Management of Status Asthmaticus in Children.

Asthma is a common chronic inflammatory disorder of the airways characterized by recurrent wheezing, breathlessness, and coughing. Acute exacerbations of asthma can be life-threatening; annual worldwide estimated mortality is 250,000 and most of these deaths are preventable. While most of the acute exacerbations can be managed successfully in the emergency room, few children have severe exacerbations requiring intensive care. Mainstay of treatment for status asthmaticus are inhaled β2 agonist and anticholinergic agents, oxygen along with corticosteroids. Children who do not respond well to initial treatment require parenteral β2 agonist and magnesium. Rarely, sick children need parenteral aminophylline infusion and mechanical ventilation. Guidelines for diagnosis, treatment, ventilator management and supportive care for status asthmaticus in children are discussed in the protocol.

Management of Acute Lung Injury/ARDS.

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are disorders of pulmonary inflammation characterized by hypoxemia and respiratory failure. Children have varying incidence of ALI/ARDS from 2.2 to 16 per 100,000 pediatric population associated with high morbidity, mortality, and financial burden. The diagnostic criteria include: acute onset, severe arterial hypoxemia resistant to oxygen therapy alone (PaO2/FIO2 ratio ≤200 for ARDS and ≤300 for ALI), diffuse pulmonary inflammation (bilateral infiltrates on chest radiograph) and No evidence of left atrial hypertension. Management includes ventilatory therapy including lower tidal volume, relatively high PEEP and supportive care. Guidelines for diagnosis, ventilator management, rescue therapies and supportive care are being discussed in the protocol.

Perinatal HIV.

HIV pandemic is one of the most serious health crises the world faces today. Approximately 5-10% of all cases of HIV are children. Majority of children acquire infection through mother-to-child transmission either during pregnancy, delivery, or by breast-feeding. MTCT can be reduced to <2% by antiretroviral prophylaxis to women during pregnancy and labour and to the infant in the first weeks of life, obstetrical interventions including elective cesarean delivery and complete avoidance of breastfeeding. Guidelines for postnatal diagnosis of HIV infection, feeding, immunization and administration of cotrimoxazole prophylaxis have been described in the protocol.

Persistent thrombocytopenia following dengue shock syndrome.

Though thrombocytopenia is one of the hallmarks of dengue hemorrhagic fever/ dengue shock syndrome, persistence of the same is rare. We report an 11 year-old child with dengue shock syndrome, who developed persistent thrombocytopenia. The possible mechanisms are discussed.