Managing malaria in the pediatric intensive care unit

Abstract

Malaria in children is associated with high mortality and morbidity. High index of suspicion is required for diagnosis. Clinical assessment should be supplemented by laboratory investigations including peripheral blood smear examination and rapid diagnostic tests. Common associated life-threatening problems include coma, seizures, raised intracranial pressure (ICP), shock, respiratory failure, acute kidney injury, anemia and fluid and electrolyte abnormalities. Aggressive supportive care in pediatric emergency and pediatric intensive care unit includes control of airway, breathing and circulation; maintaining adequate intravascular volume; management of raised ICP and status epilepticus; and close monitoring for early detection of complications. Artesunate combination therapy should be administered promptly. Clinical evaluation, laboratory workup, specific antimicrobial therapy, supportive treatment and management of associated complications should go hand in hand in a protocolized way for better outcome.