Teaching Pediatric Life Support in Limited-Resource Settings: Contextualized Management Guidelines

Abstract

Of the estimated 6.3 million global annual deaths in children younger than the age of 5 years, nearly all (99%) occur in low- to middle-income countries (LMIC). Existing management guidelines for children with emergency conditions as taught in a variety of current pediatric life support courses are mostly applicable to high-income countries with a different disease range and full resources compared with LMIC. A revised curriculum with evidence-based application to limited-resource settings would expand their potential for reducing pediatric mortality worldwide. This review provides a supplemental curriculum of standards for selected pediatric emergency conditions with attention to the context of disease range and level-specific resources in LMIC. During training sessions, contextualized management guidelines create the framework for realistic and fruitful case simulations.

Keywords

Pediatric Advanced Life Support - cardiopulmonary resuscitation - pediatric emergency conditions - limited-resource setting - mortality

• References

• 1 Liu L, Oza S, Hogan D. , et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385 (9966): 430-440
• 2 Wang H, Liddell CA, Coates MM. , et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384 (9947): 957-979
• 3 The World Bank. GNI per capita, Atlas method (current US$), 2013. Available at: http://data.worldbank.org/indicator/NY.GNP.PCAP.CD . Accessed April 16, 2015
• 4 Källander K, Hildenwall H, Waiswa P, Galiwango E, Peterson S, Pariyo G. Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ 2008; 86 (05) 332-338
• 5 Viana ME, Valete CO, Sgorlon G. , et al. An international perspective on the treatment of pediatric shock: the Brazilian experience. New Horiz 1998; 6 (02) 226-234
• 6 Nair H, Simões EAF, Rudan I. , et al; Severe Acute Lower Respiratory Infections Working Group. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 2013; 381 (9875): 1380-1390
• 7 Reyes H, Tomé P, Guiscafré H. , et al. [The verbal autopsy on children with a respiratory infection and acute diarrhea. An analysis of the disease-care-death process]. Bol Med Hosp Infant Mex 1993; 50 (01) 7-16
• 8 De Francisco A, Schellenberg JA, Hall AJ, Greenwood AM, Cham K, Greenwood BM. Comparison of mortality between villages with and without Primary Health Care workers in Upper River Division, The Gambia. J Trop Med Hyg 1994; 97 (02) 69-74
• 9 Molyneux E. Paediatric emergency care in developing countries. Lancet 2001; 357 (9250): 86-87
• 10 Gove S, Tamburlini G, Molyneux E, Whitesell P, Campbell H. Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project. Arch Dis Child 1999; 81 (06) 473-477
• 11 Oliveira CF, Nogueira de Sá FR, Oliveira DS. , et al. Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care 2008; 24 (12) 810-815
• 12 Tamburlini G, Di Mario S, Maggi RS, Vilarim JN, Gove S. Evaluation of guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child 1999; 81 (06) 478-482
• 13 Robertson MA, Molyneux EM. Triage in the developing world—can it be done?. Arch Dis Child 2001; 85 (03) 208-213
• 14 Olotu A, Ndiritu M, Ismael M. , et al. Characteristics and outcome of cardiopulmonary resuscitation in hospitalised African children. Resuscitation 2009; 80 (01) 69-72
• 15 Wright SW, Steenhoff AP, Elci O. , et al. Impact of contextualized pediatric resuscitation training on pediatric healthcare providers in Botswana. Resuscitation 2015; 88: 57-62
• 16 Ralston ME, Day LT, Slusher TM, Musa NL, Doss HS. Global paediatric advanced life support: improving child survival in limited-resource settings. Lancet 2013; 381 (9862): 256-265
• 17 World Health Organization. Handbook: IMCI Integrated Management of Childhood Illness. Geneva: WHO Press; 2005
• 18 World Health Organization. Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources. Geneva: WHO Press; 2013
• 19 World Health Organization. Evidence for Technical Update of Pocket Book Recommendations: Recommendations for the Management of Common Childhood Conditions with Limited Resources: Newborn Conditions, Dysentery, Pneumonia, Oxygen Use and Delivery, Common Causes of Fever, Severe Acute Malnutrition and Supportive Care. Geneva: WHO Press; 2012
• 20 Grant JB, Saltzman AR. Respiratory functions of the lung. In: Textbook of Pulmonary Diseases, 5th ed. Baum GL, Wolinsky E. , eds. Boston: Little, Brown; 1994
• 21 Bickler PE, Feiner JR, Severinghaus JW. Effects of skin pigmentation on pulse oximeter accuracy at low saturation. Anesthesiology 2005; 102 (04) 715-719
• 22 Feiner JR, Severinghaus JW, Bickler PE. Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth Analg 2007; 105 (6, Suppl): S18-S23
• 23 Mahle WT, Newburger JW, Matherne GP. , et al; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research; American Academy of Pediatrics Section on Cardiology and Cardiac Surgery, and Committee on Fetus and Newborn. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation 2009; 120 (05) 447-458
• 24 American Heart Association. Pediatric Advanced Life Support Provider Manual. Dallas: American Heart Association; 2011
• 25 Engorn G, Flerlage J. The Harriet Lane Handbook. 20th ed. The Johns Hopkins Hospital. Philadelphia: Elsevier Saunders; 2015
• 26 Al-Mutairi B, Kirk V. Bacterial tracheitis in children: approach to diagnosis and treatment. Paediatr Child Health (Oxford) 2004; 9 (01) 25-30
• 27 Grisaru-Soen G, Komisar O, Aizenstein O, Soudack M, Schwartz D, Paret G. Retropharyngeal and parapharyngeal abscess in children—epidemiology, clinical features and treatment. Int J Pediatr Otorhinolaryngol 2010; 74 (09) 1016-1020
• 28 Inman JC, Rowe M, Ghostine M, Fleck T. Pediatric neck abscesses: changing organisms and empiric therapies. Laryngoscope 2008; 118 (12) 2111-2114
• 29 Daya H, Lo S, Papsin BC. , et al. Retropharyngeal and parapharyngeal infections in children: the Toronto experience. Int J Pediatr Otorhinolaryngol 2005; 69 (01) 81-86
• 30 Craig FW, Schunk JE. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. Pediatrics 2003; 111 (6 Pt 1): 1394-1398
• 31 McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg 2003; 129 (11) 1207-1212
• 32 American Heart Association. Basic Life Support for Healthcare Providers. Dallas: American Heart Association; 2011
• 33 Dubey SP, Garap JP. Paediatric tracheostomy: an analysis of 40 cases. J Laryngol Otol 1999; 113 (07) 645-651
• 34 Shafi M, Suhail Z, Ashrafi SK, Sajjad SM. Frequency of tracheobronchial foreign bodies and their management in urban population of Sindh. J Pak Med Assoc 2012; 62 (09) 896-899
• 35 Chan PW, Goh A, Lum L. Severe upper airway obstruction in the tropics requiring intensive care. Pediatr Int 2001; 43 (01) 53-57
• 36 Ozmen S, Ozmen OA, Unal OF. Pediatric tracheotomies: a 37-year experience in 282 children. Int J Pediatr Otorhinolaryngol 2009; 73 (07) 959-961
• 37 Süslü N, Ermutlu G, Akyol U. Pediatric tracheotomy: comparison of indications and complications between children and adults. Turk J Pediatr 2012; 54 (05) 497-501
• 38 Ohn M, Jacobe S. Magnesium should be given to all children presenting to hospital with acute severe asthma. Paediatr Respir Rev 2014; 15 (04) 319-321
• 39 Ralston SL, Lieberthal AS, Meissner HC. , et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134 (05) e1474-e1502
• 40 Zar HJ, Brown G, Donson H, Brathwaite N, Mann MD, Weinberg EG. Home-made spacers for bronchodilator therapy in children with acute asthma: a randomised trial. Lancet 1999; 354 (9183): 979-982
• 41 American College of Surgeons Committee on Trauma. Advanced Trauma Life Support® for Doctors Student Course Manual. 9th ed. Chicago: American College of Surgeons; 2012
• 42 World Health Organization. Guidelines for the Treatment of Malaria. 2nd ed. Geneva: WHO Press; 2010
• 43 World Health Organization. Management of Severe Malaria: A Practical Handbook. 3rd ed. Geneva: WHO Press; 2012
• 44 World Health Organization. Severe malaria. Trop Med Int Health 2014; 19 (Suppl. 01) 7-131
• 45 Maitland K. Management of severe paediatric malaria in resource-limited settings. BMC Med 2015; 13: 42
• 46 World Health Organization. The Treatment of Diarrhoea. A Manual for Physicians and Other Senior Health Workers. Geneva: WHO Press; 2005
• 47 Guarino A, Albano F, Ashkenazi S. , et al; European Society for Paediatric Gastroenterology, Hepatology, and Nutrition; European Society for Paediatric Infectious Diseases. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe. J Pediatr Gastroenterol Nutr 2008; 46 (Suppl. 02) S81-S122
• 48 Gorelick MH, Shaw KN, Murphy KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics 1997; 99 (05) E6
• 49 Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated?. JAMA 2004; 291 (22) 2746-2754
• 50 Low-osmolarity ORS. Available at: http://www.agsbrands.com/oral-rehydration-salts . Accessed May 4, 2015
• 51 Armon K, Riordan A, Playfor S, Millman G, Khader A. ; Paediatric Research Society. Hyponatraemia and hypokalaemia during intravenous fluid administration. Arch Dis Child 2008; 93 (04) 285-287
• 52 Moritz ML, Ayus JC. Hospital-acquired hyponatremia—why are hypotonic parenteral fluids still being used?. Nat Clin Pract Nephrol 2007; 3 (07) 374-382
• 53 Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev 2002; 1 (01) CD002847
• 54 Khilnani P, Singhi S, Lodha R. , et al. Pediatric sepsis guidelines: summary for resource-limited countries. Indian J Crit Care Med 2010; 14 (01) 41-52
• 55 Akech SO, Karisa J, Nakamya P, Boga M, Maitland K. Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia. BMC Pediatr 2010; 10: 71
• 56 UNICEF. Unite for Children. Technical Bulletin No. 17. ReSoMal. Available at: http://www.unicef.org/supply/files/Resomal.pdf . Accessed May 4, 2015
• 57 World Health Organization. WHO Recommendations on the Management of Diarrhoea and Pneumonia in HIV-Infected Infants and Children: Integrated Management of Childhood Illness (IMCI). Geneva: WHO Press; 2010
• 58 Khan WA, Saha D, Rahman A, Salam MA, Bogaerts J, Bennish ML. Comparison of single-dose azithromycin and 12-dose, 3-day erythromycin for childhood cholera: a randomised, double-blind trial. Lancet 2002; 360 (9347): 1722-1727
• 59 Barennes H, Valea I, Nagot N, Van de Perre P, Pussard E. Sublingual sugar administration as an alternative to intravenous dextrose administration to correct hypoglycemia among children in the tropics. Pediatrics 2005; 116 (05) e648-e653
• 60 Graz B, Dicko M, Willcox ML. , et al. Sublingual sugar for hypoglycaemia in children with severe malaria: a pilot clinical study. Malar J 2008; 7: 242
• 61 Duke T. CPAP: a guide for clinicians in developing countries. Paediatr Int Child Health 2014; 34 (01) 3-11
• 62 Dellinger RP, Levy MM, Rhodes A. , et al; Surviving Sepsis Campaign Guidelines Committee Including the Pediatric Subgroup. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39 (02) 165-228
• 63 de Caen AR, Berg MD, Chameides L. , et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132 (18) (Suppl. 02) S526-S542
• 64 World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva: WHO Press; 2009 . Available at: http://www.who.int/tdr/publications/documents/dengue-diagnosis.pdf . Accessed April 16, 2015
• 65 Maitland K, Kiguli S, Opoka RO. , et al; FEAST Trial Group. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011; 364 (26) 2483-2495
• 66 Maitland K, George EC, Evans JA. , et al; FEAST trial group. Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial. BMC Med 2013; 11: 68
• 67 Opiyo N, Molyneux E, Sinclair D, Garner P, English M. Immediate fluid management of children with severe febrile illness and signs of impaired circulation in low-income settings: a contextualised systematic review. BMJ Open 2014; 4 (04) e004934
• 68 Tecklenburg FW, Cochran JB, Webb SA, Habib DM, Losek JD. Central venous access via external jugular vein in children. Pediatr Emerg Care 2010; 26 (08) 554-557
• 69 Cardiac Monitoring System. In: An ECG Primer. Nursecom Educational Technologies, 2003. Available at: http://www.nursecom.com/ECGprimer.pdf . Accessed May 4, 2015
• 70 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2 (7872): 81-84
• 71 Davis RJ. , et al. Head and spinal cord injury. In: Rogers MC. ed. Textbook of Pediatric Intensive Care. Baltimore: Williams & Wilkins; 1987
• 72 James H, Anas N, Perkin RM. Brain Insults in Infants and Children. New York: Grune & Stratton; 1985
• 73 Morray JP, Tyler DC, Jones TK, Stuntz JT, Lemire RJ. Coma scale for use in brain-injured children. Crit Care Med 1984; 12 (12) 1018-1020
• 74 Molyneux ME, Taylor TE, Wirima JJ, Borgstein A. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. Q J Med 1989; 71 (265) 441-459
• 75 Newton CR, Chokwe T, Schellenberg JA. , et al. Coma scales for children with severe falciparum malaria. Trans R Soc Trop Med Hyg 1997; 91 (02) 161-165
• 76 Roach ES, Golomb MR, Adams R. , et al; American Heart Association Stroke Council; Council on Cardiovascular Disease in the Young. Management of stroke in infants and children: a scientific statement from a special writing group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 2008; 39 (09) 2644-2691
• 77 American Academy of Pediatrics Committee on Fetus and Newborn. Controversies concerning vitamin K and the newborn. Pediatrics 2003; 112 (1 Pt 1): 191-192
• 78 World Health Organization and United Nations Children's Fund. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. A Joint Statement by the World Health Organization and the United Nations Children's Fund. Geneva: WHO Press; New York: UNICEF Press; 2009
• 79 Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year?. Lancet 2003; 361 (9376): 2226-2234
• 80 Chisti MJ, Tebruegge M, La Vincente S, Graham SM, Duke T. Pneumonia in severely malnourished children in developing countries - mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Trop Med Int Health 2009; 14 (10) 1173-1189
• 81 Falade AG, Tschäppeler H, Greenwood BM, Mulholland EK. Use of simple clinical signs to predict pneumonia in young Gambian children: the influence of malnutrition. Bull World Health Organ 1995; 73 (03) 299-304
• 82 Shann F, Barker J, Poore P. Clinical signs that predict death in children with severe pneumonia. Pediatr Infect Dis J 1989; 8 (12) 852-855
• 83 Maitland K. Joint BAPEN and Nutrition Society Symposium on ‘Feeding size 0: the science of starvation’. Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock. Proc Nutr Soc 2009; 68 (03) 274-280
• 84 Duke T, Mgone J, Frank D. Hypoxaemia in children with severe pneumonia in Papua New Guinea. Int J Tuberc Lung Dis 2001; 5 (06) 511-519
• 85 Demers AM, Morency P, Mberyo-Yaah F. , et al. Risk factors for mortality among children hospitalized because of acute respiratory infections in Bangui, Central African Republic. Pediatr Infect Dis J 2000; 19 (05) 424-432
• 86 Clifton DC, Ramadhani HO, Msuya LJ. , et al. Predicting mortality for paediatric inpatients where malaria is uncommon. Arch Dis Child 2012; 97 (10) 889-894
• 87 Chisti MJ, Salam MA, Ashraf H. , et al. Prevalence, clinical predictors, and outcome of hypocalcaemia in severely-malnourished under-five children admitted to an urban hospital in Bangladesh: a case-control study. J Health Popul Nutr 2014; 32 (02) 270-275
• 88 Manning SC, Ridenour B, Brown OE, Squires J. Measles: an epidemic of upper airway construction. Otolaryngol Head Neck Surg 1991; 105: 414-418
• 89 Kalter HD, Gray RH, Black RE, Gultiano SA. Validation of postmortem interviews to ascertain selected causes of death in children. Int J Epidemiol 1990; 19: 380-386
• 90 World Health Organization. Measles Fact Sheet. Available at: http://www.who.int/mediacentre/factsheets/fs286/en/ . Accessed May 4, 2015
• 91 World Health Organization. HIV Fact Sheet. Available at: http://www.who.int/mediacentre/factsheets/fs360/en . Accessed May 4, 2015
• 92 Gray D, Zar HJ. Management of community-acquired pneumonia in HIV-infected children. Expert Rev Anti Infect Ther 2009; 7: 437-451
• 93 McNally LM, Jeena PM, Gajee K. , et al. Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study. Lancet 2007; 369: 1440-1451
• 94 Zar HJ. Pneumonia in HIV-infected and HIV-uninfected children in developing countries: epidemiology, clinical features, and management. Curr Opin Pulm Med 2004; 10 (03) 176-182
• 95 Guzman MG, Harris E. Dengue. Lancet 2015; 385 (9966): 453-465
• 96 Simmons CP, Farrar JJ, Nguyen V, Wills B. Dengue. N Engl J Med 2012; 366 (15) 1423-1432
• 97 World Health Organization. Dengue Fact Sheet. Available at: http://www.who.int/mediacentre/factsheets/fs117/en . Accessed May 4, 2015
• 98 Reddy KR, Basavaraja GV. , Shivananda. Furosemide infusion in children with dengue fever and hypoxemia. Indian Pediatr 2014; 51 (04) 303-305
• 99 World Health Organization. Ebola Fact Sheet. Available at: http://www.who.int/mediacentre/factsheets/fs103/en . Accessed May 4, 2015
• 100 Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am 1989; 71 (01) 15-22
• 101 American Burn Association. Burn center referral criteria. Available at: http://www.ameriburn.org/BurnCenterReferralCriteria.pdf . Accessed April 16, 2015
• 102 Rice AL, West KP, Black RE. Vitamin A deficiency. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL. eds. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attribution to Selected Major Risk Factors. Geneva: WHO Press; 2004
• 103 Caulfield L, Black RE. Zinc deficiency. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL. eds. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attribution to Selected Major Risk Factors. Geneva: WHO Press; 2004
• 104 Cornblath M, Hawdon JM, Williams AF. , et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000; 105 (05) 1141-1145
• 105 McNab S, Duke T, South M. , et al. 140 mmol/L of sodium versus 77 mmol/L of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial. Lancet 2015; 385 (9974): 1190-1197
• 106 Catto AG, Zgaga L, Theodoratou E. , et al. An evaluation of oxygen systems for treatment of childhood pneumonia. BMC Public Health 2011; 11 (Suppl. 03) S28
• 107 Duke T, Graham SM, Cherian MN. , et al; Union Oxygen Systems Working Group. Oxygen is an essential medicine: a call for international action. Int J Tuberc Lung Dis 2010; 14 (11) 1362-1368
• 108 Duke T, Peel D, Graham S, Howie S, Enarson PM, Jacobson R. Oxygen concentrators: a practical guide for clinicians and technicians in developing countries. Ann Trop Paediatr 2010; 30 (02) 87-101
• 109 Litch JA, Bishop RA. Oxygen concentrators for the delivery of supplemental oxygen in remote high-altitude areas. Wilderness Environ Med 2000; 11 (03) 189-191
• 110 Enarson P, La Vincente S, Gie R, Maganga E, Chokani C. Implementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi. Bull World Health Organ 2008; 86 (05) 344-348
• 111 Rojas MX, Granados Rugeles C, Charry-Anzola LP. Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. Cochrane Database Syst Rev 2009; (01) CD005975
• 112 Dai Y, Foy HM, Zhu Z, Chen B, Tong F. Respiratory rate and signs in roentgenographically confirmed pneumonia among children in China. Pediatr Infect Dis J 1995; 14 (01) 48-50
• 113 Singhi S, Dhawan A, Kataria S, Walia BN. Validity of clinical signs for the identification of pneumonia in children. Ann Trop Paediatr 1994; 14 (01) 53-58
• 114 Mamtani M, Patel A, Hibberd PL. , et al. A clinical tool to predict failed response to therapy in children with severe pneumonia. Pediatr Pulmonol 2009; 44 (04) 379-386
• 115 Cam BV, Tuan DT, Fonsmark L. , et al. Randomized comparison of oxygen mask treatment vs. nasal continuous positive airway pressure in dengue shock syndrome with acute respiratory failure. J Trop Pediatr 2002; 48 (06) 335-339
• 116 van den Heuvel M, Blencowe H, Mittermayer K. , et al. Introduction of bubble CPAP in a teaching hospital in Malawi. Ann Trop Paediatr 2011; 31 (01) 59-65
• 117 McCollum ED, Smith A, Golitko CL. Bubble continuous positive airway pressure in a human immunodeficiency virus-infected infant. Int J Tuberc Lung Dis 2011; 15 (04) 562-564
• 118 Kinikar A, Kulkarni R, Valvi C, Gupte N. Use of indigenous bubble CPAP during swine flu pandemic in Pune, India. Indian J Pediatr 2011; 78 (10) 1216-1220
• 119 Wilson PT, Morris MC, Biagas KV, Otupiri E, Moresky RT. A randomized clinical trial evaluating nasal continuous positive airway pressure for acute respiratory distress in a developing country. J Pediatr 2013; 162 (05) 988-992
• 120 Brown J, Machen H, Kawaza K. , et al. A high-value, low-cost bubble continuous positive airway pressure system for low-resource settings: technical assessment and initial case reports. PLoS ONE 2013; 8 (01) e53622 . Doi: 10.1371/journal.pone.0053622
• 121 Smart K, Safitri I. Evidence behind the WHO guidelines: hospital care for children: what treatments are effective for the management of shock in severe dengue?. J Trop Pediatr 2009; 55 (03) 145-148
• 122 George IA, John G, John P, Peter JV, Christopher S. An evaluation of the role of noninvasive positive pressure ventilation in the management of acute respiratory failure in a developing country. Indian J Med Sci 2007; 61 (09) 495-504
• 123 Thirsk ER, Kapongo MC, Jeena PM. , et al. HIV-exposed infants with acute respiratory failure secondary to acute lower respiratory infections managed with and without mechanical ventilation. S Afr Med J 2003; 93 (08) 617-620
• 124 The Royal Children's Hospital Melbourne. High flow nasal prong HFNP oxygen guideline. Available at: http://www.rch.org.au/picu/about_us/High_Flow_Nasal_Prong_HFNP_oxygen_guideline/ . Accessed April 16, 2015
• 125 Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med 2013; 39 (02) 247-257
• 126 Bressan S, Balzani M, Krauss B, Pettenazzo A, Zanconato S, Baraldi E. High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study. Eur J Pediatr 2013; 172 (12) 1649-1656
• 127 Appropedia.™ Inspire Breathing Assistant. Available at: http://www.appropedia.org/Inspire_Breathing_Assistant . Accessed April 16, 2015
• 128 Waisman Y, Klein BL, Boenning DA. , et al. Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis (croup). Pediatrics 1992; 89 (02) 302-306
• 129 American Heart Association. Pediatric Advanced Life Support Provider Manual. Dallas: American Heart Association; 2006
• 130 Van der Merwe DM, Van der Merwe PL. Supraventricular tachycardia in children. Cardiovasc J S Afr 2004; 15 (02) 64-69
• 131 Kugler JD, Danford DA. Management of infants, children, and adolescents with paroxysmal supraventricular tachycardia. J Pediatr 1996; 129 (03) 324-338
• 132 Fulton DR, Chung KJ, Tabakin BS, Keane JF. Ventricular tachycardia in children without heart disease. Am J Cardiol 1985; 55 (11) 1328-1331
• 133 Rocchini AP, Chun PO, Dick M. Ventricular tachycardia in children. Am J Cardiol 1981; 47 (05) 1091-1097