IAP Textbook of Pediatrics 4 th Edition IAP Textbook of Pediatrics Volume 1 4 th Edition Editor-in-Chief A Parthasarathy Professor of Pediatrics, Madras Medical College, and Deputy Superintendent, Institute of Child Health and Hospital for Children, Chennai (Retired) National President, IAP 1997, Regional Advisor, APPA, 1997–99 Founding Editor-in-Chief, Indian Journal of Practical Pediatrics Contributory Editor, ColorAtlas of Tropical Pediatrics, American Academy of Pediatrics 2009 Executive Academic Editor PSN Menon Sub-Dean, Professor of Pediatrics, Division of Pediatric Endocrinology and Officer in-Charge Genetic Unit, All India Institute of Medical Sciences, New Delhi (Retired) Consultant and Head, Department of Pediatrics Jaber Al-Ahmed Armed Forces Hospital, Kuwait Senior Editors RK Agarwal Panna Choudhury President, IAP 2008 President, IAP 2009 Senior Consultant Pediatrician and Director Editor-in-Chief, Indian Pediatrics 2005-7 RK Hospital Consultant Pediatrician Udaipur, Rajasthan, India Lok Nayak Hospital, New Delhi, India Naveen C Thacker Deepak Ugra President, IAP 2006 President Elect, IAP 2010 Senior Consultant Pediatrician and Director Consultant Pediatrician Deep Children Hospital and Research Centre Lilawati Hospital and Research Centre, Mumbai Gandhidham (Kutch), Gujarat, India Guru Nanak Hospital and Research Centre, Mumbai Senior Academic Editors Piyush Gupta MKC Nair Professor of Pediatrics Professor of Pediatrics and Clinical Epidemiology University College of Medical Sciences Director, Child Development Centre New Delhi, India Medical College, Thiruvananthapuram, Kerala, India Editor-in-Chief, Indian Pediatrics 2008-10 President IAP 2004, President INDIACLEN 2005-7 Executive Editors Rohit C Agrawal Tanmay Amladi Honorary Secretary General, IAP 2007-08 Treasurer, IAP 2007-8, Honorary Neonatologist Director, Chandra-Jyoti Children Hospital Nowrosjee Wadia Maternity Hospital and NICU Mumbai, Maharashtra, India Parel, Mumbai, Maharashtra, India Academic Editor K Nedunchelian Editor-in-Chief, Indian Journal of Practical Pediatrics Assistant Professor of Pediatrics, Madras Medical College Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India ® JAYPEE Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd Corporate Office 4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, +91-11-43574357 Registered Office B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672, Rel: +91-11-32558559 Fax: +91-11-23276490, +91-11-23245683 e-mail: [email protected], Website: www.jaypeebrothers.com Branches  2/B, Akruti Society, Jodhpur Gam Road Satellite Ahmedabad 380 015 Phones: +91-79-26926233, Rel: +91-79-32988717 Fax: +91-79-26927094 e-mail: [email protected]  202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park East Bengaluru 560 001 Phones: +91-80-22285971, +91-80-22382956, +91-80-22372664, Rel: +91-80-32714073 Fax: +91-80-22281761 e-mail: [email protected]  282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon Road Chennai 600 008 Phones: +91-44-28193265, +91-44-28194897, Rel: +91-44-32972089 Fax: +91-44-28193231 e-mail: [email protected]  4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road Hyderabad 500 095 Phones: +91-40-66610020, +91-40-24758498, Rel:+91-40-32940929 Fax:+91-40-24758499, e-mail: [email protected]  No. 41/3098, B & B1, Kuruvi Building, St. Vincent Road Kochi 682 018, Kerala Phones: +91-484-4036109, +91-484-2395739, +91-484-2395740 e-mail: [email protected]  1-A Indian Mirror Street, Wellington Square Kolkata 700 013 Phones: +91-33-22651926, +91-33-22276404, +91-33-22276415, Rel: +91-33-32901926 Fax: +91-33-22656075, e-mail: [email protected]  Lekhraj Market III, B-2, Sector-4, Faizabad Road, Indira Nagar Lucknow 226 016 Phones: +91-522-3040553, +91-522-3040554 e-mail: [email protected]  106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, Parel Mumbai 400012 Phones: +91-22-24124863, +91-22-24104532, Rel: +91-22-32926896 Fax: +91-22-24160828, e-mail: [email protected]  “KAMALPUSHPA” 38, Reshimbag, Opp. Mohota Science College, Umred Road Nagpur 440 009 (MS) Phone: Rel: +91-712-3245220, Fax: +91-712-2704275 e-mail: [email protected] USA Office 1745, Pheasant Run Drive, Maryland Heights (Missouri), MO 63043, USA, Ph: 001-636-6279734 e-mail: [email protected], [email protected] IAP Textbook of Pediatrics , 4th edition © 2009, Indian Academy of Pediatrics, Kailas Darshan, 1st Floor, Kennedy Bridge, Nana Chowk, Mumbai 400 007, India Tel: (022) 23887906/23887922/23889565 Fax: (022) 23851713 E-mail: [email protected]; [email protected] Websites: www.iapindia.org/www.ijpp.org/www.indianpediatrics.net/www.iapdrugformulary.com All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the Indian Academy of Pediatrics and the publisher. This book has been published in good faith that the material provided by editors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and Indian Academy of Pediatrics will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 1999, 2000 Second Edition: 2002, 2003 Third Edition: 2006 Revised Reprint 2007 Fourth Edition: 2009 ISBN 978-81-8448-580-6 Typeset at JPBMP typesetting unit Printed at Ajanta To TTTTThhhhheeeee CCCCChhhhhiiiiillllldddddrrrrreeeeennnnn ooooofffff IIIIInnnnndddddiiiiiaaaaa WWWWWhhhhhooooossssseeeee CCCCCaaaaarrrrreeeee,,,,, SSSSSuuuuurrrrrvvvvviiiiivvvvvaaaaalllll aaaaannnnnddddd DDDDDeeeeevvvvveeeeelllllooooopppppmmmmmeeeeennnnnttttt aaaaarrrrreeeee OOOOOuuuuurrrrr CCCCCooooonnnnnccccceeeeerrrrrnnnnn IAP Textbook of Pediatrics “… This textbook has covered all aspects of child health contributed by reputed authors, in addition to National Health Programs. Thus, it has fulfilled all the criteria of a ‘reader friendly’ treatise…” Dr Uday Bodhankar President, IAP 1995 President, ISTP 1999-2001 Nagpur “… Several luminaries who are past and present teachers have contributed their might which has made the present textbook a novel production in many aspects…” Prof YC Mathur President, IAP 2001 Hyderabad “… Indeed it is a millennium gift to students and practitioners in a well written and well presented comprehensive format covering A to Z in Pediatric care…” Dr Swati Y Bhave President, IAP 2000 New Delhi “… Teachers of Pediatrics will find in this book guidelines for the course contents in undergraduate and postgraduate medical education. Medical students will find readable and reasonably detailed, yet concise information in this book, not only to complete the course and pass the final examination, but also to guide them during their clinical career as intern, house surgeon and medical practitioner…” Prof T Jacob John President, IAP 1999 Vellore “… I hope this textbook finds an appropriate place in the students' and practitioners' bookshelf. I sincerely wish that this book is also suitable for undergraduates and postgraduates…” Prof MR Lokeshwar President, IAP 1998 Mumbai Contributors Aditi Sinha Agarwal RK Anand N Pandit Senior Research Associate Consultant Child Specialist British Council Building Department of Pediatrics RK Hospital 917/1 Fergusson College Road All India Institute of Medical 5A Madhuban Pune 411 004, Maharashtra Sciences, New Delhi 110 029 Opposite RSEB Window Email: [email protected] Residence Udaipur 313 001, Rajasthan 5B Srijan Apartments Email: [email protected]; Anand RK B 9/8 Sector 62 [email protected] 55 Kavi Apartments, Worli Noida Mumbai 400 018, Maharashtra Uttar Pradesh Ajit Kumar Email: [email protected] Email: [email protected] 3/6/69/B/20/4/A Avanti Colony Anandam R Advani SH Near Skyline Theatre Professor of Pediatric Neurology (Retd) Director KB Lal Road, Bashirbag Consultant Neurologist Department of Medical Oncology Hyderabad 500 029 Jaslok Hospital, Peddar Road Andhra Pradesh PRS Hospital, Killippalam Thiruvananthapuram, Kerala Mumbai Maharashtra Amdekar YK Residence Residence 151 ‘Tushar’ 1st Floor ”RAJCOT” 201 Satyam Shivam Sunderam 14th Road Chembur Thycaud Ghatkopar Mumbai 400 071, Maharashtra Thiruvananthapuram 695 014 Mumbai 400 077 Email: [email protected] Kerala Maharashtra Email: [email protected] Email: [email protected] Amit Upadhyaya Consultant Hematologist Anil Mokashi Agarwal DK Sunflag-Pahuja Center for Ramabai Maternity General D-115 Sector 36, Noida Blood Disorders and Children’s Hospital Gautam Budh Nagar 201 301 Sunflag Hospital, Faridabad Baramati, Pune 413 102 Uttar Pradesh Haryana Maharashtra Email: [email protected] Agarwal KN Anil Sachdev D-115 Sector 36, Noida Amrish Vaidya 63/12 Gautam Budh Nagar 201 301 Consultant Pediatric Surgeon Old Rajinder Nagar Uttar Pradesh Kokilaben Dhirubhai Ambani New Delhi 110 060, Delhi Email: [email protected]; Hospital, Andheri West Email: [email protected] [email protected] Mumbai 400 053 Maharashtra Agarwal R Residence Anita Khalil Department of Pediatrics 5E Sundatta Apartments The Heart Centre BJ Wadia Hospital for Children and 10A Mount Pleasant Road 2 Ring Road Institute of Child Health Mumbai 400 006 Lajpat Nagar IV Parel, Mumbai 400 012 Maharashtra New Delhi 110 024, Delhi Maharashtra Email: [email protected] Email: [email protected] X IAP Textbook of Pediatrics Anju Aggarwal Archana Sathe Ashish R Bavdekar Reader in Pediatrics ’Om Padmalaya’ 11 Yeshwant Nagar University College of Medical 1123/A Shukrawar Peth Ganeshkhind Road Sciences and Guru Tegh Bahadur Opposite Hirabag Pune 411 007 Hospital Pune 411 002 Maharashtra Delhi Maharashtra Email: [email protected] Residence Flat # 3C Block C2B, Janakpuri Armida Fernandez Ashok Gupta New Delhi 110 058, Delhi 53 Sea Springs 25 Chetak Marg Email: [email protected]; BJ Road, Band Stand Near JK LON Hospital [email protected] Bandra (West) Jaipur 302 004, Rajasthan Mumbai 400 050 Email: [email protected] Anju Virmani Maharashtra C 6/6477 Email: [email protected] Ashok K Deorari Vasant Kanj Professor of Pediatrics New Delhi 110 070 Arun Gupta Division of Neonatology Email: [email protected] BP 33, Pitampura All India Institute of New Delhi 110 034, Delhi Medical Sciences Anupam Sachdeva Email: [email protected] New Delhi 110 029 C-107 Neelambar Apartment Residence Near Sainik Vihar Arun Kumar Gupta D-II/22, Ansari Nagar Shakurbasti Professor and Head New Delhi 110 029, Delhi New Delhi 110 034 Department of Radiodiagnosis Email: [email protected]; Email: [email protected] All India Institute of [email protected] Medical Sciences, New Delhi 110 029 Anupama Borker Email: [email protected]; Ashok K Gupta Consultant Pediatric [email protected] 50 B/D, Gandhinagar Hemato-Oncologist Jammu 180 004 SL Raheja Hospital Arun Phatak Jammu and Kashmir Mahim, Mumbai 102 Ambica Apartments Email: [email protected] Maharashtra Shanker Tekri Residence Dandia Bazaar Ashok K Patwari 22 Kaustubh Plot # 8 Vadodara 390 001 Reader’s Flat # 4 Bandra Reclamation Gujarat LHMC Campus Bandra (West) Email: [email protected] Bangla Sahib Road Mumbai 400 050 New Delhi 110 001 Maharashtra Arunmozhi T Email: [email protected]; Email: [email protected] Assistant Professor of [email protected] Community Medicine Anurag Tomar Madras Medical College Ashok S Kapse 4 Govind Marg Residence Kapse Children Hospital Jaipur 302 004 8I Block, 2nd Main Road 1st Floor, Akshar Complex Rajasthan Chennai 600 102 B/H Rang Upvan, Makkaipool Email: [email protected] Tamil Nadu Surat 395 001, Gujarat Email: [email protected] Archana S Kher Arvind Bagga 6/A Anand Bhavan Professor of Pediatrics Babu George 36th Road, TPS III Division of Nephrology Medical Superintendent Bandra (West) All India Institute of Medical Child Development Centre Mumbai 400 050 Sciences, Ansari Nagar Medical College Campus Maharashtra New Delhi 110 029 Thiruvananthapuram, Email: [email protected] Email: [email protected] Kerala