dengue%20(pediatric)
DENGUE (PEDIATRIC)
Dengue infection is caused by the dengue virus that belongs to the family Flaviviridae.
There are 4 serotypes (DENV-1, DENV-2, DENV-3, DENV-4). Each serotype provides specific lifetime protective immunity against reinfection of the same serotype, but only temporary (within 2-3 months of the primary infection) and partial protection against other serotypes.
It is transmitted to humans through the bites of infected Aedes mosquitoes. It is primarily transmitted by female Aedes aegypti, a tropical and subtropical species. Humans are the main host of the virus.
After 4-10 days of incubation period, illness begins immediately.

Supportive Therapy

Parental Education

  • Ensure adequate bed rest
  • Tepid sponging may be done
  • Advise to avoid giving their child Acetylsalicylic acid, Mefenamic acid, Ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids
  • Inform that antibiotics are not needed and treatment of dengue consists mainly of appropriate hydration and administration of Paracetamol
  • Emphasize the need to monitor warning signs and when to bring their child to the nearest hospital
  • Advise to look for mosquito breeding places in their home and eliminate them

Oral Fluids

  • Ensure adequate intake of oral fluids
    • Frequent intake of small amounts of fluid is advisable for patients with nausea and vomiting
  • Given to dengue patients with no warning signs to replace losses from fever and vomiting
  • Oral rehydration solution (ORS), fruit juices, soup and other fluids that contain electrolytes and sugar may also be given
    • However, fluids containing sugar or glucose may exacerbate hyperglycemia of physiological stress from dengue and diabetes mellitus

Paracetamol (Acetaminophen)

  • Given to control pain and fever

Intravenous Fluid (IVF)

  • IV rehydration is the therapy of choice
  • Usually needed for only 24-48 hours
  • Stable dengue hemorrhagic fever (DHF) patients admitted in the hospital should be given isotonic solutions (eg D5 LRS, D5 Acetated Ringers, D5 NSS)
  • Crystalloid solution has been shown to be safe and effective as colloids in decreasing recurrence of shock and mortality
    • Used as 1st line in fluid resuscitation in moderately severe (compensated) dengue shock
    • 0.9% Saline solution (NSS) is an appropriate choice for initial fluid resuscitation but large volumes may cause hyperchloremic acidosis
    • Ringer’s lactate solution should be given to patients with above normal chloride level if NSS was given initially
      • Avoid use in patients with liver failure and in patients taking Metformin where lactate metabolism is impaired
  • Colloid solution (eg dextran, starch, gelatin) is the IVF of choice in patients who require immediate blood pressure restoration (eg pulse pressure <10 mmHg)
    • Used as a rescue fluid in patients whose cardiovascular status do not improve after the initial fluid resuscitation
    • Faster than crystalloids to restore cardiac index and decrease hematocrit level in patients with intractable shock
    • Associated with higher risk for allergic reactions and new bleeding manifestations
      • Gelatin has the least effect on coagulation but causes allergic reactions the highest

Blood Transfusion

  • Only given to patients with suspected or severe bleeding
  • Indications for urgent blood transfusion include decreasing hematocrit level with narrowing pulse pressure, tachycardia, metabolic acidosis, low urine output
  • 5-10 mL/kg of fresh-packed red cells or 10-20 mL/kg of fresh whole blood may be given
  • Prophylactic platelet transfusion should not be given to children with platelet count <50,000/mm3 and have minimal or no active bleeding  
  • May consider plasma transfusion in children with signs of disseminated intravascular coagulation 
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21 Mar 2018
During the Kuala Lumpur International Neonatology Conference held in conjunction with the World Prematurity Day 2017, Dato Dr Musa Mohd Nordin spoke on the importance of immunizing children with the diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine. He highlighted the role of Hexaxim® as a fully liquid, ready-to-use, 6-in-1 (including hepatitis B) vaccine for the primary and booster vaccinations of infants and toddlers. Meanwhile, Dr Yong Junina Fadzil discussed the benefits of quadrivalent influenza vaccines (QIVs) in providing children with broader protection against influenza B viruses.