The Royal College of Paediatrics and Child Health (RCPCH) has published new guidance highlighting key principles for the clinical management of children admitted to hospital with suspected COVID-19.
This guidance targets general paediatricians attending children during the COVID-19 pandemic. It has been collaboratively developed by the British Paediatric Respiratory Society and the British Paediatric Allergy, Immunity and Infection Group.
- Paediatric clinicians should reassure parents and involve them in caring for their child, remain updated with emerging evidence and ensure communication with colleagues.
- Clinicians should remain extra-vigilant when treating children with pre-existing conditions, but at the same time, reassure parents that the risks for co-morbidities are much higher in adults than children.
- Although chest X-rays, blood tests and blood gas analysis are not routinely indicated in all children, they are warranted in children with persistent fever, fluid imbalance, signs of hepatic dysfunction or respiratory failure.
- The following therapies are not routinely indicated for empiric treatment of COVID-19 in children and should be only used if there is an absolute clinical need: bronchodilators, systemic steroids, antibiotics, antivirals and diuretics.
- Paracetamol is recommended as the first-line antipyretic; ibuprofen should be administered with caution.
- Despite emerging concerns about angiotensin-converting enzyme (ACE) Inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs), there is no strong evidence to discontinue these medications in children who have been taking them for pre-existing conditions.
- Locally-applicable respiratory failure pathways should be followed.
- Use of high-flow nasal cannula oxygen (HFNCO) is not recommended if low-flow oxygen provides adequate saturation.
- HFNCO and nebulisation should be used after careful consideration.
- The use of specific treatments such as antiviral and immunomodulatory therapies is justified within a treatment trial.
- A paediatric infectious diseases expert should be consulted beforehand.
The complete guidance can be found here.