Hutchison’s Paediatrics

904 Pages·2012·36.21 MB·English

by  Devendra K. Gupta

HUtcHison’s
Paediatrics

HUtcHison’s
Paediatrics
Second Edition
Edited by
Krishna M Goel
MD DCH frCp (Lond, Edin and Glas) Hon frCpCH
Formerly Honorary Senior Lecturer of Child Health
University of Glasgow and Consultant paediatrician
at the royal Hospital for Sick Children
Yorkhill, Glasgow, Scotland, UK
Devendra K Gupta
MS MCh faMS (Hon) fCSS frCS (Edin) frCS (Glas) faMS (rom) DSc (Honoris Causa)
Vice Chancellor
Chhatrapati Shahuji Maharaj Medical University
Lucknow, Uttar pradesh, India
Foreword
Professor Terence Stephenson
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Hutchison's Paediatrics
First Edition: 2009
Second Edition: 2012
ISBN : 978-93-5025-771-5
Printed at
C
ontributors
Alastair Turner David James Honorary professor of Oral and
BSc Med Sci MBchB MRcPcH MBChB Dip Ed DCH DpM frCpsych frCp (Glas) Maxillofacial Surgery—Glasgow
Consultant paediatric Intensive Care retired Child psychiatrist formerly University, Consultant Oral and
Honorary Senior Clinical Lecturer at Department of Child and family Maxillofacial Surgeon —West of Scotland
University of Glasgow psychiatry plastic and Maxillofacial Unit
royal Hospital for Sick Children royal Hospital for Sick Children Canniesburn Hospital
Glasgow, Scotland, UK Glasgow, Scotland, UK Glasgow Civilian Consultant
to the royal Navy
Alison M Cairns Devendra K Gupta
Scotland, UK
MSc BDS MfDS frCS (Edin) M paed Dent (rCpSG) MS MCh faMS (Hon) fCSS frCS (Edin) frCS (Glas)
Clinical Lecturer in paediatric Dentistry faMS (rom) DSc (Honoris Causa) Kirsteen J Thompson
University of Glasgow Dental Hospital Vice Chancellor MSc frCS (Edin)
and School, Glasgow, Scotland, UK Chhatrapati Shahuji Maharaj Medical Consultant Ophthalmologist
University Inverclyde royal Hospital
Anne Margaret Devenny Lucknow, Uttar pradesh, India Greenock, Scotland, UK
MBChB MrCp (UK) frCpCH
paediatric respiratory Consultant Elizabeth A Chalmers Krishna M Goel
royal Hospital for Sick Children MBChB MD MrCp (UK) frCpath MD DCH frCp (Lond, Edin & Glas) Hon frCpCH
Glasgow, Scotland, UK Consultant paediatric Haematologist formerly Honorary Senior Lecturer of
royal Hospital for Sick Children Child Health, University of Glasgow and
Beena Koshy Glasgow, Scotland, UK Consultant paediatrician
MBBS MD (paed) pDfDp royal Hospital for Sick Children
assistant professor of Developmental James Wallace Glasgow, Scotland, UK
paediatrics, Christian Medical College BSc Mr pharmS frCpCH (Hon)
Vellore, Tamil Nadu, India Chief pharmacist Louis Low
Yorkhill Hospitals MBChB MrCp (UK) frCp (Lond, Edin & Glas)
Benjamin Joseph Glasgow, Scotland, UK frCpCH
MS Orth MCh Orth Honorary Clinical professor in paediatrics
professor of Orthopaedics and Head of Jean Herbison Department of paediatrics
paediatric Orthopaedic Service MBChB MrCp frCpCH DCCH MffLM and adolescent Medicine
Kasturba Medical College Consultant paediatrician and Clinical The University of Hong Kong
Manipal 576104, Karnataka, India Director for Child protection Services Queen Mary Hospital
Greater Glasgow and Clyde Health Board pokfulam, Hong Kong
Christina Halsey Child protection Unit
BM Bch Ba (Hons) MrCp MrCpath phD royal Hospital for Sick Children Lydia Edward Raj
Honorary Consultant paediatric MSOT
Glasgow, Scotland, UK
Haematologist and Scottish Senior reader (In-charge OT Education)
Clinical fellow Judy Ann John Department of physical Medicine
Department of paediatric Haematology MD DipNB (pMr) and rehabilitation
royal Hospital for Sick Children associate professor Christian Medical College
Glasgow, Scotland, UK Department of physical Medicine and Vellore, Tamil Nadu, India
rehabilitation
Chikkanayakanahali Manjunatha Christian Medical College Margo L Whiteford
MD (paed) DCH DNB (paed) MrCp (UK) frCpCH BSc frCp (Glasgow)
Vellore, Tamil Nadu, India
Consultant Neonatologist Consultant Clinical Geneticist
Wishaw General Hospital ferguson-Smith Centre for Clinical Genetics
Jugesh Chhatwal
50, Netherton road MD DCH Yorkhill Hospital
Wishaw ML2 0Dp professor and Head of paediatrics Glasgow, Scotland, UK
Lanarkshire, Scotland, UK Christian Medical College
Mary Mealyea
Ludhiana, punjab, India
Craig Williams MBChB Diploma in Dermatology
MD frCp frCpath associate Specialist in paediatric
Khursheed F Moos
Consultant Microbiologist Dermatology
MBBS (Lond) BDS (Lond) frCS (Edin) fDS rCS (Eng
royal Hospital for Sick Children royal Hospital for Sick Children
and Edin) fDS rCpS (Glasg) frCpS (Glasg) Honorary
Glasgow, Scotland, UK fCpS (pakistan) Honorary OBE Glasgow, Scotland, UK
Hutchison's Paediatrics 
vvii
Maya Mary Thomas Richard Welbury Sarada David
MBBS DCH MD (paeds) DM (Neuro) BDS (Hons) MBBS phD fDSrCS fDSrCpS MS DO
associate professor and paediatric frCpCH professor and Head
Neurologist, Department of Neurological professor of paediatric Dentistry Department of Ophthalmology
Sciences, Christian Medical College University of Glasgow Dental Hospital Christian Medical College
Vellore, Tamil Nadu, India and School Vellore, Tamil Nadu, India
Glasgow, Scotland, UK
Michael Morton Shilpa Sharma
Mphil Ma MBChB frCpsych frCpCH Robert Carachi MS MCh DNB phD
Consultant Child & adolescent psychiatrist MD phD frCS (Glas & Eng) fEBpS associate professor
In-patient & Liaison Child & adolescent professor of Surgical paediatrics paediatric Surgery
psychiatry with Neuropsychiatry University of Glasgow 416 administration Block
Department of Child & family psychiatry royal Hospital for Sick Children pGIMEr, Dr rML Hospital
royal Hospital for Sick Children Glasgow, Scotland, UK Baba Kharg Singh Marg
Glasgow, Scotland, UK Connaught place
Rosemary Anne Hague New Delhi, India
NV Doraiswamy
MD MrCp (UK) frCpCH
MS frCS (Edin & Glas) fICS fISS ffaEM frCpCH
Consultant Surgeon (retd) Consultant paediatric ID/Immunology Syed Rehan Ali
Yorkhill NHS Trust MB DCH MrCp frCp
royal Hospital for Sick Children
royal Hospital for Sick Children assistant professor and Consultant in
Glasgow, Scotland, UK
Glasgow, Scotland, UK Neonatal Medicine
Paul Galea Director of Neonatal Services
MD DCH frCp (Glas) frCpCH Rosemary Sabatino Department of paediatrics and Child Health
Consultant paediatrician Trainer and Educator aga Khan University Hospital
royal Hospital for Sick Children Crisis Care Training International Karachi, pakistan
Glasgow, Scotland, UK
International Office
Peter Galloway pO Box 517, fort Mill Tahmeed Ahmed
MBBS phD
BSc DCH frCp (Edin & Glas) frCpath South Carolina, USa
Head, Nutrition programme Scientist
Consultant Medical Biochemist
Clinical Sciences Division
royal Hospital for Sick Children, Samuel E Ibhanesebhor
International Centre for Diarrhoeal
Glasgow, Scotland, UK fWaCp fMCpaed frCpCH frCp (Glasg)
Consultant Neonatologist Diseases research, B
Phyllis Kilbourn Wishaw General Hospital Dhaka, Bangladesh
International Director 50, Netherton road
Crisis Care Training International Wishaw ML2 0Dp Trevor Richens
International Office, PO Box 517 Lanarkshire, Scotland, UK MBBS BSc (Hons) MrCp (Lond)
Consultant paediatric Cardiologist
fort Mill, South Carolina, USa
royal Hospital for Sick Children
Sandra J Butler
Prabhakar D Moses Glasgow, Scotland, UK
BSc (Hons) MBChB MrCpCH frCr
MBBS MD (paed) MrCp (UK) frCp (Edin) fCaMS
Consultant paediatric radiologist
professor and Head of paediatrics Unit 111 Zulfiqar Ahmed Bhutta
royal Hospital for Sick Children
Christian Medical College
Glasgow, Scotland, UK MBBS frCp frCpCH fCpS phD
Vellore, Tamil Nadu, India
The Husein Lalji Dewraj
Rajeev Srivastava Sanjay V Maroo professor and Chairman
MBBS MS (Orth) frCS (G) frC path MBChB M-Med frCr Department of pediatrics and Child Health
Consultant Medical Biochemist Consultant paediatric radiologist The aga Khan University and
royal Hospital for Sick Children royal Hospital for Sick Children Medical Center
Glasgow, Scotland, UK Glasgow, Scotland, UK Karachi, pakistan
F
oreword
The world moves at a frightening pace and sometimes I hear a view expressed that textbooks are a thing of the past. We
should be able to get all the information we need from the Internet and what is more, it is argued, it is more likely to be up-
to-date. I disagree. I think there is still a place for a well written, comprehensive textbook and I use the books on my shelves
most days. The reader can have confidence in the contents if they are familiar with the authors and editors and this is an
advantage that has to be set against the potential benefits of electronic information. Whilst the Internet is likely to be updated
in real time, there is very little peer review or filtering of the information placed on it and the reader can rarely be sure of
the provenance of the opinions expressed.
I am delighted that Krishna M Goel and Devendra K Gupta have produced the second edition of their marvellous
textbook Hutchison’s Paediatrics. This will be of great value to all those who use it, whether students, or those preparing for
professional examinations, or simply (like myself) keeping up-to-date or finding the answers to difficult clinical problems in
daily practice.
James Holmes Hutchison graduated at the University of Glasgow. He served in the Second World War rising to the
rank of Lieutenant Colonel and was awarded an Order of the British Empire in 1945. He returned to the Hospital for Sick
Children in Glasgow and subsequently became the Samson Gemmel professor in paediatrics. He was president of the royal
College of physicians and Surgeons of Glasgow, then became president of the British paediatric association and then served
as Dean of the faculty of Medicine in Glasgow. following his time in Glasgow, he was appointed professor of paediatrics
at the University of Hong Kong.
I hope you enjoy reading Hutchison’s Paediatrics in this new edition as much as I have.
Professor Terence Stephenson
DM frCp (Lon) frCpCH
president
royal College of paediatrics and Child Health
University of Nottingham
Nottingham, UK

P s e
reFaCe to the eCond dition
The patterns of childhood disease throughout the world are changing with advancing knowledge, altering standards of living,
lifestyle and rising levels of medical care. The origins of physical and mental health and disease lie predominantly in the early
development of the child. Most of the abnormalities affecting the health and behaviour of children are determined prenatally
or in the first few years of life by genetic and environmental factors. The authors have summarised the current knowledge of
causation and have indicated where health education and prevention might reduce the burden of childhood ill health.
The more diverse authorship of chapters in this second edition reflects the growing dependence upon cooperative interests
of colleagues in paediatrics. In clinical practice, such collaborative work can only be accomplished within a large hospital
or a unit devoted to children. Both editors have been fortunate to work in such an environment and believe that the highest
standards of paediatric practice can only be attained in such circumstances. In this, the second edition, we welcome ten new
contributors. In this book we seek to provide practical advice about the diagnosis, investigation and management of the full
spectrum of childhood disorders, both medical and surgical. We have tried to indicate, and where appropriate to describe,
techniques and laboratory investigations which are necessary for advanced diagnosis and up-to-date therapy. attention is
directed to the special problems which arise in the developing countries. The need for such a text has been confirmed by the
success of the first edition, published in 2009. As is often the case, space limitation demands some selectivity of content. It
is intended in a true apprenticeship fashion of teaching to provide a manageable, readable and practical account of clinical
paediatrics for medical undergraduates, for postgraduates specialising in paediatrics and for general practitioners whose
daily work is concerned with care of children in health and sickness. Knowledge within the field of paediatrics continues to
increase exponentially. accordingly, many chapters in this edition were completely revised, updated and extended with an
additional four chapters. Many figures illustrating salient concepts summarising clinical findings and treatment results have
been added.
We are especially grateful to the parents and to the many children and their families who contributed to our knowledge
and understanding of paediatrics and willingly gave permission to reproduce photographs of their children. a book such as
this cannot be written without reproducing material reported in the medical literature. We acknowledge here, with gratitude,
the permission granted free of charge by individual publishers to reproduce material for which they hold the copyright.
We particularly wish to thank the Hutchison family for allowing us to use the name of the late professor James Holmes
Hutchison, the author of 'practical paediatric problems' to enable us to title this book Hutchison's Paediatrics. Even today,
Hutchison's name is highly respected in the paediatric world.
finally, we are grateful to the various contributors to this second edition for their cooperation in its production.
Krishna M Goel
Devendra K Gupta