Pulmonary manifestations of pediatric HIV infection.

Vertically acquired HIV infection is becoming increasingly common in India. The main clinical manifestations of HIV in childhood are growth failure, lymphadenopathy, chronic cough and fever, recurrent pulmonary infections, and persistent diarrhoea. Pulmonary disease is the major cause of morbidity and mortality in pediatric AIDS, manifesting itself in more than 80% of cases. The most common causes are Pneumocystis carinii pneumonia (PCP), lymphocytic interstitial pneumonitis (LIP), recurrent bacterial infections which include bacterial pneumonia and tuberculosis. The commonest AIDS diagnosis in infancy is PCP, presenting in infancy with tachypnea, hypoxia, and bilateral opacification on chest-X-ray (CXR). Treatment is with cotrimoxazole. LIP presents with bilateral reticulonodular shadows on CXR. It may be asymptomatic in the earlier stages, but children develop recurrent bacterial super infections, and can progress to bronchiectasis. LIP is a good prognostic sign in children with HIV infection in comparison to PCP. HIV should be considered in children with recurrent bacterial pneumonia, particularly with a prolonged or atypical course, or a recurrence after standard treatment. Pulmonary TB is common in children with HIV, but little data is available to guide treatment decisions. Much can be done to prevent PCP and bacterial infections with cotrimoxazole prophylaxis and appropriate immunisations, which may reduce hospital admissions and health care costs.

Diagnostic and prognostic value of CT brain scan in term neonates with moderate and severe birth asphyxia.

Twenty term neonates with moderate (stage II) and 5 with severe (stage III) hypoxic ischemic encephalopathy (HIE) were prospectively studied to determine diagnostic and prognostic value of CT brain scan. Three neonates expired, 4 were lost to follow up while 18 were followed up to 18 months of age. Cerebral hypodensities were noted in 20 and intracranial hemorrhage (ICH) in 8, of which 6 had both ICH and hypodensity. Twelve of 14 infants with hypodensities and 5 of 6 with ICH who were followed up were handicapped at 18 months. Thirteen of 18 babies followed up were subjected to repeat CT scans between 9 and 18 months of age for assessing extent and severity of brain damage. Major abnormality noted on repeat CT scans was cerebral atrophy. All 6 infants whose follow-up scans were abnormal had neurological sequelae, while of 7 infants who had normal repeat CT scans, 5 had neurological sequelae. We do not recommend repeat CT scans in patients with HIE as a parameter to predict neurologic outcome.