The Ministry of Health and Family Welfare on Saturday issued new fresh guidelines for the management of Covid 19 in children.
The Union Health Ministry issued a detailed and informed list of guidelines to be followed for the management of Covid 19 in children. The list of guidelines includes –
1. Covid 19 Symptoms in Children –
a. Fever, Cough, Rhinorrhoea
b. Sore throat or throat irritation, body ache or headache, Malaise or weakness
c. Diarrhoea, Anorexia or nausea or vomiting
d. Loss of sense of smell and or taste.
2. Guide for Using Mask –
a. Masks are not recommended for children aged 5 years and under.
b. Children aged 6-11 years may wear a mask depending on the ability of child to use a mask safely and appropriately under direct supervision of parents/guardians.
c. Children aged 12 years and over should wear a mask under the same conditions as adults.
d. Ensure hands are kept clean with soap and water, or an alcohol-based hand rub, while handling masks
3. Antimicrobial Use Guide –
a. COVID-19 is a viral infection, and antimicrobials have no role in the management of uncomplicated COVID-19 infection.
b. Asymptomatic and mild cases: antimicrobials are not recommended for therapy or prophylaxis.
c. Moderate and severe cases: antimicrobials should not be prescribed unless there is clinical suspicion of a superadded infection.
d. Septic shock: empirical antimicrobials (according to body weight) are frequently added to cover all likely pathogens based on clinical judgement, patient host factors, local epidemiology and antimicrobial policy of the hospital.
4. Management of Acute Respiratory Distress Syndrome (ARDS) and Shock guide –
a. Management/ Treatment of ARDS:
ARDS may be classified based on Pediatric Acute Lung Injury Consensus Conference (PALICC) definition into mild, moderate and severe.
i. Mild ARDS:
a. High flow nasal oxygen (start with 0.5 L/kg/min to begin with and increase to 2 L/kg/min with monitoring) or non-invasive ventilation (BiPAP or CPAP) may be given.
ii. Moderate and Severe ARDS:
a. Lung protective mechanical ventilation may be initiated; low tidal volume (4-8 ml/kg); plateau pressure <28-30 cmH2O; MAP <18-20 cmH2O; driving pressure <15 cmH2O; PEEP 6-10 cmH2O (or higher if severe ARDS); FiO2 <60%; sedoanalgesia ± neuromuscular blockers; cuffed ETT, inline suction, heat and moisture exchange filters (HMEF)
b. Avoid frequent disconnection of ventilator circuit, nebulization or metered dose inhaler
c. Restrict fluids; calculate fluid overload percentage, keeping it <10%
d. Prone position may be considered in hypoxemic children if they are able to tolerate it
e. Daily assessment for weaning and early extubation; enteral nutrition within 24 hours, achieve full feeds by 48 hours
f. Transfusion trigger Hb <7g/dL if stable oxygenation and haemodynamics and <10 g/dL if refractory hypoxemia or shock
— PIB India (@PIB_India) June 19, 2021
5. Management of Shock :
a. Consider crystalloid fluid bolus 10-20 ml/kg cautiously over 30-60 minutes with early vasoactive support (epinephrine).
b. Start antimicrobials within the first hour, after taking blood cultures, according to hospital antibiogram or treatment guidelines.
c. Consider inotropes (milrinone or dobutamine) if poor perfusion and myocardial dysfunction persists despite fluid boluses, vasoactive drugs and achievement of target mean arterial pressure.
d. Hydrocortisone may be added if there is fluid refractory catecholamine resistant shock (avoid if already on dexamethasone or methylprednisolone).
e. Once stabilized, restrict IV fluids to avoid fluid overload.
f. Initiate enteral nutrition – sooner the better.
g. Transfusion trigger Hb <7g/dL if stable oxygenation and haemodynamics, and <10 g/dL if refractory hypoxemia or shock.