Management of Dengue in Children

Initial Assessment and Classification

The American Academy of Pediatrics recommends assessing for warning signs of severe dengue, including high hematocrit with rapidly falling platelet count, severe abdominal pain, persistent vomiting, lethargy or restlessness, and mucosal bleeding in children with suspected dengue 1
Monitoring for signs of shock, including tachycardia, hypotension, poor capillary refill, and altered mental status, is crucial in the initial assessment of children with dengue 1

The World Health Organization recommends oral rehydration as the first line of treatment for patients with dengue without shock, and avoiding routine use of bolus intravenous fluids in patients with severe febrile illness who are not in shock 1, 2
For children with dengue shock syndrome, an initial fluid bolus of 20 mL/kg of isotonic crystalloid solution should be administered, with careful patient reassessment afterward 1, 2

The American College of Critical Care Medicine recommends watching for clinical indicators of adequate tissue perfusion, including normal capillary refill time, absence of skin mottling, warm and dry extremities, well-felt peripheral pulses, return to baseline mental status, and adequate urine output in children with dengue 1
Be vigilant during the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock in children with dengue 1

For patients with persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required, as recommended by the Society of Critical Care Medicine 1
Blood transfusion may be necessary in cases of significant bleeding in children with dengue, according to the American Academy of Pediatrics 1

The Infectious Diseases Society of America recommends hospitalization for children with moderate to severe dengue, especially those with respiratory distress or hypoxemia 3
Admission to ICU is indicated for children requiring ventilatory support, having impending respiratory failure, sustained tachycardia, inadequate blood pressure, or altered mental status, as recommended by the Pediatric Infectious Diseases Society 3