Clinical and hematological profile and outcomes of children with dengue infection: a prospective observational study

Background: Dengue is an important cause of morbidity among children in tropical countries, with clinical manifestations ranging from a self-limiting febrile illness to severe dengue associated with plasma leakage, shock, and organ dysfunction. Early identification of children at risk of severe disease is essential for prompt management and improved outcomes. The present study aimed to evaluate the clinical and hematological profile of pediatric dengue infection and determine its association with disease severity and clinical outcomes. Methods: This prospective observational study was conducted in the Department of Pediatrics at a rural tertiary-care teaching hospital in Maharashtra, India, between September 2022 and February 2024. A total of 195 children aged 0-13 years with laboratory-confirmed dengue infection (positive NS1 antigen and/or dengue IgM antibody) were enrolled consecutively. Patients were classified according to the World Health Organization (WHO) 2009 dengue classification into dengue fever (DF), dengue fever with warning signs (DFWS), and severe dengue. Clinical characteristics, laboratory parameters, treatment received, duration of hospitalization, and outcomes were analyzed. Results: Out of the 195 children, 156 (80.0%) had DF, 28 (14.4%) had DFWS, and 11 (5.6%) had severe dengue. Increasing age was significantly associated with disease severity (p<0.05), whereas sex distribution was comparable across groups (p=0.81). Bleeding manifestations (p<0.001), nausea/vomiting (p<0.001), abdominal pain (p<0.001), myalgia (p=0.013), hepatomegaly (p=0.001), ascites (p=0.001), and shock (p<0.001) were significantly associated with severe disease. Progressive thrombocytopenia, lower nadir platelet count, higher total leukocyte count, and increased highest packed cell volume were significantly associated with disease severity (all p<0.05). NS1 antigen positivity showed a significant association with severe disease (p<0.01), whereas dengue IgM positivity did not (p=0.56). Increasing disease severity was associated with greater requirements for intravenous fluids, plasma transfusion, platelet transfusion, inotropic support, and longer hospital stay (all p<0.01). All children recovered, and no mortality was observed. Conclusions: Older age, gastrointestinal symptoms, bleeding manifestations, hepatomegaly, ascites, shock, thrombocytopenia, leukocytosis, and elevated packed cell volume were significantly associated with severe dengue in children. Careful clinical assessment together with serial hematological monitoring remains essential for early recognition of severe dengue and timely institution of supportive management, contributing to favorable clinical outcomes.