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Sepsis (Pediatric)

• Definition: Life-threatening organ dysfunction caused by dysregulated host response to infection in children.

• Etiology: Bacterial (most common: Streptococcus, Staphylococcus, E. coli), viral, fungal.

• Clinical Features: Fever or hypothermia, tachycardia, tachypnea, hypotension, altered mental status, poor perfusion.

• Investigations: CBC, CRP, procalcitonin, blood cultures, urine/stool cultures, lactate, imaging as indicated.

• Management: Prompt IV antibiotics, fluid resuscitation, vasopressors if shock persists, supportive ICU care.

• Complications: Multiorgan failure, disseminated intravascular coagulation (DIC), death.

Sickle Cell Disease (Pediatric)

• Definition: Genetic hemoglobinopathy characterized by HbS, causing chronic hemolytic anemia and vaso-occlusive phenomena.

• Etiology: Autosomal recessive mutation in HBB gene.

• Clinical Features: Anemia, jaundice, pain crises, splenomegaly, delayed growth, frequent infections.

• Investigations: Hemoglobin electrophoresis, CBC, reticulocyte count, peripheral blood smear (sickle cells), bilirubin levels.

• Management: Hydroxyurea, chronic transfusions, pain management, infection prophylaxis (penicillin in young children), vaccination, stem cell transplantation in selected cases.

• Complications: Stroke, acute chest syndrome, avascular necrosis, organ damage.

Spina Bifida

• Definition: Neural tube defect resulting in incomplete closure of the spinal vertebrae.

• Types:

  • Spina bifida occulta – mild, asymptomatic

  • Meningocele – sac of meninges protrudes

  • Myelomeningocele – sac contains spinal cord/nerve roots

• Clinical Features: Variable motor and sensory deficits, bladder/bowel dysfunction, hydrocephalus in severe cases.

• Investigations: Prenatal ultrasound, MRI of spine, alpha-fetoprotein (AFP) in maternal serum.

• Management: Surgical repair, multidisciplinary rehabilitation, urologic and orthopedic management.

• Complications: Hydrocephalus, tethered cord, neurogenic bladder, recurrent infections.

Streptococcal Pharyngitis

• Definition: Acute bacterial infection of the pharynx caused by group A Streptococcus.

• Clinical Features: Sore throat, fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough.

• Investigations: Rapid antigen detection test (RADT), throat culture.

• Management: Oral penicillin or amoxicillin, symptomatic care, hydration.

• Complications: Rheumatic fever, post-streptococcal glomerulonephritis, peritonsillar abscess.

Seizures (Pediatric)

• Definition: Transient, paroxysmal neurological events due to abnormal electrical activity in the brain.

• Types: Generalized (tonic-clonic, absence), focal, myoclonic, febrile seizures.

• Etiology: Genetic disorders, structural brain abnormalities, infections, metabolic disturbances, idiopathic.

• Clinical Features: Loss of consciousness, convulsions, staring spells, automatisms, postictal confusion.

• Investigations: EEG, MRI/CT brain, metabolic panel, genetic testing if indicated.

• Management: Antiepileptic drugs (tailored to seizure type), treatment of underlying cause, safety education, ketogenic diet for refractory cases.

• Complications: Status epilepticus, cognitive impairment, injury during seizures.

Soft Tissue Infections (Pediatric)

• Definition: Bacterial or viral infections of skin and subcutaneous tissue.

• Etiology: Staphylococcus aureus, Streptococcus pyogenes, viral exanthems.

• Clinical Features: Erythema, swelling, warmth, tenderness, pustules, systemic symptoms if severe.

• Investigations: Clinical diagnosis, bacterial culture if abscess suspected.

• Management: Antibiotics (topical or systemic), incision and drainage for abscesses, wound care.

• Complications: Cellulitis, abscess formation, sepsis.

Systemic Lupus Erythematosus (Pediatric)

• Definition: Chronic autoimmune disorder affecting multiple organ systems in children.

• Epidemiology: Female predominance, onset often in adolescence.

• Clinical Features: Malar rash, photosensitivity, oral ulcers, arthritis, nephritis, hematologic abnormalities.

• Investigations: ANA, anti-dsDNA, complement levels, urinalysis, CBC, renal biopsy if indicated.

• Management: Immunosuppressive therapy (steroids, hydroxychloroquine, cyclophosphamide), supportive care, regular monitoring.

• Complications: Lupus nephritis, cardiovascular disease, infection, growth retardation.

Scabies (Pediatric)

• Definition: Contagious skin infestation caused by Sarcoptes scabiei mite.

• Clinical Features: Intense pruritus (worse at night), burrows, vesicles, secondary bacterial infection due to scratching.

• Investigations: Clinical examination, skin scraping under microscope.

• Management: Topical permethrin 5%, oral ivermectin in older children, treatment of household contacts, hygiene measures.

• Complications: Secondary bacterial infection (impetigo), post-streptococcal glomerulonephritis.

Strabismus

• Definition: Misalignment of the eyes (ocular deviation).

• Types: Esotropia (inward), exotropia (outward), hypertropia (upward), hypotropia (downward).

• Etiology: Congenital, neurologic, refractive errors, trauma.

• Clinical Features: Misaligned eyes, abnormal head posture, diplopia, amblyopia risk.

• Investigations: Cover/uncover test, Hirschberg test, cycloplegic refraction, ophthalmology referral.

• Management: Corrective glasses, patching therapy for amblyopia, strabismus surgery if indicated.

• Complications: Amblyopia, impaired depth perception, psychosocial impact.

Scoliosis (Pediatric)

• Definition: Lateral curvature of the spine >10° (Cobb angle).

• Etiology: Idiopathic (most common), congenital, neuromuscular, syndromic.

• Clinical Features: Uneven shoulders, rib hump, back pain in adolescents, leg length discrepancy.

• Investigations: Standing PA and lateral spine X-rays, MRI if neurological symptoms.

• Management: Observation for mild curves, bracing for moderate curves, surgical correction (spinal fusion) for severe curves.

• Complications: Pulmonary compromise, chronic pain, cosmetic concerns.

Stevens-Johnson Syndrome (SJS)

• Definition: Severe mucocutaneous reaction with epidermal detachment, often drug-induced.

• Etiology: Medications (anticonvulsants, sulfonamides), infections.

• Clinical Features: Fever, malaise, painful red/purplish rash, oral and ocular mucosal involvement, skin detachment <10% BSA.

• Investigations: Clinical diagnosis, skin biopsy if needed.

• Management: Discontinue offending drug, supportive care in burn unit, fluid/electrolyte management, wound care, ophthalmology consultation.

• Complications: Sepsis, ocular sequelae, chronic skin changes.

Shaken Baby Syndrome (Abusive Head Trauma)

• Definition: Inflicted traumatic brain injury from violent shaking.

• Clinical Features: Lethargy, irritability, vomiting, seizures, retinal hemorrhages, subdural hematomas.

• Investigations: CT/MRI brain, skeletal survey, ophthalmology exam for retinal hemorrhages.

• Management: Supportive ICU care, neurosurgical intervention if indicated, child protection services involvement.

• Complications: Permanent neurological deficits, blindness, death.

Syndactyly

• Definition: Congenital fusion of digits (partial or complete).

• Etiology: Genetic or sporadic; may be isolated or part of a syndrome.

• Clinical Features: Fused fingers or toes, functional impairment if severe.

• Investigations: Clinical examination, X-ray to assess bone involvement.

• Management: Surgical separation for functional or cosmetic reasons, physiotherapy postoperatively.

• Complications: Infection, recurrence, impaired digit function if untreated.