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Respiratory Syncytial Virus (RSV) Infection

• Definition: Viral infection of the lower respiratory tract, most common cause of bronchiolitis in infants.

• Epidemiology: Peak incidence in infants <1 year; seasonal outbreaks in winter/spring.

• Clinical Features: Rhinorrhea, cough, wheezing, tachypnea, chest retractions, hypoxia, apnea in neonates.

• Investigations: Nasopharyngeal swab for RSV PCR or antigen detection, pulse oximetry.

• Management: Supportive care (oxygen therapy, hydration, suctioning), mechanical ventilation if severe, ribavirin reserved for immunocompromised children.

• Prevention: Palivizumab prophylaxis for high-risk infants, infection control measures.

• Complications: Apnea, respiratory failure, secondary bacterial infections.

Rickets (Pediatric)

• Definition: Defective mineralization of growing bones due to vitamin D deficiency or phosphate metabolism disorders.

• Etiology: Nutritional deficiency (vitamin D), genetic disorders (X-linked hypophosphatemic rickets), chronic kidney disease.

• Clinical Features: Delayed growth, bone pain, bowed legs, rachitic rosary, craniotabes, dental defects.

• Investigations: Serum calcium, phosphate, alkaline phosphatase, 25(OH)D, X-rays of wrists/knees.

• Management: Vitamin D and calcium supplementation, phosphate therapy for genetic forms, orthopedic intervention if severe.

• Complications: Skeletal deformities, growth retardation, hypocalcemic seizures.

Retinopathy of Prematurity (ROP)

• Definition: Abnormal retinal vascular proliferation in preterm infants, potentially leading to blindness.

• Risk Factors: Prematurity, low birth weight, oxygen therapy, sepsis, anemia.

• Clinical Features: Often asymptomatic initially; advanced stages can present with leukocoria or strabismus.

• Investigations: Serial retinal examinations using indirect ophthalmoscopy; fundus photography.

• Management: Laser photocoagulation, intravitreal anti-VEGF therapy, surgical intervention for retinal detachment.

• Complications: Retinal detachment, visual impairment, blindness.

Rheumatic Fever (Pediatric)

• Definition: Autoimmune inflammatory disease following group A streptococcal pharyngitis.

• Epidemiology: Peak incidence 5–15 years; more common in developing countries.

• Clinical Features (Jones Criteria):

  • Major: Carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules

  • Minor: Fever, arthralgia, elevated ESR/CRP, prolonged PR interval

• Investigations: Throat culture/rapid antigen test, ASO titers, echocardiography for valvular involvement.

• Management: Eradicate streptococcal infection (penicillin), anti-inflammatory therapy (aspirin or corticosteroids), long-term prophylaxis to prevent recurrence.

• Complications: Chronic rheumatic heart disease, heart failure, valve stenosis/regurgitation.

Respiratory Distress Syndrome (RDS – Neonatal)

• Definition: Surfactant deficiency in preterm infants causing alveolar collapse and impaired gas exchange.

• Clinical Features: Tachypnea, nasal flaring, grunting, intercostal retractions, cyanosis.

• Investigations: Chest X-ray (ground-glass appearance), arterial blood gas, clinical scoring.

• Management: Surfactant replacement therapy, CPAP or mechanical ventilation, supportive care (thermoregulation, fluids, nutrition).

• Complications: Bronchopulmonary dysplasia, pulmonary hypertension, air leaks.

Renal Tubular Acidosis (RTA – Pediatric)

• Definition: Defective renal tubular acid-base handling, causing metabolic acidosis.

• Types:

  • Type 1 (distal): Impaired H⁺ secretion

  • Type 2 (proximal): Impaired HCO₃⁻ reabsorption

  • Type 4: Hyperkalemic, often due to aldosterone deficiency/resistance

• Clinical Features: Growth retardation, polyuria, polydipsia, nephrocalcinosis, rickets.

• Investigations: Serum electrolytes, blood gas analysis, urine pH, renal imaging.

• Management: Alkali therapy (sodium bicarbonate or potassium citrate), potassium supplementation if needed, treat underlying cause.

• Complications: Growth failure, nephrolithiasis, chronic kidney disease.

Rotavirus Infection

• Definition: Viral gastroenteritis caused by rotavirus, leading cause of severe diarrhea in children <5 years.

• Clinical Features: Vomiting, watery diarrhea, fever, dehydration, lethargy.

• Investigations: Stool antigen detection (ELISA), PCR for severe cases.

• Management: Oral rehydration therapy (ORT), zinc supplementation, supportive care.

• Prevention: Rotavirus vaccination.

• Complications: Severe dehydration, electrolyte imbalance, hospitalization.

Rett Syndrome

• Definition: X-linked dominant neurodevelopmental disorder primarily affecting girls, caused by MECP2 gene mutation.

• Clinical Features: Normal early development followed by regression, loss of purposeful hand skills, stereotypic hand movements, gait abnormalities, speech loss, seizures.

• Investigations: Genetic testing (MECP2 mutation), EEG, MRI to rule out structural abnormalities.

• Management: Symptomatic and multidisciplinary: physiotherapy, occupational therapy, speech therapy, seizure management.

• Complications: Respiratory dysfunction, scoliosis, intellectual disability, growth failure.

Respiratory Tract Infections (Pediatric)

• Definition: Infections of upper or lower airways; range from mild to life-threatening.

• Etiology: Viral (RSV, influenza, adenovirus), bacterial (Streptococcus pneumoniae, Haemophilus influenzae).

• Clinical Features: Cough, fever, rhinorrhea, wheezing, dyspnea.

• Investigations: Clinical diagnosis, chest X-ray if pneumonia suspected, throat swabs, CBC.

• Management: Supportive care, hydration, antipyretics; antibiotics only if bacterial etiology confirmed.

• Complications: Pneumonia, bronchiolitis, chronic lung disease, sepsis.