title: Dengue in children: a systematic review of clinical and laboratory factors associated with severity.
abstract: Dengue is a potentially life-threatening illness, and children are at higher risk of severity. This review aimed to systematize the identified clinical and laboratory parameters associated with severe dengue in children, as monitoring these signs and fluid-replacement therapy are actually the cornerstones of dengue treatment. Of the 527 studies initially reviewed, 21 were selected as follows: three cohort studies, three case-control studies, 14 cross-sectional studies and one not defined. Eighteen studies were carried out in Asia and three in the Americas. Hepatomegaly, lethargy, abdominal pain, bleeding, hemoconcentration and thrombocytopenia, all referenced as warning signs in the WHO 2009 Guidelines, were the clinical and laboratory parameters independently associated with severity in more than one study. The recognition of these known warning signs associated to severe dengue disease underlines the usefulness of the WHO 2009 classification.
authors.affiliation: a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900.
authors.forename: Mayumi Duarte
authors.initials: MD
authors.lastname: Wakimoto
authors.affiliation: b Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900.
authors.forename: Luiz Antonio Bastos
authors.initials: LA
authors.lastname: Camacho
authors.affiliation: a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900.
authors.forename: Lusiele
authors.initials: L
authors.lastname: Guaraldo
authors.affiliation: a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900.
authors.forename: Luana Santana
authors.initials: LS
authors.lastname: Damasceno
authors.affiliation: a Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Avenida Brasil, 4365, Manguinhos, Rio de Janeiro , RJ , Brazil 21040-900.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Brasil
mesh_terms: D015746:Abdominal Pain / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003715:Dengue / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D005076:Exanthema / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D005440:Fluid Therapy; D006470:Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
keywords: children; dengue; severity; shock syndrome; systematic review