Pediatric Infectious Diseases Encountered During Wartime Part II: Infectious Diseases Complications in the Individual Pediatric Patient

Abstract

Purpose of Review Children in many regions face the daily threat of injury from armed conflict. The direct effects of combat trauma have led to many morbidities in survivors, including a variety of infectious complications. Contemporary experiences from recent military operations have advanced combat casualty care and concurrently informed the care of civilian combat trauma. Unfortunately, there is a lack of data to correlate the impact armed conflict has on the specific risks for infection in pediatric casualties. We review modern literature and apply data from adult casualties to pediatric combat trauma features to form management considerations and identify future research needs. Children require a disproportionately high number of resources when injured, and recently developed pediatric injury severity scoring systems can be predictive of potential outcomes. Blast injuries are the most common trauma type, and children suffer unique injury patterns with subsequent risks for infections. Experience has shown that mixed injuries, including blasts, penetrating injuries, burns, and the need for massive blood transfusions, can pose unique infectious challenges such as invasive fungal infections. Antimicrobial resistance is a top health priority with combat injuries, as multidrug-resistant organisms rapidly emerge in hospitals caring for those injured in conflict. Resources to assist in the management of infectious complications of direct injury to children in armed conflict regions are provided. Recent FindingsWe review the recent literature with an emphasis on publications over the past decade, apply data from adult casualties to pediatric combat trauma features to form management considerations, and identify future research needs. Summary Children require a disproportionately high number of resources when injured, and recently developed pediatric injury severity scoring systems can be predictive of potential outcomes. Blast injuries are the most common trauma type, and children suffer unique injury patterns with subsequent risks for infections. Experience has shown that mixed injuries, including blasts, penetrating injuries, burns, and the need for massive blood transfusions, can pose unique infectious challenges such as invasive fungal infections. Antimicrobial resistance is a top health priority with combat injuries, as multidrugresistant organisms rapidly emerge in hospitals caring for those injured in conflict. Resources are provided to assist in the management of infectious complications resulting from direct injury to children in armed conflict regions.