Đang tải... (xem toàn văn)
(BQ) Part 2 book The short textbook of pediatrics has contents: Pediatric endocrinology, pediatric envenomations, pediatric dental problems, pediatric neuromuscular disorders, pediatric surgery, pediatric ophthalmology, pediatric orthopedics,... and other contents.
21 Pediatric Pulmonology Daljit Singh, Suraj Gupte INTRODUCTION Diseases pertaining to the respiratory system are responsible for a large proportion of pediatric admissions and outpatient attendance In north India, the highest incidence is recorded in the winter followed by the relatively lower peak during rainy season Like in other tropical areas Indian infants and children demonstrate pattern of clinical presentation which is somewhat different from what is recorded by the western authorities This variance is related to factors such as considerable delay in reporting to the hospital and high frequency of infestations and associated malnutrition All these, individually or collectively, result in a rather changed clinical picture CLNICAL EVALUATION OF A RESPIRATORY CASE For role of history-taking and clinical examination in evaluation of a respiratory case, see Chapter SPECIAL DIAGNOSTIC PROCEDURES Radiology/Imaing Chest X-ray, PA and lateral views as a routine, decubitus film for pleural effusion, oblique film for focus on hilar shadow, and lung portion at the back of heart, lordotic film for apices, lateral neck film for upper airway obstruction round the level of retropharynx, subglottis and supraglottis Barium swallow is useful in excluding tracheoesophageal fistula (TEF) of H-type, gastroesophageal reflux disease (GERD) and esophageal indentation with vascular rings Screening is of value for stridor and movements of diaphragm and mediastinum Ultrasonography is useful in pleural effusion and intrathoracic masses as also in guiding conduction of lung tap and pleural tap CT scan is very helpful in pleural, mediastinal, and parenchymal (both solid and cystic) lesions, bronchiectasis, vascular structures (provided that IV contrast enhancer is employed), and guiding biopsy MRI is particularly of great value in vascular rings and hilar structures Serology Immunoglobulin, IgG, IgA, IgM, IgD and IgE, eosinophilic cationic protein levels are elevated in asthma Antibodies to CMV, RSV, chlamydia and mycoplasma can be detected Microbiologic Examination of Body Secretions Sputum, nasal cytology, tracheal secretions, throat swab, bronchial aspiration, gastric lavage can be examined microscopically, at times following special stain like Ziehl-Neelsen stain for AFB, and even cultured for exact microbial growth and antibiotic sensitivity in several conditions (Table 21.1) Skin Tests These include Mantoux test or BCG diagnostic test for tuberculosis, Kveim test for sarcoidosis, Casoni test for hydatid disease, and skin tests (patch-prick and intradermal tests) for allergens 322 The Short Textbook of Pediatrics Table 21.1: Indication of microbiologic examination of body secretions in diagnosis of respiratory disease Secretions Indications Sputum, tracheal, bronchial, Lung abscess, bronchiectasis, gastric microscopy/culture cystic fibrosis, tuberculosis, Pneumocystis carinii pneumonia Nasal cytology for Allergic rhinitis, nasobronchial eosinophils allergy Special iron stains Hemosiderosis of bronchial secretions Pilocarpine Iontophoresis for Sweat Chloride A sweat chloride level of over 60 mEq/L in a child with clinical profile of cystic fibrosis establishes the diagnosis For quick molecular diagnosis of CF, especially for research purposes, polymerase chain reaction (PCR) and DNA studies are now available Pulmonary Function Tests These include: • Spirometry (the most important) measures forced vital capacity (FVC), forced expiratory volume (FEV1) in one second, FEV1/ FVC ratio, maximal midflow (MMF) between 25% and 75% of FVC or, alternatively, forced expiratory flow (FEF) between 25% and 75% of FVC • Mini Wright peak flow meter for evaluation of obstruction and response to bronchodilator therapy • Bronchial provocation using methacholine and histamine Arterial Blood Gas (ABG) Analysis Arterial oxygen and carbon dioxide levels faithfully reflect the state of ventilation, perfusion and gas exchange Table 21.2 gives the normal levels Table 21.2: Arterial blood gas levels Criteria Normal blood level pH PCO2 PO2 7.35-7.45 mm Hg 35-45 mm Hg 90 mm Hg Direct Laryngoscopy This is usually carried out using a fiberoptic or rigid scope under general anesthesia or sedation in the evaluation of an upper airway obstruction or stridor Bronchoscopy The procedure is carried out under general anesthesia employing a fiberoptic or rigid bronchoscope in the following situations: • Foreign body • Intractable wheeze • Recurrent or persistent pneumonia • Atelectasis • Immunocompromised state with unexplained interstitial pneumonia • Hemoptysis • Lung mass causing pressure symptoms Bronchoscopy may serve both a diagnostic and therapeutic purpose Thoracoscopy Thoracoscopy is a useful procedure for evaluating the pleural cavity The instrument used (thoracoscope) is similar to a bronchoscope Thoracocentesis Intercostal drainage is indicated for obtaining pleural fluid sample for diagnostic purpose and in case of a massive pleural effusion causing dyspnea It is best done in the 5-7th intercostal space on the posterior axillary line Lung Tap It is needed for obtaining specimen of the pulmonary parenchyma and is done with a needle subsequent to instillation of saline Blood level in acute respiratory failure Lung Biopsy > 50 mm Hg < 60 mm Hg This procedure is indicated for diagnosis of Pneumocystis carinii and other diffuse lung diseases and may be done either by open surgery or via a bronchoscope or endotracheal tube Transillumination This is a useful simple maneuver to diagnose pneumothorax in an infant under months of age A large halo of light is seen around the fiberoptic light scope Polygraphic Monitoring This consists in monitoring of heart rate, ECG, movements of chest and abdomen, arterial PCO2 and SaO2 Pediatric Pulmonology in cases of obstructive apnea and upper airway obstruction UPPER RESPIRATORY TRACT INFECTION (URTI) (Upper Respiratory Catarrh; Common Cold; Rhinopharyngitis, Acute Nasopharyngitis) URTI is usually caused by over 150 serologically different viruses, the major share being of the rhinoviruses all of which belong to picronavirus family of small RNA viruses Among bacteria, group A Streptococci take the lead though Corynebacterium diphtheriae, N meningitidis, Myc pneumoniae and N gonorrheae may also cause URI H influenzae, Pneumococcus and Staphylococcus aureus are responsible for superimposed infection, leading to complications related to ears, sinuses, mastoids, lymph nodes and lungs Symptoms of asthma may get precipitated or aggravated in a child with reactive airway It is a very common ailment and is characterized by inflammation of the upper respiratory tract, resulting in nasal discharge which is only watery or mucoid in majority of the cases These cases of mild catarrh, not need anything beyond local decongestants like ephedrine nasal drops (0.25 or 0.5%) which are best administered while the child is lying supine with the neck slightly hyperextended, 15 to 20 minutes before feeding and at bedtime Instillation of to drops to 10 minutes after the primary doses helps to achieve shrinkage of the posterior mucous membrane as well Caution: Continued use of nasal drops for over to days may lead to chemical irritation and congestion simulating acute URI In moderate catarrh, a patient has purulent nasal discharge, dry cough with postnasal discharge, fever, malaise, anorexia, etc There may also be adenitis, tonsillitis, pharyngitis and extension of the infection lower down to larynx and bronchi Ingestion of infected secretions may cause diarrhea and abdominal pain Treatment of moderate catarrh is more or less symptomatic In addition to decongestants, antipyretics and cough mixtures are of value In case of poor response to these measures, an antibiotic like penicillin, ampicillin, amoxycillin or erythromycin may be used Whether antibiotic therapy affects the course of illness or cuts short the incidence of bacterial complications is doubtful 323 FOREIGN BODY IN LOWER RESPIRATORY TRACT Toddlers often aspirate foreign bodies such as peanut, almond, groundnut seeds, grains and pulses Occasionally, small metallic coins may also be inhaled though, more often, these are swallowed There is a sudden paroxysm of cough with congestion of the face and almost a state of suffocation If the foreign body fails to be coughed out, it may cause partial or complete obstruction of a main bronchus The former results in massive emphysema whereas the latter in massive collapse (atelectasis) A few days later, the child is brought to the hospital with signs and symptoms of pneumonia Another delay may result in development of the lung abscess, or bronchiectasis Diagnosis is from the history of a sudden paroxysm of violent cough, clinical findings of pneumonia, collapse, emphysema, etc bronchoscopy and radiology (provided it is a metallic foreign body) Management is aimed at removing the foreign body (in most cases by bronchoscopy) and administration of appropriate antibiotics in case of infection ADULT RESPIRATORY DISTRESS SYNDROME (ARDS) This critical condition seen even in as young an infant as 1-2 weeks, is characterized by acute respiratory distress, and noncardiogenic pulmonary edema as a result of a diffuse lung injury Etiopathogenesis ARDS is caused by a diffuse lung injury A number of triggering factors, including shock, near-drowning, septicemia, injury, drug overdose, aspiration, inhalation injury and DIC have been incriminated Diffuse alveolar damage is the central lesion The initial or exudative stage is characterized by pulmonary congestion and edema and lasts up to 72 hours The subject may recover or pass on to the chronic or proliferative stage between first and third week after injury and is characterized by an enhanced density of type II pneumocytes and fibroblasts In due course, type II pneumocytes are transformed into type I pneumocytes and collagen is deposited by stimulation of fibroblasts The eventual fibrotic stage follows after persistence of ARDS for over weeks and is characterized by extensive fibrosis which makes gas exchange difficult 324 The Short Textbook of Pediatrics Cardiorespiratory dysfunction with resultant severe hypoxemia is the most important physiological feature of ARDS The existence of concurrent abnormalities in the surfactant system predisposes the lungs to develop atelectasis and edema formation Clinical Manifestations Initially, there is only mild respiratory distress and hyperventilation In the subsequent 4-24 hours, the subject develops hypoxemia and such manifestations as increasing respiratory distress with cyanosis and inspiratory crepitations (crackles) A large intrapulmonary shunt may be demonstrated at this point Unless the subject receives supplemental oxygen or mechanical ventilation, increasing hypoxemia and hyper capnia prove fatal • Extracorporeal membrane oxygenation (ECMO) • Exogenous surfactant replacement • Inhaled nitric oxide Lung transplant: • Ecosanoids or their inhibitors • Vasodilators • Pentoxifylline • Steroids (only in advanced stages) Complications These include nosocomial infections, septicemia, severe barotrauma, compromised cardiac output, oxygen toxicity, progressive pulmonary fibrosis, multiple system organ failure including acute tubular necrosis, DIC, hepatic dysfunction, cardiomyopathy, gastrointestinal bleed and ileus Laboratory Diagnosis Prognosis Though evidence of pulmonary edema is available in the X-ray of chest sooner or later, more useful information is obtained from arterial blood gas analyses which shows a PaO2 < 50 mm Hg or a FIO2 of > 0.6 %; a PaO2/FIO2 ratio of < 200 correlates with a QS/QT (intrapulmonary shunt) of > 20% CT scan shows that most of the pulmonary infiltrates are in the dependent (posterior) part of the lung Pulmonary function tests show poor residual capacity and lung compliance Pulmonary artery pressure and resistance show varying increase Mortality is very high (50-75%) and is usually the result of initiating causative event, multisystem organ failure or septicemia The survivors usually revert to preillness status within the following year Long-term prognosis in pediatric survivors is better than in adult Treatment The cornerstone of management of ARDS is delivery of sufficient oxygen with endotracheal intubation and mechanical ventilation, often with the help of PEEP This essentially requires the facilities of the intensive care unit (ICU) Newer therapies are: • Pressure-controlled ventilation with permissive hypercapnia • High frequency ventilation including high frequency positive pressure ventilation, high frequency oscillation and high frequency jet ventilation • Negative pressure ventilation/liquid ventilation RESPIRATORY SYNCYTIAL VIRUS (RSV) INFECTION Notwithstanding earlier impression, according to the observations of WHO, RSV infection is a common and an important cause of acute lower respiratory infection (ALRI) in infants and children even in the developing countries, resulting in acute bronchiolitis, pneumonia and acute exacerbation of asthma ACUTE BRONCHITIS It is a febrile illness, bacterial or viral in origin, characterized by dry cough (which is worst at night), wheezing and mild constitutional symptoms Cough becomes productive after about days Important chest findings are the widespread rhonchi and coarse crepitations Some tachypnea is often present X-ray chest shows nothing significant except for the increased bronchial markings in some of the cases only Pediatric Pulmonology Treatment consists in giving a suitable antibiotic, a cough expectorant, and an antipyretic Warm, moist air is of advantage With this treatment, most of the patients recover in to 10 days time but cough may continue for a month or so Chronic bronchitis is seen less frequently in pediatric practice ACUTE BRONCHIOLITIS It is a serious illness, characterized by inflammation of bronchioles, causing severe dyspnea Infants are the most likely candidates Etiopathogenesis The exact etiology is not clear In all probability, the etiologic agents appear to be some viruses like virus of primary atypical pneumonia, influenza virus type (A, B and C), adenovirus, respiratory syncytial virus (RSV), herpes virus and parainfluenza virus Certain bacteria (H influenzae, Pnenumococcus, Streptococcus hemolyticus) and “allergy” have also been incriminated However, there is no convincing evidence in support of this As a result of inflammation, exudate, edema and contraction of the circular musculature of the bronchioles, there occurs a sort of obstruction followed by areas of emphysema and collapse Epidemiology Bronchiolitis is more or less confined to winter and early spring and occurs globally It is primarily a disease of the first years of life, the peak incidence occurring around months of age Both epidemic and sporadic forms occur Clinical Features Following a mild upper respiratory infection, the disease abruptly manifests with dyspnea (rapid shallow breathing) and prostration Cough is either absent or simply mild Mild to moderate fever is usually present If dyspnea is marked (which usually is the case), air hunger, flaring of alae nasi and cyanosis may be there Also, patient may go into dehydration and respiratory acidosis Chest signs include intercostal, subcostal and suprasternal retraction, hyperresonant percussion note (this is because of emphysema which may also push 325 the liver and spleen down) diminished breath sounds and widespread crepitations, and wheezing Differential Diagnosis Acute bronchiolitis requires to be differentiated from asthma (known for frequent exacerbations), bacterial pneumonia (bronchospasm either absent or only mild), foreign body in trachea (history of FB, localized wheeze, signs of collapse/emphysema) and CCF Diagnosis Diagnosis is generally obvious from the clinical presentation and good chest examination X-ray chest shows emphysema, prominent bronchovascular markings and small areas of collapse Screening reveals low-lying diaphragm with limited movements Lungs are characteristically overinflated and intercostal spaces are wide Complications These are listed in Table 21.3 Table 21.3: Complications of acute bronchiolitis Short-term Rapidly progressive exhaustion, anoxia and death Dehydration and electrolyte imbalance with respiratory acidosis Congestive cardiac failure Bacterial invasion:bronchopneumonia, acute otitis media Long-term Bronchiolitis obliterans in which bronchioles are obliterated by nodular masses consisting of granulation and fibrotic tissue Chest X-ray suggests miliary mottlinglike picture Hyperlucent lung syndrome, also called Swyer-James syndromes Treatment Bronchiolitis is an emergency The management is mostly symptomatic General measures include humidified oxygen inhalation through face mask or head box, atmosphere well saturated with water vapors, mild sedation, postural drainage and intravenous fluids to combat dehydration Since exact etiologic diagnosis is practically impossible in clinical practice, an antibiotic cover may be given on the presumption of a causative or superimposed bacterial infection 326 The Short Textbook of Pediatrics Bronchodilators are better avoided since, rather than doing any good, they may increase the cardiac output and restlessness If indeed indicated, preferred bronchodilation therapy should be in the form of salbutamol or epinephrine (racemic or levo), preferably by nebulization Steroids are no longer recommended Severe bronchiolitis resulting from respiratory syncytial virus is best treated with the antiviral agent, ribavarin (Virazid), available as sterilized lympholyzed powder to be reconstituted for aerosol therapy Treatment is carried out using a small particle aerosol generator (SPAG) for 12 to 18 hours a day for at least days but not more than days A consistent monitoring of both patient and equipment is vital, especially if the subject is in need of assisted ventilation Therapy with this agent is expensive, one g vial costing £ 195 (approximately Rs.13,000) Moreover, it is teratogenic Nevertheless, its administration must be considered in acute bronchiolitis in such diseases as cystic fibrosis (CF), chronic lung disease (CLD), congenital heart disease (CHD), immunodeficiency state and extreme preterm babies Prophylaxis For immunoprophylaxis, see Chapter 10 (Immunization) Prognosis Overall prognosis is good In a few cases (1%) death may occur in spite of best of treatment SEVERE ACUTE RESPIRATORY SYNDROME (SARS) The truly identified cases of this newly-recognized viral disease, first originating in Guangdong province of China in late 2002, were reported in first half of 2003 from Hong Kong Singapore, Vietnam, United States and Canada among other countries Etiology The causative pathogen is a coronavirus which has seemingly spilled over to human beings from the animals This RNA virus involves only the respiratory tract cells Modes of infectivity include: • Droplet infection • Close contact • Fomites Hospitals and airtravel play an imortant role in spread of SARS Clinical Features Clinical presentation of pediatric SARS (as per Center for Disease Control (CDC) is given in Table 21.4 Table 21.4: Clinical case definition of pediatric SARS A Clinical criteria Symptomatic or mild respiratory illness Moderate respiratory illness • Temperature > 100.4°F (38°C), and • One or more clinical findings of respiratory illness (e.g cough, shortness of breath, difficulty breathing, or hypoxia) Severe respiratory illness • Temperature > 100.4°F (38°C), and • One or more clinical findings of respiratory illness (e.g cough, shortness of breath, difficulty breathing, or hypoxia), and Radiographic evidence of pneumonia, or Respiratory distress syndrome, or Autopsy findings consistent with pneumonia or respiratory distress syndrome without an identifiable cause B Epidemiologic criteria Travel (including transit in an airport) within 10 days of onset of symptoms to an area with current or previously documented or suspected community transmission of SARS, or Close contact within 10 days of onset of symptoms with a person known or suspected to have SARS Earlier belief that SARS spares children is no longer well founded It does occur in children as well Nevertheless, unlike in adults (especially the elderly in whom it is a serious emergency illness), clinical profile in children is by and large mild Most children have upper respiratory illness which may be ignored In moderate respiratory illness (more often in older children and adolescents), fever, cough, shortness of breath or hypoxia is seen In severe illness, in addition to the manifestations of moderate illness, X-ray chest shows bronchopneumonia or there may well be a frank repiratory distress Treatment See Table 21.5 Prevention and Infection Control Though SARS is not a contagious disease, “isolation” and “quarantine” are the two methods that help in containing it Pediatric Pulmonology Table 21.5: Treatment of pediatric SARS Clinical situations Treatments Diagnosis of SARS suspected on admission Intravenous cefotaxime, oral clarithromycin, and oral ribavirin (40 mg/kg daily, given in two or three doses, 1-2 week) Fever persists >48 h Oral prednisolone (0·5 mg/kg daily to 2·0 mg/kg daily, tapered over 2-3 weeks) Patients with moderate Intravenous ribavirin (20 mg/kg symptoms of high daily, given in three doses) and fluctuating fever and hydrocortisone (2 mg/kg every h) notable malaise immediately after admission Persistent fever and Pulse intravenous progressive worsening methylprednisolone clinically or radiologically (10-20 mg/kg) The term, pneumonia, refers to infection of the lung parenchyma which may be primary or secondary to acute bronchitis complicating an upper respiratory infection Nearly 10% of admissions, in our experience, are accounted by the second Classification I Etiologic Classification Bacterial • Viral • Mycoplasma • Fungal • Protozoal • Rickettsial • Miscellaneous II Anatomic Classification • Bronchopneumonia Patchy involvement of lungs • Lobar pneumonia One or more lobes of lung involved • Pneumonitis Alveoli or interstitial tissue between them affected It is more or less a radiologic diagnosis III Classification Based on Acquisition • • • Congenital Community acquired Hospital acquired IV Classification Based on Chronicity • Acute • Chronic (recurrent, persistent) PNEUMONIAS • 327 Streptococcus pneumoniae (Pneumococcus), Staphylococcus Streptococcus, H influenzae, Klebsiella, H pertussis, M tuberculosis, E.coli Influenza, measles, RSV Chickenpox Mycoplasma pneumoniae Thrush, coccidomycosis histoplasmosis, blastomycosis Pneumocystis carinii Toxoplasma gondii Entamoeba histolytica Typhus Rocky mountain spotted fever Aspiration pneumonia (vomitus, amniotic fluid in newborn, drowning, foreign body, chemicals like kerosene oil); Loeffler pneumonia; hypostatic pneumonia Pneumococcal pneumoniae accounts for 90% of bacterial pneumonias in childhood After first year of life, it is responsible for virtually all bacterial pneumonias H influenzae, and staphylococcal infections occur most often in infancy The term, persistent penumonia, denotes a chronic nonresolving pneumonia in which radiologic findings persist for over one month Predisposing factors are given in Table 21.6 Table 21.6: Predisposing factors for chronic pneumonia Immunodeficiency • PEM • HIV Congenital respiratory malformations • Tracheoesophageal fistula • Gastroesophageal reflux Congenital heart disease • Ventricular septal defect Defective clearance of airway secretions • Cystic fibrosis Chronic pulmonary diseases • Tuberculosis • Bronchiectasis • Asthma Clinical Features The onset is usually sudden with high fever, chills, cough and respiratory distress Active movements of the alae nasi, grunting expiration and lower costal 328 The Short Textbook of Pediatrics recession with some cyanosis are alarming manifestations In some cases, diarrhea, vomiting convulsions and chest pain (referred to abdomen) may be present Chest signs of consolidation include diminished movements of affected side, increased vocal fremitus and resonance, dullness, diminished breath sounds, and bronchial breathing Crepitations denote beginning of resolution Mind you, there is no shifting of mediastinum Chest signs of bronchopneumonia include tachypnea, normal or harsh breath sounds and diffuse crepitations spread all over both lungs World Health Organization (WHO) has recommended that very fast breathing, especially in association with cough, difficult breathing or indrawing of chest, must always be considered a reflection of pneumonia, unless proved otherwise Fever undoubtedly causes elevation in respiratory rate But, the effect is only weak, say to breaths per one degree celsius rise above 37°C per minute The cut-off point for high respiratory rate is over 60 per minute up to months of age, over 50 per minute between months to 12 months, and 40 per minute between 12 months to years In debilitated infants and children, despite the presence of extensive pneumonia, signs and symptoms may not be as classical as described above The diagnosis of pneumonia in such cases is often made following detailed examination and a chest radiograph Presence of certain predisposing factors (Table 21.7) should arouse suspicion for staphylococcal pneumonia Table 21.7: Predisposing factors for staphylococcal pneumonia • Infectious diseases of childhood such as measles and chickenpox • Staphylococcal infections elsewhere in the body, e.g skin (furunculosis), throat, etc • Debilitating illnesses, e.g advanced protein-energy malnutrition (PEM), cystic fibrosis, malignancies, etc • Hypogammaglobulinemia • Immunosuppressive therapy Complications These include: • Pleural effusion or emphysema • Collapse Fig 21.1: Subcutaneous emphysema in an infant with bronchopneumonia • • • • • Pneumatocele Lung abscess, Bronchiectasis Subcutaneous emphysema (Fig 21.1) Metastatic spread: Meningitis, septic arthritis, osteomyelitis, etc Of the various types, staphylococcal pneumonia carries the worst prognosis Diagnosis Besides clinical suspicion, an X-ray chest (PA view, ordinarily) is most reliable to detect the type and extent of lesions X-ray finding suggesting bronchopneumonia include diffuse patchy consolidations, usually involving both lungs X-ray finding, suggesting lobar pneumonia (consolidation) include a homogeneous opacity occupying the anatomic area of a lobe without any mediastinal shift, usually involving only one lung Detection of pleural effusion, pyopneumothorax or pneumatoceles (small inflated abscesses) highly favor the diagnosis of staphylococcal pneumonia (Figs 21.2 and 21.3) Nonradiopaque foreign bodies may produce multiple abscesses or pneumatoceles, resulting in a radiologic picture simulating that seen in staphylococcal pneumonia Miliary mottling constitutes another important differential diagnosis Recurrent pneumonia must arouse suspicion of the following conditions: • Abnormalities of antibody production such as agammaglobulinemia 804 The Short Textbook of Pediatrics Appendices 805 806 The Short Textbook of Pediatrics Index A ABC of resuscitation 190 Abdominal paracentesis 750 ABO-hemolytic disease 237 Abscess 708 Acanthamoeba 310 Acardi syndrome 404 Accidental poisoning 608 Anhidrotic ectodermal dysplasia 605 Achondroplasia 714 Acid-base balance 176 Acidemia 179, 180 Acne 68, 605 chloracne 605 conglobata 606 fulminans 606 halogen 606 infantile 606 neonatal 606 steroid 606 tropical 606 vulgaris 605 Acquired hypothyroidism 629 Acrobatic rickets 164 Acrodermatitis enteropathica 470 Activated charcoal 610 Activated partial thromboplastin time 540 Acute bacillary dysentery 454 Acute bronchiolitis 325 Acute bronchitis 324 Acute diarrhea 444 clinical features 446 clinical assessment 448 severe diarrheal dehydration 447, 449 complications 453 etiology 444 bacterial 445 parasitic 446 viral 445 pathogenesis 446 prognosis 453 treatment 448 ancillary measures 452 chemotherapy 451 conventional rehydration therapy 448 diet 452 symptomatic control 452 WHO guidelines on management 450 Acute epiglottitis 687 Acute flaccid paralysis 95, 260 Acute glomerulonephritis 510 Acute inflammatory demyelinating polyradiculoneuropathy 406 Acute laryngotracheobronchitis 687 Acute nasopharyngitis 323 Acute otitis media 681 Acute pharyngitis 685 Acute renal failure 182, 513 Acute scrotum 707 Acute septic (pyogenic) arthritis 716 Acute stroke syndromes 405 Adaptation hypothesis 134 Addison disease 630 Adenoidal hypertrophy 686 Adenoids 686 Adjustment reaction 52 Adolescence 60 factors influencing health 62 health education 69 nutrition 64 psychology 63 psychosocial problems 64 puberty changes morphological 60 psychological 61 sexuality 63 three stages 60, 61 violence 66 Adolescent nutritional dwarfing 170 Adoption 95 Adoption laws 723 Adrenal and its disorders 630 Adrenal cortex 630 Adrenal hyperactivity 630 Adrenal insufficiency 630 Adrenal medulla 630 Adrenocorticotrophin hormone 624 Adult diabetes 635 Adult respiratory distress syndrome 323 Agenesis of corpus callosum 404 of cranial nerves 404 Air bronchogram 216 Alacrima 671 Albinism 600, 648 Albright-McCune syndrome 624 Albumin infusion 520 Albuminocytologic dissociation 407 Algid malaria 299 Alkalemia 181 Alkaptonuria 648 Alma Ata Declaration 78 Alopecia 594 Amaurosis 676 Ambiguous genitalia 633, 706 Amblyopia 675 Amebiasis 309 Amebic liver abscess 501 Amelia 709 Amenorrhea 67 Ametropia 675 Amniocentesis 237 Amyoplasia 714 Anaerobic infections 288 Anal fissure 701 Anaparasana 119 Anaphylactoid (Henoch-Schoenlein) purpura 549 Anaphylactoid purpura 590 Anatomy of breast 115 Ancylostomiasis 313 Anemia control program 153 Anemia of infection 529 Anemia of lead poisoning 529 Anemia of protein-energy malnutrition 528 Anemia of thalassemia 530 Anemia/micronutrient deficiency 150 Anencephaly 192, 403 Anganwadi 85 Angiocardiography 355 Anhidrotic ectodermal dysplasia 604, 605 Aniridia 673 Anisocoria 673 Anisometropia 675 Ankyloglossia 732 Anorectal malformations 480 Anorectal problems 700 Anorexia nervosa 55, 64 Anthropometry 6, 131 Antigen presenting cells 572 Antioxidants 112 Antituberculous treatment 345 Aortic stenosis 373 Apert syndrome 429 Apgar score 195 Aplastic anemia 537 Apneic spells 219 Applied nutrition program 151 Aprotes 176 Arginine vasopressin 623 Arithmetic mean 72 Arterial blood gas analysis 322 Arterial puncture 747 Arterial thrombosis and embolism 405 Arthralgia 380 808 The Short Textbook of Pediatrics Arthrogryposis multiplex congenita 714 Artificial (formula) feeding 122 Ascariasis 312 Ascites 501 Asperger’s disorder 48 Aspirin poisoning 614 Assisted ventilation 754 Astigmatism 675 Ataxia or incoordination 435 Ataxia telangiectasia 434, 577 Atopic dermatitis 591 Atrial septal defect 363 clinical features 364 complication 364 diagnosis 364 hemodynamics 363 treatment 364 Attention deficit hyperactivity disorder 47, 58 Auspitz sign 606 Australia antigen 494 Autism 48, 58, 413 Autistic spectrum disorder 48 Autoimmune disease 580 Autoimmune hemolytic anemia 537 Autoimmune hypoparathyroidism 630 Autonomic neuropathies 663 B Baby-friendly hospital initiative 80 Bacterial meningitis 416 Bag and mask ventilation 194, 754 Balanitis 68 Balanoposthitis 68 Balwadi nutrition program 153 Barbiturate poisoning 613 Barlow syndrome 389, 512 Base 176 Battered baby syndrome 724 B-cells defects 575 BCGosis 100 Becker muscular dystrophy 661 Bedwetting 49, 55, 732 Behavioral problems 51-53 Behcet disease 590 Bell palsy 406, 663 Benign congenital hypotonia 658 Benign intracranial hypertension 404 Benign neonatal hemangiomatosis 203 Benign rheumatois nodules 588 Bezoars 479 Bilateral renal agenesis 505 Bili blankets 232 Bilirubin toxicity 237 Biostatistics 71 Bird (avian) flu 269 Birth trauma 188 Bitot’s spot 156 Black water fever 299 Black-sickness 302 Bleeding time 540 Bleeding/hemostatic disorder 539 Blepharitis 670 Blepharospasm 670 Block-Sulzberger disease 435 Blood component therapy 553 Blood examination 756 Blood gas analyser 177 Blood pressure measurement in children 394 Blood transfusion 542 Body mass index 34 Bone age 35 Bone marrow aspiration 748 Bone marrow transplantation 569, 583 Bone marrow trephine 749 Bone tumors 566, 718 Bordetella 271 Bottle addiction 127 Bourneville disease 434 Bow leg 164, 710, 732 Bowel irrigation 610 Brachial cyst 708 Brachial sinus and fistula 708 Brain abscess 425 Brain tumors 565 Brainstem tumors 565 Brandt syndrome 470 Breast abcess 119 Breast disorders 67 Breast engorgement 118 Breast milk 212 Breastfeeding 116, 212 advantages/benefits 116 for the community 117 for the infant 116 for the mother 117 breastfeeding schedule 117 contraindications 117 problems 118 technique and principles 118 Breath-holding spells 55 Bronchial asthma 334 Bronchiectasis 330 Bronchoscopy 322 Brucellosis 280 Bruxism 56 Buffer 176 Bulimia 55, 64 Burping 213 C Café-au-lait spots 599 Caffey disease 166 Cancrum oris 294 Candidiasis 226, 594 Capillary hemangioma 600 Caput succedaneum 188, 190, 203 Carbohydrate malabsorption 70 Carbohydrates 110 Cardiac catheterization 355 Cardiac examination 353 Cardiac resuscitation 754 Cardiomyopathy 391 Cardiothoracic ratio 354 Carditis 378 Caries of spine 342 Cartilage-hair hypoplasia 577 Cataplexy 69 Cataracts 673 Categories of vaccines 97 Catheterization 233 Cavernous hemangioma 601 Cavernous sinus thrombosis 428 Celiac disease 465, 468 Celiac rickets 165 Cell-mediated immunity 573 Cells of the immune system 572 Centronuclear myopathy 658 Cephalhematoma 188-190, 203 Cerebellar tumors 565 Cerebral gigantism 624 Cerebral palsy 51, 413 Chalazion 670 Chédiak-Higashi syndrome 578 Chemosis 672 Chest compression 193, 195 Chest infection 350 Chickenpox (varicella) 248 clinical features 248 complication 249 diagnosis 249 etiopathogenesis 248 prophylaxis 250 treatment 249 Chikungunya fever 263 Child abuse and neglect 58, 93, 716, 724 girl child 91 Child adoption 723 Child development project officer 85 Child labor 86 Child with ataxia 435 Childhood diabetes 635 Childhood scurvy 162 Child-survival rate 84 Chloroquine-induced psychosis 615 Cholecystitis 498, 704 acute acalculous 499 with cholelithiasis 498 Choledochal cyst 498, 703 Cholera 453 Cholestasis 235 Chromosomal disorders 645 Chromosomal studies 645 Chromosomes 644 Chronic diarrhea 462, 463 Chronic Epstein-Barr virus infection 730 Appendices Chronic fatigue syndrome 730 Chronic granulomatous disease 577 Chronic hepatitis 492 Chronic mononucleosis 730 Chronic otitis media 681 Chronic renal failure 514 Chvostek sign 201 Circulatory changes at birth 356 Classification of anemias 525, 525 Cleft lip and cleft palate 692, 707 Cleidocranial dysostosis 710 Clostridium 280 Clostridium difficile-associated diarrhea 455 Club foot 709 Clubbing 12 CNS tuberculosis 417 Coarctation of aorta syndrome 374 Cold chain 98 Colic 127 Collagen diseases 291 Coloboma 670 Coma 436 Combined immunodeficiency 577 Common cold 323 Community pediatrics 78 Complement 571 Complement defects 578 Complementary feeding 120 Computer application in pediatrics 735 Concept of normal 71 Congenital acholuric jaundice 532 Congenital adrenal hyperplasia 634 Congenital constriction bands/rings 710 Congenital diaphragmatic hernia 190, 242, 696 Congenital heart disease 359, 376 Congenital hemolytic anemia 237, 532 Congenital hypertrophic pyloric stenosis 694 Congenital hypothyroidism 625, 626 Congenital microcoria/miosis 673 Congenital mydriasis 673 Congenital nasolacrimal duct obstruction 671 Congenital pseudoarthrosis of the tibia 710 Congenital rubella 221 Congenital rubella syndrome 253 Congenital syphilis 220 Congenital toxoplasmosis 221 Congenital ureteropelvic junction obstruction 704 Congestive cardiac failure 182, 357 Conjugation 97 Conjunctival diseases 671 Conjunctival nevus 672 Conjunctivitis 225, 671 Consanguinity Constipation 202, 472 Constricted pupil 673 Construction of family pedigree Continuous positive airway pressure 755 Convulsive disorders 430, 432 Cooley anemia 532 Corneal diseases 672 Corneal light reflex tests 674 Corneal ulcers 673 Corticotrophin 624 Corynebacterium diphtheriae 273 Cow milk allergy 470 Craniofacial dysostosis 429 Craniopharyngioma 566 Craniostenosis 428 Craniosynostosis 428 Craniotabes 32 Cretinism 625, 626 Crossectional study 72 Croup 687 Crouzon’s disease 429 Crying in newborn 127 Cryoprecipitate 554 Cryptorchidism 68, 631, 707 Cryptosporidiosis 311 CSF examination 762 CT scan 734 Cushing syndrome 640 Cyanosis Cyberhealth services 75 Cybermedicine 75 Cyproheptadine poisoning 615 Cystic fibrosis 350, 467, 468 Cystic hygroma 707 Cytogenesis 400 Cytomegalovirus disease 222 D Dacryocystitis 671 Danger signs 210 Data 71 Datura (atropine) poisoning 616 d-dimer assays 540 DDT poisoning 613 Deafness 682 Degenerative brain disorders 438 Dehydration 177 Dehydration fever 126 Delayed puberty 632 Delayed speech 732 Demyelinating disease 439 Dendritic keratitis 672 Dengue fever 261 clinical features 262 complications 262 diagnosis 262 differential diagnosis 262 etiopathogenesis 262 prevention 263 treatment 263 809 Dengue shock syndrome 262 Dental caries 690 Dental malocclusion 690 Dental/oral hygiene 691 Dentition 34, 690 Depression 65 Dermal zones 230 Dermatoglyphics 654 Dermatomyositis 587 Dermatophycosis 594 Dermatophytosis 594 Desensitization 620 Development 25, 37 assessment 37 Baroda DST 38 Denver developmental screening test 38 Trivandrum DST 38 developmental screening 39 Developmental delay 46 Developmental dysplasia of the hip 711 Devic disease 440 Dextrocardia 393 Diabetes insipidus 623 Diabetes mellitus 634 Diabetic coma 636 Diabetic ketoacidosis 636, 637 Diabetic retinopathy 677 Diaper rash 595 Diarrheal diseases 444 Diastematomyelia 403 Diastolic murmurs 10 Differential leukocyte count 758 DiGeorge syndrome 576, 630 Dinner-fork sign 379 Diphtheria 273, 687 cutaneous 274 faucial 273 laryngeal 274 nasal 274 Diplopia 676 Directly observed therapy (DOT) 347 Disability 89 Disability prevention 89 Discrimination against females 92 against girl child 91 Disease of lens 673 Diseases of the eyelids 669 Diseases of the retina and vitreous 676 Disequilibrium syndrome 514 Dislocation of patella 710 Disorders of muscles 658 Dispersion 72 Disseminated disease 222 Disseminated intravascular coagulation 540 Distance communication 75 DNA double helix 643 Doll’s eye phenomenon 436 Doll’s eye reflex 198 810 The Short Textbook of Pediatrics Double elevator palsy 674 Down syndrome 410 Drowning 351 Drug abuse 57 Drug eruption 592 Drug-induced liver injury 499 Drug-induced thrombocytopenia 549 Drugs employed in asthma 336 Dry eye 671 Dry pleurisy 331 Duchenne muscular dystrophy 659] Duodenal and other intestinal atresias 697 Duplex renal system 506 D-xylose test 464 Dyscoria 673 Dyslexia 46, 676 Dysmenorhea 67 Dysmorphic facies 190 Dyspnea Dysraphism 402 E Ear disorders 680 Early infant mortality 83 Eating problem 732 Ebstein anomaly 370 Echinococcosis 317 Echocardiography 355, 733 Ecology of malnutrition bad economy 129 bad start 130 closely-spaced families 130 ignorance, faulty food habits and feeding 129 large families 130 medical reasons 130 secondary malnutrition 130 working mother 130 Ectodermal dysplasias 604 Ectopia lentis 673 Ectropion 670 Ehler-Danlos syndrome 590, 603 Eisenmenger syndrome or complex 362, 371 Electrocardiography 354 Electrolytes 175 Electronic mail 76 Ellis-van Creveld syndrome 363 Emerging and re-emerging infections 737 Emmetropia 675 Emphysema thoracis 333 Encephalitic disease 222 Encephalitis 421 Encephalitis-like syndrome 150 Encephalocele 403 Encopresis 55 Endemic goiter 172 Endemic tropical sprue 469 Endocrinal myopathies 662 Endocrine orchestra 623 Endotracheal intubation 193, 194, 752 End-stage renal disease 522 Energy 109 Enhanced inactivated polio vaccine 102 Enophthalmos 668 Enteric fever 277 antibiotic therapy 279 Entropion 670 Enuresis 49, 55 Eosinopenia 277 Ependymoma 565, 566 Epidemic parotitis 254 Epidemic typhus 275 Epidermolysis bullosa 601 dermolytic 602 epidermolytic 601 junctional 602 Epididymo-orchitis 707 Epispadias 706 Epistaxis 683 Epstein pearls 203 Erb paralysis 188, 189 Erysipelas 597 Erythema marginatum 379 multiforme 602 nodosum 604 toxicum 202 Erythrocyte sedimentation rate 758 Erythrocytosis 552 Esophageal atresia 695 Evidence-based medicine 737 Ewing sarcoma 567 Exchange blood transfusion 232, 752 Exomphalos 701 Exophthalmos 668 Expressed breast milk 124 Extrahepatic biliary atresia 498, 702 Extrahepatic portal hypertension 495 F Facial palsy 418 Facioscapulohumeral muscular dystrophy 662 Failure to thrive 40 Fallot’s physiology 368 Family health 79 Fanconi syndrome 164 Fascitis 588 Fatal sting 621 Fats 111 Febrile seizures 430 atypical (complex) 431 typical (simple) 430 Feeding problems 126 Feeding the low birthweight infant 12, 213 Female feticide/infanticide 91 Fetal circulation 356 Fiberoptic phototherapy 232 FIGLU test for folate deficiency 531 Filariasis clinical features 305 diagnosis 306 treatment 306 Fine needle aspiration 752 Fissure-in-ano 701 Flat foot 709, 733 Flexural eczema 592 Floppy baby syndrome 663 Floppy or billowing mitral valve syndrome 389 Fluid and electrolyte therapy 181 Fluoride and fluoridation 691 Fluorosis 691 Folate deficiency 530 Fontanels and sutures 32 Food allergy 478 Foreign bodies in the ear 680 in lower respiratory tract 323 in nose 683 Fourth ventricle tumor 565 Fracture zone 162 Free radicals 112 Fröhlick syndrome 624 Frontal encephalocele 191 Full-term newborn 196 Fulminant hepatitis 490 Fulminant/acute hepatic failure 490 Functions of liver 481 Fundus ophthalmicus 157 Funnel-chest deformity 165 G G-6-PD deficiency 235, 536 Galactosemia 649 Gallop rhythm Gangrenous stomatitis 294 Gastric lavage 610, 753 Gastrointestinal bleeding 476 Gastrointestinal decontamination 610 Gastrointestinal problems 694 Gastrointestinal tract 443 Gastroschisis 701 Gastroesophageal reflux disease 475 Gated blood pool scanning 355 Gaucher disease 650 Gavage (tube) feeding 123 Gender bias 90 Gender gap 90 Gene therapy 642, 655 Genetic counseling 655 Genetic disorders 644 Genetic skeletal dysplasias 712 Genetic traits 44 Genetics 642 Genitourninary problems 704 Appendices Genome project 644 Genu valgum 710, 732 Genu varum 710, 732 Geographic tongue 474 Geophagia 54 German measles clinical features 253 diagnosis 254 treatment 254 Gestational age 209 Ghon focus 340 Giardia lamblia 308 Girdiasis 308 Girl child 90 Girl child week 91 Gliomas 566 Glossitis areata migrans 474 Glycogen storage disease 649 Goiter 629 Goiter control program 153 Gomez syndrome 149 Gonadotrophins 624 Gonads and their deficiency 631 Goodpasture syndrome 588 Gowers sign 660 Grades of breathlessness Grading of splenic size 11 Growing pains 730 Growth 25 factors influencing growth and development 25 indices for assessment 28 body ratio 31 growth velocity 31 head 31 length/height 30 weight 28 weight for height 30 law (principles) 27 body proportions 28 growth spurts 28 order of growth 27 postnatal growth pattern 27 types of body build 28 period 27 Growth hormone 624 Growth studies 25 Grunting 350 Guillain-Barré syndrome 259, 406, 407, 663 Gynecomastia 68 H H pylori infections 478 Habit spasm 56 Hair tuft 192 Hansen disease 282 Harlequin fetus 598 Harlequin color change 203 Hartnup disease 648 Head circumference 31 Head/chest circumference ratio 32 Health 78 Health hazards 87 Hearing impairment 682 Heat hyperpyrexia 736 Heat injury 736 Heel puncture 751 Helicobacter pylori infection 288 Hemangioma 600 Hematocrit 756 Hematopoietic system 522 Hematuria 507 Hemihypertrophy 711 Hemimelia 709 Hemiplegia of childhood 405 Hemoglobin 756 Hemolysis 531 Hemolytic anemias 531 Hemolytic crisis 535 Hemolytic disease of the newborn 236 Hemolytic-uremic syndrome 516 Hemophilia 544 Hemophilus influenzae B disease 270 Hemopoietic stem cell transplantation 552 Hemorrhagic diseae of the newborn 168, 228, 542 Henderson-Hasselbach equation 177 Heparinized saline 233 Hepatic encephalopathy 490 Hepatobiliary system 481 Hepatoblastoma 564 Hepatolenticular degeneration 440, 501 Herediatary motor-sensory neuropathies 663 Hereditary spherocytosis 532 Hermaphroditism 633 Herpes simplex 222 Heterochromia 673 Heterotropia 674 Hiatal hernia 295, 480 Hiccup (hiccough) 204 High-risk pregnancy 186 Hilar lymphadenitis 340 Hindu Adoption and Maintenance Act, 1956 723 Hirschsprung’s disease 699 Hirsutism 68 Histiocytosis 730 Histogenesis 400 History taking Hodgkin’s disease 559 Holt-Oram syndrome 363, 364 Homocystinuria 648 Homosexuality 63 Hookworm 313 Hordeolum 670 Horse-shoe kidneys 505 House-dust mite 334 Human cell division 642 811 Human milk fortifiers 124 Humoral immunity 572 Hurler syndrome 628, 652 Hutchinson-Gilford syndrome 729 Hyaline membrane disease 215 Hydatid disease 317 Hydrocele 68, 204, 706 Hydrocephalus 423 acquired 420, 423, 424 congenital 423, 424 Hydrophobia 264 Hydrops fetalis 236 Hymenal tags 204 Hymenolepis nana 315 Hyperadrenocorticism 630 Hyper-IgE syndrome 578 Hyperkalemia 179 Hypermetropia (hyperopia) 675 Hypernatremia 178 Hyperparathyroidism 630 Hypertelorism 667 Hypertension 394, 521 Hypertensive retinopathy 677 Hyperthyroidism 629 Hypertrophy of pharyngeal tonsils 686 Hyperventilation syndrome 58 Hypervitaminosis 158 Hypochromic anemias refractory to iron 529 Hypochromotrichia 727 Hypogeusia 171 Hypokalemia 179 Hyponatremia 177 Hypoplastic left heart syndrome 373 Hypospadias 706 Hypotelorism 668 Hypothalamus and its disorders 623 Hypotonia 727 Hypoxic-ischemic encephalopathy 213 Hysteria 58 Hysterical seizures 58 I Ibuprofen toxicity 614 Ichthyosis 598 Icterus gravis 236 Immune dysfunction syndrome 730 Immune response 97 Immune thrombocytopenic purpura 546 Immunity 97 Immunization 97 Immunodeficiency states 574 primary 575 secondary 578 Immunoglobulins 573 Immunologic memory 573 Immunologic system 571 Immunonutrition 173 IMNCI case management process 789-791 812 The Short Textbook of Pediatrics Impairment 89 Imperforate anus 242, 700 Important conversions 785 Inborn errors of metabolism 647 Incontinentia pigmenti 435 Incubator care 212 India’s national health programs 94 India’s national nutrition policy 95 India’s national nutrition programs 95 Indian childhood cirrhosis 482, 483 Indian Family of Cerebral Palsy 415 Infant immobilization boards 744 Infant mortality rate 83 Infantile cortical hyperostosis 166 Infantile hemiplegia 405 Infantile polyarteritis 588 Infantile scurvy 161 Infantile skeletal proportions 627 Infantile syncope 55 Infantile tremor syndrome 173, 434, 726 Infantometer 30 Infants of diabetic mothers 240 Infections in the newborn 220 Infectious mononucleosis clinical features 260 complications 261 differential diagnosis 261 etiopathogenesis 260 treatment 261 Infectious polyradiculitis 406 Infective endocarditis 386 Infective polyneuritis 406 Inflammations of bones and joints 716 Inflammatory bowel disease 471 Information 71 Inguinal hernia 480, 706 Inhalation devices 337 Innocent murmur 353 Inotropic drugs 359 Insect bite hypersensitivity 592 Insomnia 69 Integrated child development services scheme 84, 153 Intelligence 71 International days 788 Internet 76 Interstitial keratitis 672 Interventional cardiac procedures 399 Intestinal malrotation 697 Intestinal obstruction 182 Intracranial hemorrhage 405 Intracranial space-occupying lesions 425 Intracranial tumors 428 Intractable seizures 433 Intradermal injection 744 Intrahepatic portal hypertension 494 Intramuscular injection 744 Intraosseous infusion 747 Intrapartum suctioning 192 Intraperitoneal infusion 748 Intravenous immunoglobulins 581 Intravenous infusion 745 Intubation 687, 752 Intussusception 480, 698 Iodine deficiency control program 153 Iris coloboma 673 Iron (iron salts) poisoning 615 Iron-deficiency anemia 65, 525 Irregular/asymmetrical skull 732 J Jamaican cirrhosis 482 Japanese encephalitis 263 Jaundice 202 Job syndrome 578 Jugular vein puncture (JVP) 745 Juvenile delinquency 66, 82 Juvenile Graves disease 629 Juvenile rheumatoid arthritis 584 K Kala-azar clinical features 302 complications 303 epidemiology 302 laboratory diagnosis 303 polymerase chain reaction 304 serological test 303 treatment 304 Kangaroo mother care 211 Kawasaki disease 588 Keratoconus 672 Keratomalacia 157 Kernicterus 236, 237 Kernig sign 13 Kerosene oil poisoning 612 Kidney biopsy 751 Kinky hair (Menkes) disease 162, 439 Kiss the knee sign 256 Klinefelter syndrome 631 Klumpke paralysis 188 Knock knee 710, 732 Knock-knee deformity 641 Kocher-Debre-Semelaigne (KDS) syndrome 627 Koebner response 606 Kwashiorkor 133, 140 Kyphosis 712 L Lactation failure 119 Lactobezoars 479 Lagophthalmos 670 Laryngomalacia 686 Laryngoscopy 322 Latching 213 Late infant mortality 84 Lathyrism 617 Laurence-Moon-Biedl syndrome 624, 639, 640 Lazy leukocyte syndrome 578 Lead poisoning 616 Learning disability 46 Legionellosis 351 Leigonnaires’ disease 351 Leishmania donovani 302, 304 Leprosy 282, 600 borderline 283 lepromatous 283 tuberculoid 283 Leptospirosis 286 Leukemia acute 555 aleukemic 555 chronic 555, 557 congenital 557, 559 Leukemoid reactions 557 Leukocoria 673 Leukocyte dysfunction 550 Leukoderma 600 Lid retraction 670 Limb length discrepancy 715 Limb-girdle muscular dystrophy 662 Linear catchup growth 36 Linear nevus syndrome 435 Lissencephaly (agyria) 403 Little disease 413 Liver abscess 500 Liver biopsy 751 Long QT syndrome 390 Longitudinal study 72 Low birthweight infants 173, 206 Lumbar puncture 749 Lung abscess 334 Lung biopsy 322 Lung tap 322 Lyell syndrome 597 Lymph node biopsy 752 Lymphangioma 707 Lymphomas 559 M Macular hemangioma 203 Magnetic resonance imaging 735 Malaria 296 clinical features 298 complications 298 algid malaria 299 black water fever 299 Appendices cerebral malaria 299 coagulation abnormalities 299 hypoglycemia 299 noncardiogenic pulmonary edema 299 quartan malaria/nephropathy 300 tropical splenomegaly 300 diagnosis 300 epidemiology 296 host response 297 life cycle of parasite 296 pathogenesis 297 treatment 300 Malformations of kidney and urinary tract 505 Malnutrition 65 Malnutrition (tip of “iceberg”) 134 Mantoux test 343 Manual removal of foreign body from airway 753 Maple syrup urine disease 648 Marasmic kwashiorkor 134, 145 Marble bone disease 715 Marfan syndrome 590, 713 Maternal and child health 82 Maternal medication 243 adverse effects on breastfed infant 244 adverse effects on the fetus 243 Maternal mortality rate 83 Mayer-Rokitansky syndrome 505 Mean corpuscular hemoglobin 757 Mean deviation 72 Measles (rubeola) 250 clinical features 251 complication 252 diagnosis 252 differential diagnosis 252 etiopathogenesis 250 prophylaxis 253 treatment 253 Measures of variation 72 Meatal stenosis 506, 706 Mechanical ventilation 755 Mechanism of coagulation hemostasis 538 Meckel’s diverticulum 700 Meckel-Gruber syndrome 403 Meconium aspiration syndrome 217 Meconium ileus 699 Meconium plug syndrome 699 Median 72 Medical informatics 73 Mediterranean anemia 532 Medulloblastoma 565 Megaloblastic anemia 530 Megalocornea 672 Meningitis 416 Meningocele 192, 402 Meningococcal infections 286 Meningoencephalitis 416 Meningomyelocele 192, 402 Menometrorrhagia 67 Menstrual problems 67 Mental retardation 53, 408 Mercury poisoning 17 Metabolic acidosis 177, 179 Metabolic alkalosis 180 Metabolic myopathies 662 Metachromatic leukodystrophy 439 Metered dose inhaler 337 Methemoglobinemia 537 Microcephaly 408 Microcornea 672 Microminerals 111 Micronutrients 170 Micropenis 633 Microphthalmia 668 Midarm circumference 32, 131 Midday meal program 152 Milia 202 Mineral deficiencies 170 arsenic 172 calcium 172 chromium 172 cobalt 171 copper 171 fluorine 172 iodine 172 iron 170 manganese 172 molybdenum 172 nickel 172 potassium 173 selenium 171 silicon 172 sodium 173 vanadium 172 zinc 170 Minerals 111 Missense mutation 643 Mitral systolic murmur-systolic click syndrome 389 Mitral valve prolapse syndrome 389 Mixed acid-base disturbances 181 Mixed connective tissue disease 588 Mode 72 Modern imaging techniques 733 Molality 175 Molluscum contagiosum 604 Mongolian spots 6, 202 Mongolism 410 Moniliasis 226, 594 Monkeypox 247 Morphine and other opiates poisoning 616 Morquio syndrome 653 Motor neuron disorders 657 Mucocutaneous lymph node syndrome 588 Mucopolysaccharidoses 651, 650 Mucoviscidosis 467 Multiple sclerosis 440 813 Mumps clinical features 254 complications 255 diagnosis 255 differential diagnosis 254 prophylaxis 255 treatment 255 Muscular dystrophies 659 Mutation 642 Myasthenia gravis 657 Mycobacterium leprae 282 Myelodysplasia 402 Myelomeningocele 402 Myeloperoxidase deficiency 578 Myocarditis 393 Myopia 675 Myotonic muscular dystrophy 661 Myotubular myopathy 658 N Nabarrow’s thinners chart 131 Nailbiting 56 Nappie or napkin flash intertrigo 595 Narcolepsy 68 Nasal polyps 685 Nasolacrimal duct blockade 204 Natal teeth 203 National immunization schedule 98 National nutrition policy 153 National nutrition programs 151 Nebulizer 337, 338 Necrotizing enterocolitis 700 Neonatal and perinatal mortality in India 186 Neonatal behavioral assessment scale 198 Neonatal blood circulation 356 Neonatal care 185 Neonatal cholestasis syndrome 235, 496, 497 Neonatal cold injury 241 Neonatal conjunctivitis 225 Neonatal hepatitis syndrome 235 Neonatal hyperthermia 241 Neonatal hypocalcemia 240 Neonatal hypoglycemia 239 Neonatal hypomagnesemia 240 Neonatal hypothermia 210 Neonatal jaundice 228, 231 breastfeeding 229 breastmilk 229 pathologic 229 physiologic 228 Neonatal malaria 226 Neonatal mortality 83 Neonatal necrotizing enterocolitis 242 Neonatal resuscitation 188 Neonatal seizures 238 Neonatal shock 218 Neonatal tetanus 227, 240 Nephritic syndrome 517 814 The Short Textbook of Pediatrics Nephroblastoma 562 Nephrogenic diabetes insipidus 512, 623 Nettle rash 596 Neural tube defects 402 Neuroblastoma 563 Neurocutaneous syndromes 434 Neurocysticercosis 316, 427 Neurodevelopment 198 Neurofibromatosis 434 Neurogenic bladder 506 Neurologic evaluation 400 Neurologic examination 12 Neuromuscular transmission disorders 657 Neuromyelitis optica 440 Neurosis 52 Neurotuberculosis 417 Neutropenia 550 Nevus flameus 600 Nevus simplex 203 Newer antituberculous drugs 349 Nezelof syndrome 577 Niemann-Pick disease 650 Night blindness 676 Nipple discharge 68 Nocturia 636 Noma 294 Noma neonatorum 226 Nonaccidental injury 724 Non-Hodgkin lymphoma 561 Nonketotic hyperosmolar coma 637 Nonnutritive suckling 125 Nonorganic failure-to-thrive 725 Noonan syndrome 631 Normal laboratory values 785 Nose disorders 683 Nosebleeds 683 Nosocomial infections 291 common infections 293 etiologic considerations 292 investigations 293 mode of transmission 292 preventive and control measures 293 Nuclear medicine 735 Nursing bottle caries 690 Nutritional anemia cycle 528 Nutritional anemias 525 Nutritional blindness prevention program 153 Nutritional dwarfing 145 Nutritional marasmus 133, 143 Nutritional recovery syndrome 149 Nyctolopia 676 O Obesity 44, 65, 640 Observation hip 718 Obstructive uropathy 506, 704 Occipital encephalocele 191 Occult blood 760, 761 Ocular trauma 679 Omphalitis 223 Oncologic emergencies 568 Open care system 212 Opening the airway 191 Ophitoxemia 619 Opportunistic infection 290 Optic atrophy 678 Optic nerve diseases 677 Optic neuritis 677 Oral polio vaccine program 101 Oral rehydration therapy 448, 456 Oral thrush 226 Orbital cellulitis 669 Orbital diseases 667 Organic brain syndrome 52 Organic phosphate poisoning 612 Organogenesis 400 Orthophoria 674 Orthotopic liver transplantation 502 Osmolarity 175 Osmotic diarrhea 462 Osteochondritis 715 Osteogenesis imperfecta 712 Osteomyelitis 716 Osteopetrosis 715 Osteosarcoma 566 Otitic hydrocephalus 404 Otitis externa 680 Overfeeding 127 Oxycephaly 428 Oxytocin 623 Oxyuriasis 313 P Panophthalmitis 157 Papillary and iris abnormalities 673 Papilledema 677 Paracetamol toxicity 613 Paralysis of accommodation 675 Paraphimosis 506, 521, 706 Paraplegia 440 Parasitic infestations of gut 307 Parathyroid and its disorders 629 Parathyroid myopathy 662 Parenteral nutrition 125 Parianal abscess and fistula 701 Paroxysmal atrial tachycardia 389 Partial thoracic stomach 295 Patent ductus arteriosus clinical features 365 complications 365 diagnosis 365 pathophysiology 365 treatment 366 Pectus excavatum 164 Pediatric AIDS 265 clinical features 266 diagnosis 266 etiology 265 pathogenesis 266 prevention 268 Pediatric drug dosage 775 Pediatric education 23 Pediatric fractures 719 Pediatric sports medicine 718 Pediatric sports medicine program 719 Pediatrics changing scenario 15 contemporary disease pattern 18 delivery of child health care 20 education 23 mortality scenario 20 rights of the child 17 tropical pediatrics 16 Pediatric syndromes 767 Pediculosis 593 Pellagra 160 Pelviureteric junction (PUJ) stenosis 506 Pemphigus 603 Percentile 73 Pericardial effusion 392 Pericardial puncture 750 Pericarditis 391 Perinatal aids 223 Perinatal asphyxia 213 Perinatal mortality rate 84 Perinatal/neonatal period 185 Periodic syndrome 57 Periorbital (preseptal) cellulitis 669 Peripheral blood film 757 Peroral jejunal biopsy 464 Persistent diarrhea 459 Persistent pulmonary hypertension of the newborn 218 Pertussis 271 Pes planovalgus 733 Peter’s anomaly 673 pH 176 Phakomatoses 434 Phantom hernia 257 Phenothiazine toxicity 614 Phenylketonuria 47 Phimosis 204, 506, 521, 706 Phlyctenular keratoconjunctivitis 672 Phlyctenules 672 Phocomelia 709 Phototherapy 230, 752 Physical examination Physiologic anemia of prematurity 528 Physiologic mastitis 203 Physiology of lactation oxytocin milk ejection reflex 115 prolactin milk-secreting reflex 115 rooting reflex 116 suckling reflex 116 swallowing reflex 116 Phytobezoars 479 Pica 54 Appendices Pierre Robin syndrome 190 Pilocarpine iontophoresis 322 Pilonoidal sinus and abscess 701 Pingueculum 672 Pitting edema 12 Pituitary and its disorders 624 Pituitary dwarfism 628 Plagiocephaly 428 Plasmodium 298 Plastic pleurisy 331 Platelet count 540, 758 Pleural effusion 331, 332 Plucked bird disease 729 Plumbism 616 Pneumonias 327 staphylococcal 327 Poliomyelitis 255 clinical features 256 complications 258 diagnosis 258 etiolopathogenesis 256 prophylaxis 259 treatment 258 Polyarteritis nodosa 589 Polyarteritis nodosa periarteritis 587 Polyarthritis 378 Polycystic disease of kidneys 505 Polycythemia 552 Polydactyly 710 Polydypsia 636 Polygraphic monitoring 322 Polymorphisms 643 Polyphagia 636 Polyuria 636 Pontiac fever 351 Pontine glioma 565 Porencephaly 404 Pork tapeworm 315 Portal hypertension 494 Portwine stain or mark 600 Positive pressure ventilation 193 Posterior urethral valve 506, 704 Postinfectious polyneuritis 406 Postnatal growth curves 28 Postneonatal mortality 84 Potassium 176 Potassium-related periodic paralysis 662 Potentially dangerous sting 621 Prader-Willi syndrome 640 Prazosin 621 Precocious puberty 631 Pre-excitation syndrome 390 Prekwashiorkor 145 Premature senility 729 Premenstrual syndrome 67 Prenatal diagnosis 653 Preterm infant 204 Preventive pediatrics 79 Priapism 705 Prickly heat 595 Primary bladder stone 521 disease 705 Primitive neonatal reflexes 199 Chvostek sign 201 crossed extension 201 glabeller reflex/tap 201 grasp 201 Landau 202 Moro 199 parachute 201 plantar (Babinski) 201 rooting and suckling 201 startle response 201 tonic neck 201 traction 201 Probability 73 Progeria 729 Prolactin 624 Promiscuous sex 63 Proptosis 668 Protein 110 Protein-energy malnutrition 133 classification 139 complications 146 evolution adaptation hypothesis 134 aflatoxin contamination hypothesis 134 dietary hypothesis 134 Golden’s hypothesis of free radicals 134 Jellife’s hypothesis of interactions 134 long-term sequelae 150 management domiciliary (home) management 146 hospital management 147 management in nutrition rehabilitation 146 PEM and disturbances of metabolism 135 endocrinal status 137 family planning 137 infection 136 cardiac function 138 diarrhea 138 drug disposition 139 renal function 139 prevention 150 community level 151 family level 151 national level 151 world level 151 prognosis 150 Protein-losing enteropathy 469 Proteinuria 507 Prothrombin time 540 Protuberant abdomen 732 Pruritus ani 313 Pseudodefiency rickets 164 Pseudoachondroplasia 715 Pseudohermaphroditism 63 815 Pseudohypertrophic muscular dystrophy 659, 660, 661 Pseudohypoparathyroidism 630 Pseudomembranous colitis 455 Pseudotumor cerebri 149, 404 Psoas abscess 342 Psoriasis 606 Psychiatric disorders 52 Psychogenic vision problems 676 Psychosis 52 Pterygium 672 Ptosis 669 Puberty 37 Puberty goiter 65 Puberty spurt 61 Pulmonary function tests 322 Pulse polio 101 Pulseless disease 390 Purpura fulminans 550 Pyelonephritis 509 Pyoderma 226, 596 Pyogenic liver abscess 500 Pyridoxine (vitamin B6) dependency anemia 529 Pyruvate kinase deficiency 536 Q Qartan malaria/nephropathy 300 QUAC-stick method 131 Quetlet index 132 R Rabies 264 Rachitic rosary 165 Radial club hand 709 Radionuclide scintigraphy 735 Range 72 Reactive airway disease 334 Rectal examination 11 Rectal infusion 748 Recurrent abdominal pain 477 Recurrent aphthous stomatitis 473 Recurrent convulsions 431 Recurrent neonatal apnea 219 Recurrent respiratory infection 350 Red cell count 757 Refeeding edema 148 Refractive errors 675 Refractory rickets 166 Regurgitation 126 Rehabilitation 90 Renal agenesis 505 Renal or uremic rickets or dwarfism 522 Renal osteodystrophy 522 Renal rickets 164 Renal stone 521, 704 Renal system 504 Renal tubular acidosis 511 Reproductive and child health (RCH) program 94 816 The Short Textbook of Pediatrics Respiratory acidosis 177, 180 Respiratory alkalosis 177, 181 Respiratory catarrh 323 Respiratory distress of polio 257 Respiratory distress syndrome 215 Respiratory syncytial virus infection 268, 324 Respiratory system examination Reticular pigmentation of skin 727 Reticulocyte count 758 Retinal detachment 677 Retinitis pigmentosa 676 Retinoblastoma 567, 676 Retinopathy of prematurity 206 676 Retracted nipples 118 Retrobulbar neuritis 677 Retrolental fibroplasias 676 Rett syndrome 48, 439 Reye syndrome 434, 484 Rh isoimmunization 236 Rhabdomyosarcoma 567 Rhesus hemolytic disease 236 Rheumatic (Sydenham’s) chorea 378 Rheumatic fever 376, 584 Rheumatic heart disease 382 aortic regurgitation 385 mitral regurgitation 383 mitral stenosis 383 rheumatic aortic valve disease 385 rheumatic tricuspid valve disease 386 Rheumatoid arthritis 718 Rhinopharyngitism 323 Rhythmic dilatation and constriction of pupil 673 Rickets 150 Rickettsia prozawekii 275 Rights of the child 17 Ringworm infections 594 Ritter disease 597 Rooting reflex 212 Rotahaler 337, 338 Roth’s spot 387 Routine diabetes 637 S Salicylism 614 Saline washed platelets 554 Salmon patches 203 Salmonella 276 Salter spring machine 29 Sarcoidosis 731 Scabies 593 Scalded skin syndrome 597 Scalp vein infusion 745, 746 Scaphocephaly 428 Scapuloperoneal or scapulohumeral muscular dystrophy 661 Schilder disease 439 Schizencephaly 403 School health service 81 School phobia 57 Sclerema 241 Sclerocornea 672 Scleroderma 588 Scoliosis 712 Scorbutic rosary 162 Scorpion sting 621 Scrofuloderma 342 Seborrhea 595 Seborrheic dermatitis 595 Secretory diarrhea 462 Self-gratification 63 Self-inflating bag 194 Septic umbilicus 223 Septicemia 223 Severe acute respiratory syndrome 269, 326 Sex chromatin 645 Sex-determination shops 91 Sexual abuse 725 Sexually transmitted diseases 67 Shakir tape 131 Shigellosis 454 Shock 736 Short stature 42, 624, 641 Sick sinus syndrome 390 Sickle cell anemia 535 Sideroblastic anemia 529 Significant value 73 Simian (single palmar) crease 412 Sinusitis 684 Skin tests 321 Skin tuberculosis 604 Skin-eye-mouth disease 222 Skin-fold thickness 34 Sleep disorders 68 Sleep walking 55 Slipped capital femoral epiphysis 711 Slow virus infection 264 Smallpox (variola) 247 Snake bite 619 Snoring 350 Social pediatrics 79 Sodium 175 Soft tissue sarcomas 567 Somnambulism 55 Sore nipple 118 Space device inhaler 337 Spasmus nutans 435 Spastic Society of India 415 Special nutrition program 151 Spider nevus 601 Spina bifida occulta 402 Spinal muscular atrophies 658 Spinhaler 337 Squint 674 Stages of newborn care 208 Standard deviation 72 Staphylococcal scalded skin syndrome 597, 598 Statistical averages 72 Status asthmaticus 338 Status epilepticus 432 Sternocleidomastoid tumor 708 Sternomastoid tumor 708 Steroid-induced myopathy 662 Stevens-Johnson syndrome 602 Stool examination 760 fat globules 762 formalin-ether sedimentation technique 761 microscopy 760 occult blood 761 pH 762 reducing substances 762 zinc sulfate 761 Stork bites 203 Strabismus 674 Strabismus syndromes 674 Street children 88 Stress (secondary) ulcer disease 474 Stridor 220, 350, 686 Stroke 405 Strongyloidiasis 314 Stunting 145 Sturge-Weber disease 434 Stuttering 56 Subacute sclerosing panencephalitis 438 Subconjunctival hemorrhage 203, 671 Subcutaneous emphysema 328 Subcutaneous infusion 748 Subcutaneous injection 744 Subcutaneous nodules 379 Subdural effusion 426 Subdural hematoma 426 Subdural puncture or tap 749 Substance abuse 57, 66 Suckling 126 Suckling callosities 203 Suckling reflex 212 Sudamina 595 Sudden infant death syndrome 728 Suicide 66 Suprapubic bladder aspiration 751 Swallowing difficulties 126 Swallowing reflex 212 Swimmer’s ear 680 Syllabus (MCI) 792 final MBBS part II 793 undergraduates 792 Symblepharon 672 Syncope 736 Syndactyly 710 Syndrome of generalized lipodystrophy 624 Syphilis 284 syphilitic stigmata 285 Syringomyelia 403 System review Appendices Systemic hypertension 394 Systemic lupus erythematosus 586 T Tactile stimulation 193 Takayasu arteritis 390, 590 Tanner’s sexual maturity rating 60, 62 Tapeworms 315 T-cell defects 576 Teenage pregnancy 66 Teeth grinding 56 Telangiectatic angioma 601 Telemedicine 74 Television and the child 95 Tenia solium 315 Teratomas 568 Testing of cranial nerves 13 Tetanus 280 Tetanus neonatorum 227 Tethered spinal cord 403 Tetralogy of Fallot 366 Thalassemia 532 The Child Labor (Protection and Regulation) Act, 1986 88 The genes 643 The handicapped child 89 Thoracentesis 750 Thoracocentesis 322 Thoracoscopy 322 Throat disorders 685 Thrombin time 540 Thrombocytopenic purpura 546 Thrush 474 Thumb sucking 56 Thymoma 568 Thyroglossal cyst 708 Thyroid and its disorders 625 Thyroid myopathy 662 Thyroid-stimulating hormone 624 Thyromegaly 629 Tics 56 Tietze sundrome 69 Tight external urethral meatus 706 Tongue-tie 732 Tonsillitis 685 Total anomalous pulmonary venous return 372 Total body water 174 Total leukocyte count 757 Tourette syndrome 57 Toxic epidermal necrolysis 597 Toxic erythema 202 Toxic shock syndrome 294 Toxin elimination 610 Trace elements 111 Tracheoesophageal fistula 695 Tracheostomy 687 Trancheoesophageal fistula 242 Transient hypoparathyroidism 630 Transient synovitis of the hip 718 Transient tachypnea of the newborn 218 Transillumination 322 Transitional stools 202 Transport of sick neonates 242 Transposition of great arteries 371 Triceps skin fold thickness 131 Trichobezoars 54, 479 Trichotillomania 54 Trichuriasis 314 Tricuspid atresia 369 Tricuspid regurgitation 386 Trigger thumb 710 Trilateral retinoblastoma 568 Tripod sign 256 Tropical eosinophilia 306 Tropical pediatrics 16 Tropical splenomegaly 301, 307 Tuberculoma 420 Tuberculosis 286, 339, 341 abdominal 342 chronic pulmonary 343 CNS 341, 417 miliary 341 renal 342 skeletal 342 Tuberculosis of bones and joints 717 Tuberculous encephalopathy 420 Tuberculous meningitis 417, 418 Tuberculous ulcers 343 Tuberous sclerosis 434 Tumors 670 Turbuhaler 337 Turner syndrome 631 Types of fever Types of inheritance 643 Types of studies 72 Typhoid fever 276 Tyrosinemia 649 U Ultrasonography 733 Umbilical hernia 204, 480, 701, 732 Umbilical polyp 701 Umbilical vein catheterization 746 Under-5 mortality rate 84 Underfeeding 127 Under-fives clinics 80 Undescended tested 68, 631, 707 Upper respiratory tract infection 323 Urinary tract infection 509 Urine examination 758 chemical examination 759 albumin 759 bile pigments 760 bile salts 760 dipstick test 759 ketones 759 occult blood 760 817 phenylpyruvic acid 760 porphyrins 760 sugar 759 physical examination 758 urine microscopy 760 Urticaria 596 V Vaccination 97 BCG 98 cholera 103 combination 106 DPT 102 H influenzae 105 hepatitis A 106 hepatitis B 105 influenza 107 Japanese encephalitis 108 measles 103 meningococcal 107 MMR 104 mump 104 pneumococcal 107 polio 100 rabies 108 rubella 104 typhoid 103 vericella virus (chickenpox) 106 Vaccine vial monitoring 98 Vaginal bleeding 203 Varicella bullosa 248 Vasculitis syndromes 588 Vasopressin 623 Vasopressin sensitive diabetes insipidus 623 Venesection (cutdown or cutopen) 746 Venipuncture 744 Venous thromboembolism 551 Venous thrombosis 405 Ventricular septal defect classification 361 clinical features 362 complications 363 diagnosis 362 hemodynamics 361 treatment 363 Ventricular tap 750 Viral hepatitis 264, 487 Viral pharyngitis 685 Visual disorders 675 Vitamin D-deficiency rickets 164 Vitamin deficiencies 155 folic acid 161 nicotinic acid 160 pyridoxine 160 riboflavin 159 thiamine 158 vitamin A 155 vitamin B12 161 818 The Short Textbook of Pediatrics vitamin C 161 vitamin D 163 vitamin E 167 vitamin K 168 Vitamin K deficiency bleeding 542 Vitamins 111 Vitellointestinal fistula 701 Vitiligo 600 Vomiting 126, 202, 473 Von Hippel-Lindau disease 434 Von Willebrand disease 546 W Waddling gait 659 Warm chain 211 Warts 604 Water 109 Waterhouse-Friderichen syndrome 630, 416 Wax (cerumen) 680 Weaning 120 Websites on pediatrics and allied fields 793 Wegener’s granulomatosis 590 Werlhof disease 546 Wheezy chest 350 Whipworm 314 White line of Frankel 162 WHO ATT regimens 346 WHO growth chart 29 Whole bowel irrigation 610 Whooping cough 271 Wilms’ tumor 562 Wilson disease 440, 501 Wiskott-aldrich syndrome 57, 548 Wolf-Parkinson-White syndrome 390 World breastfeeding week themes 788 World health day (April 7) themes 788 World wide web 76 Worminian bones 32 Wright stain 758 Wuchereria bancrofti 305 X Xerophthalmia 156 ... 0.6 %; a PaO2/FIO2 ratio of < 20 0 correlates with a QS/QT (intrapulmonary shunt) of > 20 % CT scan shows that most of the pulmonary infiltrates are in the dependent (posterior) part of the lung Pulmonary... intradermal tests) for allergens 322 The Short Textbook of Pediatrics Table 21 .1: Indication of microbiologic examination of body secretions in diagnosis of respiratory disease Secretions Indications... chest deformity 336 The Short Textbook of Pediatrics Box 21 .1 gives salient clinical fearures of acute exacerbation of asthma Box 21 .1: Clinical spectrum of acute exacerbation of asthma Definition