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Measles

Abstract Measles (rubeola) is an extremely contagious, prolonged respiratory and systemic viral illness characterized by high fever, an erythematous maculopapular rash, cough, coryza, and conjunctivitis. Measles infects the immune system and leads to continued susceptibility to other pathogens long after recovery. A variety of complications lead to serious morbidity and mortality, particularly in under- and malnourished populations, where death rates can be up to 30%. Vitamin…

Rotavirus Infection

Acknowledgment The author acknowledges S. Michael Marcy and Susan Partridge for their contribution to the previous edition chapter. Abstract Rotavirus infections are the most common cause of severe dehydrating gastroenteritis worldwide. In developing countries, virtually all children have been infected by 2 to 3 years of age. Rotaviruses are segmented, nonenveloped, double-stranded ribonucleic acid (RNA) viruses that belong to the family Reoviridae. There are eight distinct…

Influenza

Abstract Influenza is a viral infection characterized by abrupt onset of fever, chills, myalgias, and respiratory symptoms such as cough, sore throat, and rhinitis. Influenza viruses, types A and B, cause annual epidemics worldwide leading to a substantial morbidity and mortality. Vaccination is the most cost-effective means of prevention. Antiviral therapy is available, but development of strain-specific resistance is becoming more common and requires continued global…

Poliomyelitis (Polio) and Polioviruses

Abstract In the early 20th century, poliomyelitis was one of the most feared illnesses of humans, in part because it affected previously healthy individuals with little or no warning and could result in devastating paralysis. Although the disease was once endemic worldwide, with vaccines eradication has been achieved in all but two countries. In current times, acute flaccid paralysis (AFP) is associated with vaccine-derived poliovirus strains…

Infections Caused by Neisseria meningitidis

Acknowledgment The author acknowledges Anjali N. Kunz for contributions to the previous edition. Abstract Neisseria meningitidis is both a commensal organism of the upper respiratory tract and a significant pathogen for humans. It causes devastating disease with significant morbidity and mortality worldwide. Infections caused by N. meningitidis can have various clinical presentations ranging from asymptomatic carriage or a mild upper respiratory illness to purulent meningitis and/or…

Pneumococcal Disease: Infections Caused by Streptococcus pneumoniae

Abstract Streptococcus pneumoniae (pneumococcus) is a gram-positive encapsulated bacterium that causes significant morbidity and mortality across all age groups. S. pneumoniae can be carried asymptomatically in the nasopharynx, and it can cause a wide range of diseases from upper respiratory infections including sinusitis and otitis media, lower respiratory infections (most commonly pneumonia), and invasive disease, including bacteremia and meningitis. Children younger than age 2 years, the…

Haemophilus influenzae Type b

Abstract Haemophilus influenzae type b (Hib) was a leading cause of bacterial sepsis and meningitis in children before the widespread availability of conjugate vaccines. Globally, the burden and incidence of Hib disease has dramatically declined with increases in vaccine uptake. Clinical Vignette A 3-year-old boy presents to the emergency department with high fever and difficulty breathing for 1 day. There is mild rhinorrhea but no rash.…

Bordetella pertussis and Pertussis (Whooping Cough)

Abstract Despite the availability of vaccines against pertussis in most developed and developing countries, pertussis remains a significant cause of morbidity and mortality worldwide due to immunity following vaccination and clinical disease waning with time. Routine use of pertussis vaccines has shifted the burden of disease from middle childhood to young infants and older children, adolescents, and adults. The changing epidemiology dictates the need for new…

Introduction to Vaccine-Preventable Diseases in Children and Adolescents

Acknowledgment The author acknowledges ChrisAnna M. Mink for her contribution on this chapter in the previous edition. The assertions expressed herein are those of the author and do not reflect the official policy or position of the Uniformed Services University or the Department of Defense. Abstract This section provides information about the vaccines currently recommended in the United States for routine immunization of children and adolescents,…

Neonatal resuscitation

Essentials 1 Occasionally deliveries occur in the ED when labour cannot be delayed to enable transfer of the patient to a labour ward setting. 2 The ED should have available appropriate equipment and guidelines for the resuscitation of the newborn. 3 The unique physiological events at birth affect the resuscitative interventions in the newborn. 4 Ventilation is the main priority in the resuscitation of the newborn.…

Acute neonatal emergencies

Essentials 1 Duct-dependent congenital heart disease is the most common cause for the collapsed neonate presenting to the emergency department (ED). Left-sided obstructive heart lesions can present with shock in the first few weeks after birth, often precipitated by delayed closure of the ductus arteriosus. Prostaglandin E1 maintains ductal patency. 2 In the collapsed neonate, bacterial sepsis must be considered. 3 Endocrine emergencies are rare but…

Neonatal dermatology

Skin in the neonatal period The skin has many important functions. It provides a physical, chemical and immunological barrier and has a major role in thermoregulation, electrolyte balance, metabolism, sensation and physical appearance. Defects or changes in the skin can impact on these functions. At birth, the barrier function of the skin is reduced, particularly in premature infants. This makes newborns vulnerable to increased transepidermal water…

The crying infant

Essentials 1 Define if this presentation is part of a recurrent stereotypical pattern in an otherwise well infant or a single acute episode. 2 A careful history and examination will often lead to an appropriate diagnosis. 3 Screening tests, except for urine culture, have little utility. 4 Carefully review carer’s coping and supports. 5 Organise appropriate follow-up. Introduction Crying is normal physiological behaviour in young infants…

The normal neonate

Definition and introduction A neonate is an infant aged from birth to 28 days of life. This is a period of rapid change and vulnerability for both the infant and their parents. Neonates are at higher risk than older infants of serious bacterial infections and may also present with previously unsuspected congenital abnormalities. Many parents have limited family support and little experience to guide them through…

Paediatric procedural sedation within the emergency department

Essentials 1 Procedural sedation has mirrored the development of paediatric emergency medicine as a subspecialty. 2 Local (departmental, hospital, state and national) governance and educational programmes must be developed to facilitate safe sedation practice. Ask ‘Can we do this procedure?’ before considering sedation. 3 Develop a sedation plan that includes patients, families/carers and staff. 4 Organise staff, equipment and the environment to allow the procedure to…

Analgesia

Essentials 1 Acute pain is one of the most common emergency department presenting problems. 2 Pain-rating scales appropriate to the age and development of the child are useful in establishing a child’s level of pain and assessing the adequacy of analgesia. 3 Adopt a multimodal (nonpharmacological, pharmacological) and multidisciplinary (medical staff, play therapists, parents) approach to pain management. 4 Tailor interventions to the individual child. 5…

Sepsis recognition and initial management

Essentials 1 Paediatric sepsis is the final common pathway for many decompensated infections. 2 Clinical judgement is the best-performing tool for early recognition; senior clinician review should be sought if there is diagnostic uncertainty. 3 Initial resuscitation includes intravenous access, sampling for blood culture and venous blood gas and early administration of empiric intravenous antibiotics. 4 Haemodynamic support using fluid resuscitation should be titrated carefully to…

Shock

Essentials 1 Shock is a syndrome that arises because of acute failure of the circulation that results in inadequate tissue perfusion. It may result from hypovolaemic, distributive, cardiogenic, obstructive or dissociative causes. 2 The normotensive child may have profound compensated shock. 3 As tachycardia may be a nonspecific sign and hypotension occurs late, it is crucial to recognise the early features of shock in a child…

Paediatric resuscitation in specific circumstances

Teamwork in critical care management Paediatric resuscitation involves a series of critical decisions and procedures which should be performed rapidly and safely with the aim of stabilising and/or reversing clinical deterioration in a child. As these critical procedures (e.g. endotracheal intubation) are performed in the seriously unwell child, management should also be focused upon avoiding further clinical deterioration and cardiac arrest. The individuals, the team and…