Management of dengue fever in infants

The article was professionally consulted by Doctor Nguyen Hung Tien - Department of Pediatrics - Neonatology - Vinmec Hai Phong International General Hospital.

Whether they are infants, children as well as adults, they all have two common causes of illness:
Caused by Dengue virus. Mosquitoes that feed on the blood of infected people spread the disease to healthy people. Of course, dengue fever will not spread from person to person as parents often worry. Usually children with dengue fever need to be identified in the first 3 days from the day the child has a fever. In addition, mothers should also note that at that time, they were in the midst of a dengue fever outbreak, or if anyone around them was sick.

Dengue is endemic in the tropics, mainly in Southeast Asia and the Western Pacific. Vietnam is one of the countries with severe outbreaks of the disease. In the North, the epidemic season usually starts from June to July and peaks in August, September, October, and November. In contrast, in the South, the epidemic tends to appear all year round, and tends to increase in the months of heavy rain and high humidity.

Dengue fever in infants, infants, children or adults is shown by the following symptoms:
High fever, sudden and continuous for 2-7 days. Difficulty lowering fever, muscle pain, joint pain, nausea, vomiting, abdominal pain, headache. After a few days, the patient will see signs of a rash, bleeding in different forms such as nosebleeds, petechiae under the skin, vomiting, blood in the urine, decreased white blood cells (4000/mL). ..In neonates, the disease occurs at a lower rate, often with symptoms that need to be distinguished from other diseases such as: sepsis, meningitis, respiratory tract infections, gastrointestinal infections..
Note the stages of dengue fever in children:
Usually children with dengue fever need to be identified in the first 3 days from the date of fever.
Day 1: The child has a high fever, sudden, red face, red throat but no pain. At this stage, it is not necessary to take the child to the hospital, but can stay at home for further monitoring. Day 2: If the child still has signs of high fever, the mother should try to look for signs of bleeding under the skin on the abdomen, limbs, neck, eyelids. Day 3: Dengue symptoms become more obvious. In addition to high fever, the baby may have bleeding from the skin and mucous membranes such as bleeding from the teeth and nose. Days 4, 5: The symptoms are clearer when the baby has red rashes all over the body, high fever, nosebleeds... Usually babies under 12 months old when they have dengue fever will have high fever symptoms, cough, little runny nose, many petechiae under the skin, enlarged liver, low red blood cell volume, low platelet count and a very high tendency to shock.
Therefore, during the dengue epidemic season, parents (and also medical staff) need to be careful because this disease is easily confused with babies under 12 months of age with respiratory symptoms. Delayed treatment can lead to unpredictable consequences.

Most cases of dengue fever in the early stages (no signs of bleeding) are treated at home. But this does not mean that complications do not occur. Therefore, children need to be closely monitored to promptly deal with complications. Ideally, the mother should take her baby to the hospital as soon as she notices unusual signs such as: fatigue, lethargy, abdominal pain, vomiting, heavy bleeding, cold hands and feet.
For the patient's family, it should be noted:
How to take care at home: Let the child rest and drink plenty of water. Food should be in liquid form so that it is easy for the child to swallow and does not cause vomiting. If the baby is still breastfed, the frequency of feedings should be increased. Dengue fever makes the blood concentrated and difficult to circulate, so the baby needs to drink a lot of water to avoid shock, because shock is the leading cause of death in those infected. Dengue fever usually develops in 7 days, most of which is self-limited, the rate of serious complications is only 3%-5%. Patients with the disease must necessarily go to the doctor, if severe symptoms such as abdominal pain, irritability, bleeding gums, nosebleeds, cold hands and feet appear, they should be taken immediately to the hospital. It is necessary to monitor to promptly handle when the child shows signs of shock. If your child has abdominal pain, vomiting, and cold hands and feet, you need to take the child to the emergency room immediately. Another manifestation of shock is that the child suddenly becomes lethargic, sometimes struggling, and not alert. Children may also experience a reduction in the number of times they urinate, but feel very thirsty. Bruised skin and gray lips are also signs of shock. The red spots in the skin are caused by some red blood cells escaping from the blood vessel wall to the outside of the skin to collect under the skin, causing a subcutaneous hemorrhage. These marks will disappear in 5-7 days. Therefore, it is not recommended to treat it in a folk way such as rubbing betel leaves on the skin or scraping the wind, which can hurt the baby's skin. Children should take fever-reducing medicine as prescribed by the doctor, do not let the child have a high fever, which can easily lead to convulsions. Families need to take the child to the doctor as soon as there are signs of vomiting, fever, fatigue, cold hands and feet, bleeding. Remember to schedule re-examination by appointment: every day until the fever is gone for > 48 hours.

The child has been fever free for at least 24 hours without the use of antipyretics. Children showed signs of appetite, good urination, and marked clinical improvement. There were no signs of respiratory failure due to pleural and peritoneal effusion. Platelet index 50000/mm3. If there are positive signs of improvement as above, the child can be discharged from the hospital by the family and receive further treatment at home.
Pediatrics department at Vinmec International General Hospital is the address for receiving and examining diseases that infants and young children are susceptible to: viral fever, bacterial fever, otitis media, pneumonia in children, .... With modern equipment, sterile space, minimizing the impact as well as the risk of disease spread. Along with that is the dedication from the doctors with professional experience with pediatric patients, making the examination no longer a concern of the parents.