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Development of Pediatric Pulmonology as a speciality in India is steadily improving over past few decades. Present profile of Indian pediatric chest services include: asthma, recurrent infections, bronchiectasis, etc. It is expected to change and the emerging pulmonary illnesses include: human immunodeficiency virus (HIV infection) associated pulmonary illnesses, cystic fibrosis, primary ciliary dyskinesia, bronchopulmonary dysplasia, interstitial lung diseases, gastroesophageal reflux diseases, neuromuscular illnesses, sleep disorders, disorders due to malformations and opportunistic pulmonary infections. Respiratory infections constitute major load in pediatric outpatient services and are the leading cause of mortality in under-five children. To reduce morbidity and mortality due to respiratory tract infections, Indian Academy of Pediatrics (IAP) has developed Respiratory Tract Infection Group Education Module (RTIGEMS). After initial increase in prevalence of asthma, it seems to have stabilized now but going by the numbers, it will remain a major health problem in India. Diagnosis of pulmonary tuberculosis was always a challenge to pediatricians and with emergence of drug resistant tuberculosis, it is even more challenging. Presently few centers are providing specialized Pediatric pulmonology services in India. There is a need to develop more centers to enhance services including (a) assessment of pulmonary physiology by performing pulmonary function testing in all age groups, (b) improving diagnostic and therapeutic role of bronchoscopy and bronchoalveolar lavage, (c) sweat testing, (d) molecular diagnostics for various respiratory illnesses, and (e) utilizing advance imaging and minimally invasive technologies for diagnosis and treatment of respiratory illnesses. At present there is no degree course in Pediatric Pulmonology in India. Initially middle level pediatricians wanting to pursue their career in pediatric pulmonology should undergo training in existing centers. Trained persons should develop a network to collect data and answer relevant research questions.

Bronchobiliary fistula (BBF) is a rare condition, defined by the presence of abnormal communication between biliary tract and bronchial tree. We describe a 3½-year-old child who developed BBF after rupture of liver abscess. She underwent exploratory laparotomy and peritoneal wash for ruptured liver abscess. Seven months later she presented with fever and cough with yellow-colored expectoration (bilioptysis). An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract. On follow-up child was asymptomatic and doing well.

Introduction: Pleural effusion is the most common manifestation of pleural disorders and is mostly secondary to bacterial infections in children. Aims and Objectives: The primary objective was to study the clinical presentation of pleural effusion in hospitalized children. The secondary objective was to establish the etiology. Methods: A prospective observational study conducted from April 2014 to September 2015. Children >1 month and <14 years diagnosed to have pleural effusion on clinical and radiological examination were included in the study. Data regarding demographic profile, presenting complaints, immunization history, anthropometry, biochemical and radiological investigations, and the outcome of the patients were collected. Results: Seventy-five patients were included in this study. The mean age of the patients was 69.97±48.23 months. Regarding etiology of pleural effusion, it was parapneumonic in 35 (46.6%), empyema in 18 (24%), transudative in 12 (16%), tubercular in 9 (12%), and malignant (non-Hodgkin’s lymphoma) in 1 (1.3%) case. The presenting complaints were fever (82.6%), cough (78.7%), respiratory distress (69.3%), chest pain (36%), and abdominal pain (9.3%). There was no sex predominance. About 16% patients were severely malnourished. Severe anemia was present in 5 (6.7%) patients. None of them required decortication surgery, and none of the patients expired during hospitalization. Conclusion: Pleural effusion is a major health problem with parapneumonic effusion still beingthe most common etiology. Our study also confirmed that fever, cough, and respiratory distress were the most common presenting complaints and most of the children were malnourished. A high index of suspicion is required to avoid delays in diagnosis that may influence treatment and outcome.