Objectives:To evaluate and analyze the clinical and laboratory parameters that were predictive of the development of shock in children with dengue fever.Subjects and Methods:Retrospective study carried out from August 2012 to July 2014 at a tertiary care hospital in Puducherry.Results:Two hundred and fifty-four children were admitted with dengue fever and among them dengue fever without shock was present in 159 children (62.5%) and dengue fever with shock was present in 95 cases (37.4%). Various clinical and laboratory parameters were analyzed using univariate and multivariate logistic regression between the two groups and a P value of <0.05 was taken as significant. The most common risk factors for shock on univariate analysis were headache, retro-orbital pain, palmar erythema, joint pain, facial flush, splenomegaly, lymphadenopathy, bleeding, giddiness, persistent vomiting, pleural effusion, ascites, hematocrit >20% with concomitant platelet count <50,000/mm3 on admission, deranged liver function tests, and gallbladder wall edema. On multivariate analysis, it was seen that in age >6 years, hepatomegaly, pain in the abdomen, and oliguria were the most common risk factors associated with shock in children with dengue fever. There were six deaths (2.4%) and out of them four presented with impaired consciousness (66.6%) at the time of admission.Conclusion:Age >6 years, hepatomegaly, abdomen pain, and oliguria were the most common risk factors for shock in children with dengue fever. Impaired consciousness at admission was the most ominous sign for mortality in dengue fever. Hence, these features should be identified early, monitored closely, and managed timely.

Background: The objective of the study was to evaluate and analyze the role of preceding early warning signs at admission in children with severe dengue infection.Methods: All children (0-12 y of age) diagnosed and confirmed as dengue fever admitted at a tertiary care hospital at Puducherry were retrospectively analysed from hospital case records as per the revised World Health Organization(WHO) guidelines 2009 for dengue fever. The data was analysed by descriptive statistics using SPSS 16.0 statistical software. Early warning signs were analyzed by logistic regression and a P-value of <0.05 was taken as significant.Results: Out of 360 children confirmed with diagnosis of dengue fever, non-severe and severe dengue infection was seen in 214(59.4%) and 146 cases (40.6%) respectively. The most common manifestation of severe dengue infection were shock (40.6%), bleeding (16.7%) and multiorgan failure (2.2%). On logistic regression, the warning signs most commonly associated with severe dengue infection were pain abdomen, hepatomegaly, hypotension at admission and HCT>20% with concomitant platelet<50,000/mm3. Clinical variables which were unlisted in the revised guidelines but significantly associated with severe dengue infection were Age >6 yrs, retro-orbital pain, palmar erythema, joint pain, splenomegaly, positive tourniquet test, right hypochondriac pain and epigastric tenderness.Conclusions: Early identification of the preceding warning signs, timely intervention and vigilant monitoring can reduce the morbidity and mortality in children with severe dengue infection. Since there were other clinical variables not enlisted as warning signs but were significantly associated with severe dengue infection, the list of warning signs in the revised guidelines needs to be expanded.

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