Editor Emeritus
A Parthasarathy MD (Ped) DCH DSc (Hon) FIAP
Senior Consultant Pediatrician, AP Child Care, Chennai Former Distinguished Professor, Department of Pediatrics The Tamil Nadu Dr MGR Medical University Retired Senior Clinical Professor, Department of Pediatrics Madras Medical College, Chennai Deputy Superintendent Institute of Child Health and Hospital for Children Chennai, Tamil Nadu, India
Editor-in-Chief
PSN Menon MD MNANS FIAP FIMSA
Consultant and Head Department of Pediatrics Jaber Al-Ahmed Armed Forces Hospital Kuwait Former Professor of Pediatrics All India Institute of Medical Sciences New Delhi, India
Executive Academic Editor
Alok Gupta MD (Ped) FIAP
Pediatrician and Counselor Pediatric Specialties Clinic, Jaipur Formerly Assistant Professor in Pediatric Medicine Mahatma Gandhi Medical College and Hospital Jaipur, Rajasthan, India
Chief Academic Editors
MKC Nair MD MMedSc PhD DSc MBA FIAP
Formerly Vice-Chancellor Kerala University of Health Sciences, Thrissur Founder Director Child Development Center Government Medical College Thiruvananthapuram, Kerala, India
Piyush Gupta MD FNNF FIAP FAMS
Professor Department of Pediatrics University College of Medical Sciences and Guru Teg Bahadur Hospital New Delhi, India
Forewords
Digant D Shastri
Santosh T Soans
Bakul Parekh
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© 2020, Indian Academy of Pediatrics
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IAP Recent Advances in Pediatrics
First Edition: 2020
9789389776348
Printed at
_FM_5Dedicated to
The Academic-oriented Practitioners, Postgraduate Students in Pediatrics, its subspecialties and the Specialists in Neonatology, Pediatrics and Adolescent Medicine, who will be best benefited by selected topics in the subject to quench their thirst for recent advances in the field for their advanced learning and up-to-date knowledge and research. May they have the best of expertise to take care of the future generations in India and abroad.
_FM_6Academic Editors
- Dhanya Dharmapalan
- MD PG Dip in PID (Oxford)
- Consultant
- Department of Pediatrics and
- Pediatric Infectious Diseases
- Apollo Hospitals
- Navi Mumbai, Maharashtra, India
- P Ramachandran
- MD (Pediatrics) DNB (Pediatrics)
- Associate Dean (PG Studies) and
- Professor of Pediatrics
- Sri Ramachandra Medical College and
- Research Institute (SRMC and RI), and
- Sri Ramachandra Institute of Higher
- Education and Research (SRIHER)
- Chennai, Tamil Nadu, India
- Jaydeep Choudhury
- P Ramachandran
- MD (Pediatrics) DNB (Pediatrics)
- Associate Dean (PG Studies) and
- Professor of Pediatrics
- Sri Ramachandra Medical College and
- Research Institute (SRMC and RI), and
- Sri Ramachandra Institute of Higher
- Education and Research (SRIHER)
- Chennai, Tamil Nadu, India
- DNB (Ped) MNAMS FIAP
- Professor
- Department of Pediatrics
- Institute of Child Health
- Kolkata, West Bengal, India
- Remesh Kumar R
- MD FIAP
- Medical Superintendent and
- Senior Consultant and Head
- Department of Pediatrics
- Apollo Adlux Hospital
- Kochi, Kerala, India
- Digant D Shastri (President IAP 2019)
- Bakul Parekh (President IAP 2020)
- Piyush Gupta (President Elect 2020)
- Remesh Kumar R (Hony Sec Gen IAP 2018-19)
- Anupam Sibal MD FIMSA FIAP FRCP (Glasg) FRCP (Lon) FRCPCH FAAP
- Senior Consultant
- Pediatric Gastroenterologist and Hepatologist
- Indraprastha Apollo Hospital
- New Delhi, India
- Group Medical Director
- Apollo Hospitals Group
- Clinical Professor
- Faculty of Medicine and Health Sciences
- Macquarie University
- Sydney, Australia
- Anupama Borker MD
- Consultant and Head
- Department of Medical Oncology
- Goa Medical College
- Bambolim, Goa, India
- Anuradha Sovani MPhil PhD
- Professor and Head
- Department of Psychology
- Associate Dean Humanity
- SNDT Women's University
- Mumbai, Maharashtra, India
- Ashish Pathak DNB (Peds) FCPS Diploma in Global Health (KI, Sweden) PhD (Sweden)
- Professor
- Department of Pediatrics
- RD Gardi Medical College
- Ujjain, Madhya Pradesh, India
- Ashok S Kapse MD
- Professor and Head
- Department of Pediatrics
- Mahavir Superspecialty Hospital
- Surat, Gujarat, India
- Bakul Parekh MD DCH
- Head
- Bakul Parekh Children's Hospital (BPCH) and Multispecialty Tertiary Care Centre
- Mumbai, Maharashtra, India
- Camilla Rodrigues MD
- Consultant Microbiologist
- PD Hinduja Hospital and Medical Research Center
- Mumbai, Maharashtra, India
- Deepika Harit MD
- Associate Professor
- Department of Pediatrics
- University College of
- Medical Sciences and
- Guru Teg Bahadur Hospital
- New Delhi, India
- Dhanya Dharmapalan MD PG Dip in PID (Oxford)
- Consultant
- Department of Pediatrics and
- Pediatric Infectious Diseases
- Apollo Hospitals
- Navi Mumbai, Maharashtra, India
- Digant D Shastri MD (Ped) PGDHHM FIAP
- Senior Consultant Pediatrician and CEO
- Killol Children Hospital
- Surat, Gujarat, India
- Ganesh Ramaswamy DNB (Ped) MRCPCH MNAMS PhD
- Senior Consultant (Pediatrics and Metabolic Disorders)
- Rainbow Children's Hospital
- Chennai, Tamil Nadu, India
- Ira Shah MD DCH FCPS DNB DPID (UK)
- Professor and Head
- Department of Pediatric Infectious Diseases
- Nodal Officer
- Pediatric DR-TB Center and
- Pediatric HIV/ART Center
- BJ Wadia Hospital for Children
- Mumbai, Maharashtra, India
- Jaydeep Choudhury DNB (Ped) MNAMS FIAP
- Professor
- Department of Pediatrics
- Institute of Child Health
- Kolkata, West Bengal, India
- drjaydeep_choudhury@yahoo.co.in
- K Siddhanth Shetty MD (Pediatrics)
- Fellow Pediatric Intensive Care
- Narayana Health City
- Bengaluru, Karnataka, India
- Krishna Mohan R MBBS DNB Dip (Allergy & Asthma) MNAMS
- Consultant Pediatrician
- Government Taluk Hospital
- Kozhikode, Kerala, India
- M Vijayakumar MD DCH DNB FIAP FRCP
- Professor and Head
- Department of Pediatrics
- Government Medical College
- Manjeri, Kerala, India
- MR Lokeshwar MBBS MD DCH
- Consulting Pediatrician and
- Pediatric Hematologist/Oncologist
- Lilavati Hospital and Research Centre, Mumbai
- Shushrusha Citizens Cooperative
- Hospital Ltd
- Mumbai, Maharashtra, India
- Malathi Sathiyasekaran MD DCH MNAMS DM
- Consultant Pediatric Gastroenterologist
- Kanchi Kamakoti CHILDS Trust Hospital, SMF
- Rainbow Children's and
- Apollo Children's Hospital
- Chennai, Tamil Nadu, India
- Moinak Sen Sarma MD DM
- Assistant Professor
- Department of Pediatric Gastroenterology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Narendra Chaudhary
- MD IAP Fellowship and FNB (Pediatric Hematology Oncology)
- Associate Professor
- Department of Pediatrics
- All India Institute of Medical Sciences
- Bhopal, Madhya Pradesh, India
- Naveen Thacker MD
- Director
- Deep Children Hospital and
- Research Centre
- Gandhidham, Gujarat, India
- NC Gowrishankar MD DCH DNB FIAP
- Pediatric Pulmonologist and
- Bronchoscopist
- Head
- Pediatrics–Clinical
- Operations and Quality
- Mehta Multispecialty
- Hospital India Pvt Ltd
- Chennai, Tamil Nadu, India
- P Ramachandran MD (Pediatrics) DNB (Pediatrics)
- Associate Dean (PG Studies) and
- Professor of Pediatrics
- Sri Ramachandra Medical College and
- Research Institute (SRMC and RI), and
- Sri Ramachandra Institute of Higher
- Education and Research (SRIHER)
- Chennai, Tamil Nadu, India
- PAM Kunju
- MD DM (Neurology) WHO Fellowship Ped Neuro (USA) FIAPN
- Dean
- Faculty of Medicine
- University of Kerala
- Professor and Head
- Department of Pediatric Neurology
- Government Medical College
- Thiruvananthapuram, Kerala, India
- Pankaj Deshpande
- MRCP (Ped) MD (Ped) FCPS (Child Health) DCH
- Consultant Pediatric Nephrologist
- Hinduja Hospital, Mumbai
- Apollo Hospital, Belapur
- Hinduja Surgical, Navi Mumbai
- Maharashtra, India
- Piyush Gupta MD FNNF FIAP FAMS
- Professor
- Department of Pediatrics
- University College of
- Medical Sciences and
- Guru Teg Bahadur Hospital
- New Delhi, India
- PSN Menon MD MNANS FIAP FIMSA
- Consultant and Head
- Department of Pediatrics
- Jaber Al-Ahmed Armed Forces Hospital
- Kuwait
- Former Professor of Pediatrics
- All India Institute of Medical Sciences
- New Delhi, India
- Remesh Kumar R MD FIAP
- Medical Superintendent and
- Senior Consultant and Head
- Department of Pediatrics
- Apollo Adlux Hospital
- Kochi, Kerala, India
- Rhishikesh Thakre
- DM (Neonatology) MD DNB DCH FCPS FIAP
- Director
- Neo Clinic and Hospital
- Aurangabad, Maharashtra, India
- Sanjay Khatri MD DNB FNB
- Pediatric Cardiologist
- Fortis Escorts Hospital
- Jaipur, Rajasthan, India
- Santosh T Soans MD FIAP
- Professor and Head, Chief
- Neonatal and Pediatric Intensive Care Division
- AJ Institute of Medical Sciences and Research Centre
- Mangaluru, Karnataka, India
- Senthil Ganesh Kamaraj MS (Gen Surg) Mch (Paediatric Surgery) DNB (Paediatric Surgery)
- Consultant Pediatric Surgeon
- Kanchi Kamakoti CHILDS Trust Hospital
- Rainbow Children's Hospital
- Apollo Children's Hospital
- Chennai, Tamil Nadu, India
- Sheikh Minhaj Ahmed
- MD DNB MNAMS (Pediatric)
- Fellowship Pediatric Critical Care
- Pediatric Intensivist
- Lilavati Hospital and Research Center
- Mumbai, Maharashtra, India
- Shubha Phadke MD DM
- Professor and Head
- Department of Medical Genetics
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Smita Malhotra DNB (Peds) MRCPCH (UK)
- Consultant Pediatric Gastroenterology and Hepatology
- Indraprastha Apollo Hospitals
- New Delhi, India
- Snehal Desai
- DNB (Ped) IDPCC (Indian Diploma in Pediatric Critical Care)
- Fellowship in Neonatal Intensive Care
- Amruta Hospital
- Surat, Gujarat, India
- Surender Kumar Yachha MD DM
- Director
- Pediatrics and Pediatric Superspecialty
- Head
- Department of Pediatric Gastroenterology, Hepatology and Liver Transplant
- Sakra World Hospital
- Bengaluru, Karnataka, India
- Swati Kanakia MD DCH PhD
- Pediatric Hematologist Oncologist
- Lilavati Hospital and Research Centre and
- Kanakia Healthcare
- Mumbai, Maharashtra, India
- Swati Bhave MD DCH FCPS FIAP FAAP (HON)
- Adjunct Professor (Adolescent Medicine)
- Dr DY Patil Medical College, Pimpri and
- Dr DY Patil Vidyapeeth, Pune
- Senior Consultant (Adolescent Pediatrics)
- Head and In-charge
- Adolescent Wellness Clinic
- Jehangir Hospital, Pune
- Executive Director
- Association of Adolescent and Child Care in India (AACCI)
- Mumbai, Maharashtra, India
- Tanu Singhal MD MSc (LSHTM, UK)
- Consultant (Pediatrics and Infectious Diseases)
- Kokilaben Dhirubhai
- Ambani Hospital and
- Medical Research Institute
- Mumbai, Maharashtra, India
- Uday Bhaskar Post Graduate-DNB (Paediatric Surgery)
- Kanchi Kamakoti CHILDS Trust Hospital
- Chennai, Tamil Nadu, India
Indeed, it is proud privilege for me to write “Foreword” for “IAP Recent Advances in Pediatrics”.
The medical science is ever expanding and in era of consumerism, Google learned patients and cut-throat competition, it is imperative for practitioners to get their knowledge updated regularly. The availability of literature is so vast that at times one gets confused which book to read and which guidelines to be put in practice. On one side, there is availability of too much material and on other side, the readers do not have enough time to read these available materials and it ends with failure. To address this problem, regular Annual Release of IAP Recent Advances in Pediatrics is the best possible solution. The idea was conceptualized when I visited Dr A Parthasarathy at his home in the month of June 2019 and on my humble request Professor A Parthasarathy agreed to take the lead and guide us. We feel blessed to have Dr PSN Menon, Dr MKC Nair, Dr Piyush Gupta, Dr Alok Gupta, Dr Remesh Kumar, Dr Jaydeep Choudhary, Dr P Ramachandran and Dr Dhanya Dharmapalan on board to give final shape to this concept.
For busy practitioners, reading this comprehensive book on recent updates will be big boon as they do not need to refer several books. For the postgraduate students, it will enhance their knowledge with recent developments which will ultimately help them to have better performance in the examination and also to appear as well updated doctor to the Google generation of parents.
This book has been brought out as a “Pediatric Digest” like Pediatric Clinics of North America and Best Clinical Practice Research Series, consisting of 568 pages incorporating 28 chapters. Each major subspecialty is covered in this book by at least one chapter on a selected topic. The write-up provides the most recent review on the topic with clinical practice points by a chosen Indian Pediatric Experts in the field. The first volume of the book is ready to be released during PEDICON-2020, Indore, Madhya Pradesh, India.
My heartiest congratulations to editorial team as well as contributors for coming out with this ready reckoner for the practitioners. I am sure that it will be popular amongst readers.
Digant D Shastri
President 2019
_FM_13Foreword
The first decade of the 21st century brought a number of discoveries, mistakes, and medical advances that have influenced medicine from the patient's bedside to medicine cabinet. Medical knowledge has been expanding exponentially. Whereas the doubling time was an estimated 50 years back in 1950, it accelerated to 7 years in 1980, 3.5 years in 2010, and a projected 73 days by 2020, medicine will advance more in the next 10 years than it did in the last 100 years according to a 2011 study in transactions of the American Clinical and Climatological Association.
In some cases, these advances changed deep-seated beliefs in medicine; in others, they opened up possibilities beyond what doctors thought was possible years ago. Medicine is built on progress. Looking back over the past few decades, we have come along in leaps and bounds. But what lies ahead for the future of medicine? Change does not happen overnight, but the future looks bright. The new technologies will also make the world truly globalized…. herald the age of doctors without boundaries and patients without borders. Focusing on exponential growth trends in medicine, I feel in future books we bring out there is a need to emphasize more on futuristic learning-like artificial intelligence deep learning, genomics, which is coming in a big way.
With membership touching 31,000, IAP has an unimaginably large talent pool of doctors which the organization should tap for furthering the cause of medicine through knowledge sharing. I am extremely proud and happy to learn this team is bringing out this book, IAP Recent Advances in Pediatrics. IAP is blessed to have academicians such as Drs PSN Menon, MKC Nair, Piyush Gupta, Alok Gupta, Remesh Kumar, Jaydeep Choudhary, P Ramachandran and Dhanya Dharmapalan, who have given their heart and soul to bring out this book. Compiling this book would have taken extraordinary effort and I congratulate the editorial board as well as the individual contributors for giving us a well-rounded work. I wish the reader a fruitful reading experience.
Santosh T Soans
President 2018
_FM_15Foreword
Dear friends,
Season's Greetings!
It gives me great pleasure to write a foreword to a book which is edited by Professors A Parthasarathy, PSN Menon, MKC Nair, Piyush Gupta and Dr Alok Gupta.
The world has seen a tremendous technology-driven change in the last couple of decades. Many things that were expensive and affordable only to the wealthiest people are now within reach of the common man. The Internet, Mobile Phones and Tablets have reduced the cost of communication nearly to zero. Ready access to knowledge is no longer the privilege of the few. Today, anybody has immediate ready access to the knowledge online which would have taken us hours to find a few decades back. Also, the knowledge from across the globe is accessible right from the first day to everyone, irrespective of the distance or amount of knowledge involved. Such is the impact of technology.
Technology is not without its own limitations though. One of the major ones being an explosion of knowledge which may be difficult to understand. In such a scenario, we must stick to the Gold standards of authors who keep on giving consistently great books year after year.
IAP Recent Advances in Pediatrics is another feather in the cap of IAP Publications. Chapters on Recent Advances in Pediatrics on selected topics by experts in the field covering all aspects of Neonatology, Pediatrics and Adolescence was much needed and the concept of having it every year with different topics and authors will be most welcomed by all practicing as well as research-oriented pediatricians and postgraduate students in India and abroad.
I can definitely say that there is absolutely no compromise made to the science or the simplicity with which any pediatrician can understand the book.
I am certain that this book will be a great asset to all the practicing pediatricians and would take this opportunity to congratulate them on the herculean task that the team have managed together so easily once again. I would like to offer my best wishes to them and urge the practicing pediatricians as well as postgraduate students to go through this digest _FM_16completely from end to end so that you may derive maximum benefits from the hard work put in by the entire team.
Thank you once again Sirs, for giving me such an honor. May you and your efficient and passionate team continue enriching our lives with your wisdom.
Bakul Parekh
President 2020
Preface
It gives us great pleasure to present to you, IAP Recent Advances in Pediatrics, a baby of the Indian Academy of Pediatrics (IAP). This treatise on pediatrics covering the perinatal age to adolescence, is designed to be a regular annual release during PEDICON every year from 2020. The idea conceptualized by our doyen of Pediatrics, Dr A Parthasarathy, solemnized by IAP President 2019, Dr Digant D Shastri and CIAP Team 2019, has taken form of Healthy Cuddly Newborn destined to grow into a perfect young adult. The process has been lovingly nurtured by all the esteemed authors and co-authors who have put in the best systems and organs in this creation.
This book has been brought out as a “Pediatric Digest” like Pediatric Clinics of North America and Best Clinical Practice Research Series, consisting of 568 pages incorporating 28 chapters. Each major subspecialty is covered in this book by at least one chapter on a selected topic. The write-up provides the most recent review on the topic with clinical practice points by chosen Indian Pediatric Experts in the field.
The first volume of the book is now in your hands, after being released during PEDICON-2020, Indore, Madhya Pradesh, India. The book is being published by M/s Jaypee Brothers Medical Publishers, New Delhi, India. I thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy), Ms Pooja Bhandari (Production Head), Ms Kritika Dua (Senior Development Editor) and team of M/s Jaypee Brothers Medical Publishers, for burning the midnight oil in bringing out this tome in a very timely manner. I request you to please give your feedback to enable us to plan future editions.
Alok Gupta MD
Executive Academic Editor
(On behalf of the Editorial Board, IAP-RAP)