Assessment and management of hypertension in children and adolescents: part A- epidemiology, clinical evaluation and prognosis

The renewed interest in hypertension in children and adolescents has resulted from the recognition that its presence in adults often has its roots at a younger age. Accurate measurement of blood pressure in children is essential to establish a diagnosis and it should be based on an appropriate technique and comparison to well established population-based standards. The causes are multiple in young children and a thorough evaluation of possible primary causes is imperative

Assessment and management of hypertension in children and adolescents: part B - investigations and management

Once the diagnosis of hypertension has been established in a child or an adolescent, the investigations to be requested need to include a search for the primary cause when secondary hypertension is suspected, the identification of associated and co-morbid conditions and the evaluation of target-organ damage. Instituting therapy should be based on clear indications, the choice of lifestyle and/or pharmacological treatment should be guided by the pathophysiology of the underlying mechanism and based on evidence-based guidelines

Bacterial tracheitis: when croup is not what it seems

Croup or viral laryngotracheobronchitis is a very common paediatric condition. It presents with inspiratory stridor, barking cough and sometimes respiratory distress, following a viral upper respiratory tract infection. The condition has a very good prognosis and responds well to therapy, if required. However, other conditions may mimic it and doctors are always aware of the need to exclude a foreign body aspiration and not to overlook a potential life threatening epiglotittis, much less common now with the successful immunisation against Haemophilus influenzae type B [HiB]. A less well known respiratory tract infection, bacterial tracheitis, can also mimic croup. As it is potentially fatal if unrecognised, it is vital to diagnose it early. Luckily, if suspected early, an immediate and specific management is associated with an excellent prognosis. We describe two children, initially managed as croup, who developed this condition. We discuss when bacterial tracheitis should be suspected, how to differentiate it from the extremely common croup, and how to diagnose and treat it

Regional hemophilus influenzae type B immunization program: a success or a false sense of security?

Assessment of the hemophilus influenzae type B [Hib] immunization program in our institution. Design: Comparing the change in the incidence of Hib meningitis with the Hib immunization program. Saudi Aramco Al Hasa Health Center, Kingdom of Saudi Arabia. All 16 cases of Hib meningitis diagnosed between January 1983 and October 1995. Interventions: Institution of Hib immunization program. Main outcome measures: Incidence of Hib meningitis after the institution of the immunization program. Eight cases occurred before the Hib immunization program and all survived. Three developed sequellae which included hydrocephalus, cerebral atrophy, transient seizures and sensorineural hearing loss. Eight cases occurred after the Hib immunization program and all survived without severe sequellae. All these 16 infants were non- or incompletely immunized in dispensaries outside Saudi Aramco, where Hib immunization is not offered. No child fully immunized with Hib had Hib meningitis, or any other systemic Hib infection. The efficacy of Hib immunization in preventing invasive Hib infections in infancy and childhood is highlighted as well as the vulnerability of non-immunized infants. The only realistic and long-term solution to protect all children is to have the Ministry of Health implement a compulsory nation-wide Hib immunization campaign