital Chennai, Tamil Nadu cugowri@yahoo.com Associate EditorsR Remesh Kumar Medical Superintendent and Chief Pediatrician NSS Medical Mission Hospital Pandalam, Pathanamthitta Kerala drremesh2006@yahoo.com S Narmada Director and Consultant Pediatrician Nalam Medical Center and Hospital Vellore, Tamil Nadu dr.narmadhaashok@gmail.com RV Dhakshayani Assistant Professor Department of Pediatrics Institute of Child Health and Hospital for Children Madras Medical College Chennai, Tamil Nadu dhaksh357@yahoo.com Hemchand K Prasad Consultant and Head Department of Pediatric Endocrinology and Diabetes Dr Mehta’s Children's Hospital Chennai, Tamil Nadu hemchan82@gmail.com Ex-Officio Editorial AdvisersR Somasekar Professor Department of Pediatrics Institute of Child Health and Hospital for Children Madras Medical College Chennai, Tamil Nadu T Muthusamy Senior Consultant Pediatrician Apollo Clinic Chennai, Tamil Nadu S Vasanth Kumar Visiting Consultant Kanchi Kamakoti CHILDS Trust Hospital Anna Nagar Chennai, Tamil Nadu TN Manohar Senior Consultant Pediatrician Chennai, Tamil Nadu S Babu Consultant Pediatrician VeeCare Sundar Hospital, Poonamallee Chennai, Tamil Nadu
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Practical Pediatric Digest
First Edition :2017
9789386150868
Printed at
vDedicated to
The parents and their suffering children whose valuable history and clinical presentation have contributed to enrich our knowledge.
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viiContributors xiForeword
Pediatrics made Palatable and Digestible
It is the tragedy of the world that no one knows what he doesn’t know—and the less a man knows, the more sure he is that he knows everything!
– Jouce Cary, British Author (1888–1957)
Theory and practice are the two hands of any clinician. Practicing with just one leaves the doctor and the patient with a handicap. Our increasing knowledge will benefit child care, only if the ‘right’ knowledge combines with the ‘left’ out.
Practical Pediatric Digest is a bridge between what needs to be known and what needs to be done.
Dr Parthasarathy (Editor-in-Chief) has set on our (study) tables, a variety of dishes, cooked with intelligent technique by masterchefs of their field, to give us Pediatrics in a Palatable and Digestible form. I congratulate all the authors for their hard work, knowledge and thoughtfulness.
If a little knowledge is dangerous, where is the man who has so much to be out of danger!
– TH Huxley
The Indian Academy of Pediatrics (IAP) has always promoted ethical and rational pediatric care, and this publication will keep our members out of danger for years to come.
I am confident that the digest, a flagship project of IAP, Chennai will become extremely popular among students and doctors over the years, and guides all those caring for neonates, children and adolescents in India and abroad.
Pramod Jog
President IAP, 2016
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xiiiForeword
It is my pleasure to write a foreword for Practical Pediatric Digest. The editors of the book are very well-known authors and have been the forefront of producing excellent manuscripts for the Indian Academy of Pediatrics (IAP). The contents of the book show how well thought out the chapters are. I am sure with the group of wisemen, writing and editing this book it will be a part of the library of each pediatrician.
I congratulate the editors in this effort.
Anupam Sachdeva
National President Elect IAP, 2016
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xvForeword
It is both a pleasure and a privilege to write a foreword for Practical Pediatric Digest published under the aegis of Chennai-City Branch of Indian Academy of Pediatrics (IAP), Tamil Nadu State Chapter (IAP–TNSC). The book with 14 chapters covering 42 topics has relevant clinical and significant diagnostic information, and can be comparable to the best available currently in the global market. As a digest, it reflects the intensive effort by contributors and reviewers, assuring the user of a broad and collective expertise.
I congratulate Dr A Parthasarathy (Editor-in-Chief), Dr A Somasundaram (Executive Editor), Dr P Sudhakar (Publication Editor), Drs PSN Menon, MKC Nair, K Nedunchelian, P Ramachandran (Chief Academic Editors) and the dedicated contributors for their magnanimous and magnificent effort in bringing out this remarkable book.
I also commend the office bearers of Chennai-City Branch of IAP–TNSC for their brilliant initiative in bringing out the book.
I am sure that this will become an indispensable tool for practicing pediatricians, neonatologists, undergraduates and postgraduates of pediatrics and academicians.
S Sachidananda Kamath
National President, IAP 2015
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xviiForeword
I am delighted to write this foreword for Practical Pediatric Digest brought out by Indian Academy of Pediatrics (IAP), Chennai-City Branch.
Going through the contents of the book, I am convinced that this book is useful for the practicing pediatricians as a desktop reference. All chapters are relevant and authors have taken great pains to present the recent advances in their respective fields.
I congratulate Dr A Parthasarathy (Editor-in-Chief), appropriately supported by Dr A Somasundaram, Dr P Sudhakar, and other editors for bringing this beautiful book.
I appreciate the publishers, M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for bringing the book in a beautiful format.
Major K Nagaraju
President
Indian Academy of Pediatrics–Tamil Nadu State Chapter (IAP–TNSC), 2016
President, Pediatric Allergy Association of India
Professor
Allergy and Clinical Immunology
Saveetha Medical College and Hospital, Chennai
Director
VN Allergy and Asthma Research Center
Chennai, Tamil Nadu
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xixForeword
Ignited minds are the most powerful resource on earth.
– Dr APJ Abdul Kalam
True to these thoughts, the Practical Pediatric Digest designed to be a practical and easy-to-use ready-reckoner, providing a plethora of knowledge and information in a simple-lucid format to the busy practicing pediatricians in their day-to-day practice. It is not an exhaustive reflection, instead it provides a concise summary of the most common disorders in children.
Practical Pediatric Digest stands proud with the focus on applications and exercises, and discussion of all pediatric problems that call for retrieval and integration of prior knowledge. I am sure that this book will be very useful for undergraduates, postgraduates, and also to busy consultants to give the much-needed confidence in each field written by various competitive authors.
The articles contributed by experts in their respective fields are written in a simple and easy-to-understand format, and have taken pains to give updated information in the reader-friendly manner. I congratulate the various editors for having done the excellent job in choosing the right topics in the related field. I also deeply appreciate their extraordinary efforts, their dedications and commitments to excellence under the noble leadership of its Editor-in-Chief, Dr A Parthasarathy.
I thank one and all involved in this venture and bringing out the book on the eve of MAMMALLA PEDICON 2016, this honor at this stage the Indian Academy of Pediatrics (IAP)–Chennai City Branch.
R Somasekar
Professor
Department of Pediatrics
Institute of Child Health and Hospital for Children
Madras Medical College, Chennai, Tamil Nadu
President
Indian Academy of Pediatrics–Chennai City Branch (IAP–CCB)
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xxiPreface
Medical learning is a continuous process. Apart from the theory we learnt during our undergraduate and postgraduate trainings, we gain our own experience and practical knowledge during subsequent office/hospital practice, and also through various continuing medical educations (CMEs) about the latest trends in the diagnosis and management of common and uncommon pediatric illnesses, and update ourselves with new knowledge. Thus ‘we learn to unlearn only to re-learn and thus continue to learn’.
With this objective in mind of educating the practicing and upcoming pediatricians, faculties and medical students, the Chennai-City branch of the Tamil Nadu State Chapter of Indian Academy of Pediatrics (IAP) regularly organizes at least one CME a month and an annual mega CME every year to benefit the delegates who attend them. Many who could not attend felt that they should also get the experts’ views and update themselves. None other than our Editor-in-Chief gave the idea of coming out with a book containing all the topics discussed. And that is how the Practical Pediatric Digest is born with selected topics of practical guidelines.
This book contains 14 chapters with 42 topics discussed during the three annual mega CMEs conducted during the years 2013, 2014 and 2015 in about 300 pages presented in a ‘reader-friendly’ format, which have undergone 3 levels of reviews and edited by ‘eagle-eyed’ expert editors. It is our fervent hope that the topics presented will benefit you in your day-to-day practice. Kindly pass on your feedback to us so that we can improve upon the contents in the future editions of the book.
A Parthasarathy
A Somasundaram
P Sudhakar
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xxiiiAcknowledgments
The editorial board would like to place on record its appreciation and gratitude to all editors who responded with their fine-tuned manuscripts on time enabling the publishers to bring out the book on schedule.
The Editor-in-Chief thanks all members of the editorial board—the Associate, Academic and Chief Academic Editors for their ‘eagle-eye’ review and edit remarks at the 3 levels of reviews and editing process which have been incorporated with author approval. In particular, the services rendered by the Executive Editor and the Publication Editor in getting the manuscripts from authors on time and the production department of M/s Jaypee Brothers Medical Publishers (P) Ltd (Health Sciences Publishers), New Delhi, India, for formatting and obtaining approval for the proofs from respective authors within a short span of time.
For secretarial and correspondence assistance, the Editor-in-Chief would like to thank Mrs Nirmala, Dr (Mrs) Pathibha, Mrs Kavitha, Dr (Ms) Shruthi Pavana, Miss Swathi Pavana, Miss Kavya, Miss Mahiya, Mr R Janardhanan, Mr P Balaji, (Late) Mr A Sriramulu, Chennai and Mr R Asokan, Thiruvananthapuram, Kerala, India. The Executive Editor is indebted and grateful to the services of Dr (Mrs) Kirupa Somasundaram.
The editorial board is indebted to Dr R Somasekar (President, IAP-CCB) and Dr S Babu (Secretary, IAP-CCB) for kind permission to publish the book and to all the National Presidents and the TNSC State President for their encouraging Forewords.
Our grateful thanks to Shri Jitendar P Vij (Group Chairman); Mr Ankit Vij (Group President); Mr Tarun Duneja (Director-Publishing); Mr KK Raman (Production Manager); Mrs Samina Khan (Executive Assistant to the Director-Publishing); Heena Gogia (Project Coordinator); Mohit Bhargava (Production Coordinator); and the team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for printing and publishing the book at record time.
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