Pediatric Conditions: Diagnosis and Treatment
Systemic Lupus Erythematosus (SLE) in Children
Diagnosis: 4 out of 11 criteria are sufficient for diagnosis in children. Common symptoms include cutaneous lupus, oral/nasal ulcers, arthritis, serositis, renal symptoms, neurological disorders, hemolytic anemia, leukopenia, and thrombocytopenia.
Immunological Findings: Positive ANA, anti-DNA, anti-Sm, antiphospholipid antibodies, high ESR and CRP, low complement (C3 and C4), and direct Coombs test.
Infective Endocarditis (IE)
Risk Factors: History of infective endocarditis, cyanotic heart defects, repaired heart defects with prosthetic material, defects remaining at or adjacent to the surgical site, prosthetic material implantation within 6 months of operation, dental procedures, upper respiratory tract invasive procedures, and gastrointestinal/urinary procedures.
Antibiotic Prophylaxis: Amoxicillin for dental procedures, oxacillin and cephalosporin for invasive procedures, ampicillin, amoxicillin, and vancomycin for GI/urinary procedures, and oxacillin or cephalosporin for surgeries.
Pneumonia (Pn)
Hospitalization Criteria: Oxygen saturation below 92%, dehydration, moderate to severe respiratory distress, toxic appearance, complications (pleuritis, necrotizing pneumonia, pleural empyema, lung abscess, bronchopleural fistula, sepsis), and failure of outpatient therapy.
ICU Admission Criteria: Oxygen saturation below 92%, signs of impending respiratory failure, recurrent apneic episodes, and cardiovascular compromise.
Treatment: Amoxicillin or amoxicillin-clavulanic acid for home management, and benzylpenicillin, amoxicillin-clavulanic acid, or cefotaxime for hospital management.
Tuberculosis (TB)
Treatment: 6 months of isoniazid and rifampicin, with pyrazinamide and ethambutol for the first 2 months. Long treatment duration is due to the slow growth of Mycobacterium tuberculosis.
Prevention: Cure adults (the main source of infection), vaccination, treatment regimens for latent TB infection, and BCG vaccine.
Cystic Fibrosis (CF)
Diagnostic Criteria: One or more characteristic phenotypic features, a history of CF in a sibling, positive sweat chloride test (>60 mmol/L), identification of two CF mutations, or abnormal nasal potential difference.
Spasmophilia
Symptoms: Chvostek’s sign, Trousseau’s sign, Lust’s sign, low calcium levels, prolonged QT interval on ECG, carpopedal spasm, laryngospasm, and eclampsia.
Treatment: Temporary discontinuation of vitamin D, stimulation of breathing or artificial respiration for laryngospasm, antispasmodics (e.g., diazepam) for spasms, and resumption of vitamin D after 2-4 days.
Atopic Dermatitis (AD)
Acute AD: Flare-ups with erythematous, scaly, itchy, and xerotic papular rash affecting extensors, cheeks, forehead, and scalp. Diaper area and nose are typically spared.
Chronic AD: Itchy, dry skin with lichenification (white plaques) affecting areas with frequent acute rashes, such as folds, bony prominences, and forehead.
Diagnostic Criteria: Three or more major criteria (characteristic rash location, intense itch, chronic/repeated symptoms, personal/family history of atopic disease) or three or more minor criteria (early age of onset, xerosis, susceptibility to skin infections, nonspecific dermatitis on hands and feet, keratosis pilaris, cheilitis, pityriasis alba).
Treatment: AD cannot be cured, only controlled. Management involves education, elimination of trigger factors, regular bathing and hydration, and topical corticosteroids.
Spherocytosis
Treatment: Splenectomy is typically performed after 5 years of age due to the risk of postoperative sepsis. Vaccination against Haemophilus influenzae, meningococcus, and pneumococcus is recommended, along with prophylactic penicillin until 12 years of age.
Acute Leukemia
Treatment: Induction therapy (4-6 weeks), consolidation therapy (up to 6 months), supportive treatment with oral mercaptopurine and methotrexate (2-3 years), neuroleukemia prophylaxis, allogeneic blood stem cell transplantation, and treatment of relapse.
Meningitis
Treatment:
- Infants under 3 months: Third-generation cephalosporin (e.g., ceftriaxone or cefotaxime) plus ampicillin.
- Children over 3 months: Third-generation cephalosporin plus vancomycin.
- Treatment duration: 14-21 days for most infections, 7 days for Hemophilus influenzae and influenza, and 6 months for tuberculous meningitis.
Meningococcemia
Treatment: Aggressive IV fluids, vasoactive agents, low-dose corticosteroids, IV antibiotics (penicillin or ceftriaxone), and symptomatic treatment.
Prophylaxis: Rifampicin, ciprofloxacin, or ceftriaxone for close contacts and individuals in daycare environments. Vaccination with meningococcal group B vaccine and polysaccharide or conjugate vaccines is also recommended.
Rh Fever Prophylaxis
Treatment: Antibiotics, anti-inflammatory medications (aspirin or prednisolone), and treatment of complications (e.g., heart failure, valvuloplasty).
Prophylaxis Duration: 10+ years for individuals with rheumatic carditis and heart defects, 10 years for those with rheumatic carditis without defects, and 5 years for those with acute rheumatic fever.