From the Guidelines
The primary treatment approach for a child presenting with symptoms of dengue fever should focus on supportive care, emphasizing fluid replacement and monitoring for signs of severe disease, as there is no specific antiviral medication available. The management of dengue fever in children involves careful assessment and monitoring of the patient's condition to promptly identify and manage potential complications such as dehydration, shock, and bleeding.
Supportive Care
- Ensure adequate hydration through oral rehydration solutions or intravenous fluids if the child cannot drink enough, as recommended for managing fluid resuscitation in resource-limited settings 1.
- Administer acetaminophen for fever and pain management, avoiding aspirin and NSAIDs like ibuprofen due to the increased risk of bleeding.
- Monitor vital signs, urine output, and watch for warning signs of severe dengue such as persistent vomiting, abdominal pain, bleeding, or lethargy.
Fluid Resuscitation
For children with severe Dengue shock syndrome, colloid solutions may be considered when available, although crystalloid solutions are generally preferred due to their lower cost and fewer side effects 1. The choice between crystalloids and colloids should be based on the severity of the shock and the availability of these solutions.
Vasoactive Medications
In cases of persistent tissue hypoperfusion despite fluid resuscitation, dopamine or epinephrine may be used, with a preference for dopamine due to its potentially lower risk of adverse effects 1. It's crucial to monitor arterial blood pressure and heart rate frequently in patients requiring these medications.
Corticosteroids
Consider administering intravenous hydrocortisone or prednisolone in children with severe shock, although the evidence for this is less strong compared to adult patients 1.
Monitoring and Follow-Up
Regular complete blood counts should be performed to monitor platelet levels and hematocrit. The child should continue to rest and take fluids even as the fever subsides. Hospitalization is necessary for severe cases with significant plasma leakage, shock, or severe bleeding for intensive monitoring and intravenous fluid therapy. Early recognition and prompt management of dehydration and shock are crucial to prevent complications and improve outcomes in children with dengue fever.
From the Research
Dengue Symptoms in Children
- The most common presenting symptom of dengue fever in children is fever, seen in 100% of cases 2
- Other common symptoms include hepatomegaly (43.8%), gastrointestinal bleeding, pain, rashes, and vomiting 2
- Thrombocytopenia is a common finding in dengue fever, with a mean platelet count of 6800/mm(3) in severe cases 3
- Elevation in aspartate transaminase (SGOT) is also common, found in 47.42% of cases 2
Treatment of Dengue Fever in Children
- Currently, no effective antiviral agents are available to treat dengue infection, and treatment remains supportive 4
- Supportive treatment includes close hematological monitoring, recognition of warning signs of severe disease, and fluid-replacement therapy and/or blood transfusions when required 4
- Intravenous anti-D immune globulin may be a treatment option for refractory thrombocytopenia in dengue hemorrhagic fever 3
- However, platelet transfusions as a treatment for thrombocytopenia have no clear benefits in reduction of severe bleeding or improvement of the platelet count 5
Management of Severe Dengue Fever in Children
- Early suspicion and effective management can reduce the severity of dengue fever in children 2
- Myocardial dysfunction may be an additional factor for hypotension in dengue hemorrhagic fever, and myocardial functions need to be assessed in patients with this disease, especially those who have persistent hypotension in spite of adequate hydration 6
- The case fatality rate (CFR) for dengue fever in children is relatively low, at 1.03% 2