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Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 1 Dear Colleagues We are writing to you in regards to a clinical alert published by the Royal College of Paediatrics and child Health on the 1 st of May 2020 highlighting a new COVID-19-associated paediatric hyper-inflammatory presentation (Guidance - Paediatric multisystem inflammatory syndrome temporally associated with COVID-19). Although COVID-19 respiratory presentation in children has been rare, several (...) children have recently presented to hospitals in the South Thames region with the described Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Many of the children have been severely unwell at presentation requiring resuscitation and transfer to paediatric intensive care. As the anaesthetic team you may be asked to review and assist in their resuscitation and stabilisation. We thought it may be helpful to summarise some of the salient features of the presentation
was of the infant described above in the case series by Cai et al.. (1) The authors conducted an analysis of the data assuming that asymptomatic children are being mistakenly overlooked as the index case in familial clusters. Using this approach (assuming asymptomatic children as the index case), 21% (6/28) of family clusters would have a paediatric index case. (6) A case series describing the epidemiological and clinical characteristics of 74 children with COVID-19 admitted to two hospitals in China reported (...) -CoV-2 from one of the 10 included children to two family members. This transmission was from a three month old infant to both parents, who developed symptomatic COVID-19 seven days after looking after the infant. (1) A case report of this infant confirms that, at the time of diagnosis, both parents had negative SARS-CoV-2 PCR results. Seven days after Evidence summary of potential for children to contribute to transmission of SARS-CoV-2 Health Information and Quality Authority Page 4 of 14
system dysfunction, a rate that is also lower than that seen in adults. Preschoolchildren and infants were more likely to have severe clinical manifestations than older children. There has been no evidence to date of SARS-Cov-2 involvement in the nervous system in children of any age. Nevertheless, virus infectivity and the severity of the infection represent major alarms for patients affected with chronic (and possibly acute) neurological diseases, including children. Over the last few weeks (...) . However, as reported in literature so far, only a few SARS-Cov-2–positive children have been admitted to paediatric departments and, generally speaking, severe COVID-19 in children is rare. Symptoms can be disparate and designing differentiating clinical criteria aiming to isolate suspected SARS-CoVID-2 children to avoid spreading infection between health care professionals, other patients and visitors is challenging. Some children with an underlying chest condition (eg. cystic fibrosis or severe
drainage. In a child with a very small pancreatic duct diameter in which only a 3-French pancreatic duct stent would be appropriate to place, drainage may be suboptimal because of the small diameter of the stent. Transpapillary stenting of pancreatic fluid collections in children can be a safe and successful treatment (69,74), yet its effectiveness compared with EUS-guided drainage has not been well studied in pediatrics. Overall application of ERCP for pediatric patients with CP to improve symptoms (...) on low to very low quality of evidence, and primarily represent consensus expert opinions. Some of the most urgent issues that need to be addressed relating to advanced endoscopic procedures in children with CP include: 1. Development of equipment allowing for the full breadth of EUS- and ERCP-guided endotherapy across the pediatric age range. 2. Increasing and optimizing the probability that a child undergoing EUS or ERCP is managed by an endoscopist with expertise performing these interventions
; Benchimol C; Reyes-Acevedo R; Genevray M; Bradley D et al.. Tolerability of up to 200 days of prophylaxis with valganciclovir oral solution and/or film-coated tablets in pediatric kidney transplant recipients at risk of cytomegalovirus disease. Paediatric transplantation; Feb 2017; vol. 21 (no. 1) 10. We recommend that children and young people should be monitored for CMV viral load at least monthly for 12 months post transplant if either donor or recipient are CMV positive (CMV D+R- / CMV D-R+ / CMV D (...) . No literature was sent to participants to avoid risk of bias. The process was iterative (participants able to change their views in subsequent rounds). Two rounds were undertaken. Standardisation of immunosuppressive and anti-infective drug regimens in UK Paediatric Renal transplantation: The Harmonisation Programme 4 Table 1 – PICO characteristics Population Intervention Comparison Outcome Study design Children ( 5 (maximum dose 5mg) on alternate days Azathioprine should be prescribed at 2 mg/kg daily from
COVID-19: paediatric surveillance COVID-19: paediatric surveillance - GOV.UK Tell us whether you accept cookies We use about how you use GOV.UK. We use this information to make the website work as well as possible and improve government services. Accept all cookies You’ve accepted all cookies. You can at any time. Hide Search Coronavirus guidance is being updated. Read Stay alert. Control the virus. Save lives. Guidance COVID-19: paediatric surveillance Description and contact details of PHE (...) paediatric surveillance programmes for COVID-19. Published 27 April 2020 From: Paediatric surveillance for . If you would like more information about the surveillance, please contact Dr Shamez Ladhani at . 2. Clinical follow up of laboratory-confirmed cases in neonates up to 28 days of age . Paediatricians across the UK and Ireland will receive weekly emails from the . For more information about the . At the end of the surveillance, cases will be linked to a similar surveillance of . For more information
describes millions of childhood deaths from preventable causes due to kids not being able to access care – see ‘ Millions of children are at risk of dying, the United Nations said on Wednesday, not of Covid-19, but of preventable causes. Unable to get care at hospitals that are straining to fight the virus, more than a million children aged 5 or younger will die every six months, UNICEF said in a report.’ Acknowledgements: thanks to Peter Doshi for the updates Conflicts of Interest: Both TJ and CH have (...) COVID-19: Have we forgotten our children in all this? COVID-19: Have we forgotten our children in all this? - CEBM CEBM The Centre for Evidence-Based Medicine develops, promotes and disseminates better evidence for healthcare. Navigate this website COVID-19: Have we forgotten our children in all this? May 14, 2020 Carl Heneghan, Tom Jefferson UNESCO has produced a report on the . The main points are: ‘Most governments around the world have temporarily closed educational institutions
, cognitive behavioral therapy; CCAL, Camp Cope‐A‐Lot; CPRS, Conners’ Parent Rating Scales; FIQ, full scale IQ; IT, intervention group; MASC, Multidimensional Anxiety Scale for Children; PARS, Pediatric Anxiety Rating Scale; RCADS, Revised Child Anxiety and Depression Scale; RCMAS, Revised Children's Manifest Anxiety Scale; SCARED, Screen for Child Anxiety Related Disorders; SCAS, Spence Child Anxiety Scale; STAI‐C, State‐Trait Anxiety Inventory for Children; SWQ, Social Worries Questionnaire; TAU (...) , Ziviani, & Rodger, ; Gjevik, Eldevik, Fjæran‐Granum, & Sponheim, ; Lecavalier, ). The prevalence of anxiety among school‐aged children is of particular concern considering that anxiety during this period has a negative impact on intellectual functioning and academic achievement, and broadly on a child's overall school‐functioning (Mazzone et al., ; Wood, ). School may present students with ASD particular cognitive, social and behavioral challenges that may increase levels of anxiety, and conversely
reviewed by the Adolescent Health and Community Paediatrics Committees and the Child and Youth Maltreatment Section Executive of the Canadian Paediatric Society. Shazeen Suleman, Yasmine Ratnani, Christine Loock, Katrina Stockley, Susan Bennett, Radha Jetty, Katharine Smart, Sarah Gander; Canadian Paediatric Society, Social Paediatrics Section References Gupta RP, de Wit ML, McKeown D. The impact of poverty on the current and future health status of children. PaediatrChild Health 2007;12(8):667–72 (...) , Courtemanche DJ. The Little BEARS QI Questionnaire (All Ages): (Accessed April 30, 2020). Kenyon C, Sandel M, Silverstein M, Shakir A, Zuckerman B. Revisiting the social history for child health. Pediatrics 2007;120(3):e734-8. Fazalullasha F, Taras J, Morinis J, et al. From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice. PaediatrChild Health 2014;19(4):195–9. Morinis J, Levin L, Bloch G, Ford-Jones L; Social Pediatrics
The medical evaluation of pre-pubertal children with suspected sexual abuse Child sexual abuse is an important and not uncommon problem. Children who have been sexually abused may present to a physician’s office, urgent care centre, or emergency department for medical evaluation. A medical evaluation can provide reassurance to both child and caregiver, identify care needs, and offer an accurate interpretation of findings to the justice and child welfare systems involved.  (...) ;Given the potential medico-legal implications of these assessments, the performance of a comprehensive evaluation requires both current knowledge and clinical proficiency. This position statement presents an evidence-based, trauma-informed approach to the medical evaluation of pre-pubertal children with suspected or confirmed sexual abuse. Keywords: Ano-genital examination; Child protection; Child sexual abuse; Forensic evidence; Sexually transmitted infections
are based largely on the disease experience in China, Europe, and the United States, the paediatric literature on COVID-19 is still in its infancy and will undoubtedly evolve. Canadian guidelines have been developed, notably by [ ] . This statement provides acute care guidance for community paediatricians working in both outpatient and inpatient settings. Clinical presentation Most children presenting with fever and cough do not require hospital care. However, as with adults, infected children may (...) that asymptomatic rates are probably significantly higher, given that all these studies were based solely on cases presenting with clinical features. One recent paper suggested that children younger than 5 years of age are more likely to experience severe COVID-19 symptoms than older children and should be promptly assessed [ ] . Emerging data also appear to suggest that while infants with COVID-19 generally experience mild symptoms, they are at higher risk for severe disease than other paediatric age groups
milder cases and a better prognosis than adults. Acta Paediatr 2020; online ahead of print: DOI: 10.1111/apa.15270. Cui Y, Tian M, Huang D, et al. A 55-day-old female infant infected with COVID 2019: Presenting with pneumonia, liver injury, and heart damage. J Infect Dis 2020; online ahead of print: DOI: 10.1093/infdis/jiaa113. Hong H, Wang Y, Chung H-T, Chen CJ. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr Neonatol 2020;61(2):131-2 (...) Update on COVID-19 epidemiology and impact on medical care in children: April 2020 Update on COVID-19 epidemiology and impact on medical care in children: April 2020Update on COVID-19 epidemiology and impact on medical care in children: April 2020 | Canadian Paediatric Society A home for paediatricians. A voice for children and youth. Current: Update on COVID-19… Practice Point Update on COVID-19 epidemiology and impact on medical care in children: April 2020 Posted: Apr 29, 2020 The Canadian
of Children’s Diabetes Clinicians Clinicians Version 4, May 2018, Review 2021 Authors: SM Ng, E Williams , F Ackland, C Burren, J Edge, E Hind, A McAulay, Bill Lamb Treatment of Severe Hypoglycaemia Follow this page if child is unconscious or fitting (or also not responded from page 2) CHECK CAPILLARY BLOOD GLUCOSE AND CONFIRM HYPOGLYCAEMIA ( 25kg for 1mg glucagon by IM injection Glucagon is a fast acting drug and the child/adolescent should respond after 5 minutes. After the child has regained (...) for review of treatment, advice or education If child not improving: • If patients have protracted vomiting and are unable to tolerate oral fluids, hospital admission and IV glucose infusion must be considered, especially if a child has returned to the emergency department with further hypoglycaemia during the same intercurrent illness. • If a child/Adolescent remains unconscious on correction of BG consider cerebral oedema, head injury, adrenal insufficiency or drug overdose ssociation of Children’s
*)ti,ab OR (L asparaginase)ti,ab OR (L asparaginase*)ti,ab 19 4 ( (hyperglycaemia or hyperglycemia) ti,ab OR HYPERGLYCEMIA/) 21 23 (cyclosporine) ti,ab OR cyclosporine*ti.ab OR (tacrolimus,ti,ab OR (tacrolimus*)ti,ab OR (L asparaginase)ti,ab OR (L asparaginase*) AND (child*OR infant* OR pediatric* or Paediatric* )35 68 Glycosuria AND 35((steroids) ti,ab ) AND STEROID/ OR , Chemotherapy) ti,ab OR Transplant * ti,ab 4,5,6,7 ) 23 25 AND (child*OR infant* OR pediatric* or Paediatric* )35 26 1 (...) ( (hyperglycaemia or hyperglycemia) ti,ab OR HYPERGLYCEMIA/)20 35((steroids) ti,ab ) AND STEROID/ OR , Chemotherapy) ti,ab OR Transplant * ti,ab 4,5,6,7 ) 23 AND (child*OR infant* OR pediatric* or Paediatric* ) 133 28 Transplant * ti,ab 43 HYPERGLYCEMIA/ep AND (child*OR infant* OR pediatric* or Paediatric* ) 9 (Chemotherapy) ti,ab 6 AND 43 HYPERGLYCEMIA/ep AND (child*OR infant* OR pediatric* or Paediatric* ) 3 5 (STEROID/, 43 HYPERGLYCEMIA/ep AND (child*OR infant* OR pediatric* or Paediatric* ) 0 4(steroids) ti
Care of the Well Child-Newly Diagnosed with Type 1 Diabetes Version 4, Dec 2019 Review 2022 Authors: J Chizo Agwu, SM Ng, A Timmis, C Moudiotis, K. Matyka,, N.P.Wright, M. Kershaw S.Bahl, A. Alston . N Trevelyan Page of 7 1 ssociation of Children’s Diabetes Clinicians Clinical Guideline Care of the well child, newly diagnosed with Type 1 Diabetes Mellitus SETTING Insert hospital name FOR STAFF Medical and nursing staff PATIENTS Children with diabetes and their families (...) ssociation of Children’s Diabetes Clinicians References 1. British Society for Paediatric Endocrinology and Diabetes (BSPED) guidelines for the management of DKA. http://www.bsped.org.uk/professional/ guidelines/docs/DKAGuideline.pdf 2. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia. Report of WHO/IDF Consultation 2006. 3. Wang J, Miao D, Babu S, Yu J, Barker J, Klingensmith G et al. Prevalence of Autoantibody- Negative Diabetes Is Not Rare at All Ages and Increases
paediatrician. B. EMERGENCY MANAGEMENT IN A & E: 1. General Resuscitation: A, B, C. Airway Ensure that the airway is patent and if the child is comatose, insert an airway. If consciousness reduced or child has recurrent vomiting, consider inserting N/G tube, aspirate and leave on open drainage. Seek urgent anaesthetic review and discuss with a paediatric critical care specialist if the child or young person has a reduced level of consciousness and is unable to protect their airway. Breathing Give 100 (...) Examination - looking particularly for evidence of - ? cerebral oedema headache, irritability, slowing pulse, rising blood pressure, reducing conscious level N.B. papilloedema is a late sign. ? ? infection ? ? ? ileus (which is common in DKA) ? ? ? 3. WEIGH THE CHILD. If this is not possible because of the clinical condition, use the most recent clinic weight as a guideline, or an estimated weight from centile charts. Consider where the child or young person should be nursed – Children and young people
the greatest burden of malnutrition with more than half of all stunted children and two‐third of all wasted children under 5 years of age living in Asia and over one‐third stunted children and a quarter of wasted children living in Africa (UNICEF, ). Childhood malnutrition is a major public health concern since it is associated with significant morbidity and mortality (WHO, ). The consequences of malnutrition among infants and children can be short‐term like morbidity, mortality and disability or long‐term (...) implementation of nutrition‐sensitive as well as nutrition‐specific interventions (Ruel, Alderman, & Maternal Child Nutrition Study Group, ). 2.2 Description of the intervention The existing WHO guidelines for the management malnutrition among children suggests the following (WHO, ): 1. Early identification of children with SAM in the community through active community screening by trained community health workers (CHWs) and community members. CHWs should measure the MUAC of infants and children under 5
Guidance on Providing Pediatric Well-Care During COVID-19 / Guidance on Providing Pediatric Well-Care During COVID-19 The American Academy of P ediatrics (AAP) strongly supports the continued provision of health care for children during the COVID-19 pandemic. Specifically , w ell-child care should be provided consistent with the (4th Edition) and the corresponding (Periodicity Schedule). Since the onset of the pandemic, a significant drop in well-child visits has resulted in delays in vaccinations (...) exam virtually, these telehealth visits should continue to be supported, followed by a timely in-person visit . Pediatricians should identify children who have missed well-child visits and/or recommended vaccinations and contact them to schedule in person appointments inclusive of newborns, infants, children , and adolescents. Pediatricians should work with families to bring children up to date as quickly as possible. State-based immunization information systems and electronic health records may
British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Coronavirus (SARS-CoV-2) and COVID-19 in children with Inflammatory Bowel British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Coronavirus (SA 1 IBD Working Group British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Coronavirus (SARS-CoV-2) and COVID-19 in children with IBD Position Statement: Management of PIBD during the SARS-CoV-2 pandemic Specific (...) that children are safe to continue all IBD therapies during the coronavirus pandemic and that stopping medicines put children at risk of disease relapse. The international SECURE-IBD registry, a database curating cases of IBD patients infected with SARS-CoV-2 world-wide, shows that current outcomes for IBD patients do not vary substantially from outcomes from the general population . Reassuringly, first international paediatric data published by Turner et al. confirms that the small number of reported