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Covid-19 in children: DGHS issues guidelines on Remdesivir, masks, steroids

The Directorate General of Health Services (DGHS) under the union health ministry has issued guidelines for the management of COVID-19 among children below 18 years of age. As per the guidelines Remdesivir has not been recommended and rational use of HRCT imaging has been suggested. Children having mild COVID infection may be given paracetamol 10-15mg/kg/dose every 4-6 hours for fever. For cough, throat soothing agents and warm saline gargles in older children and adolescents have been recommended.

Comprehensive guidelines for management of COVID in children

Steroids and anti-coagulants guide:

Self-medication of steroids must be avoided.

Steroids are not indicated and are harmful in asymptomatic and mild cases of COVID-19

They are indicated only in hospitalised moderately severe and critically ill COVID-19 cases under strict supervision.

Steroids should be used at the right time, in right dose and for the right duration.

Corticosteroids may be used in rapidly progressive moderate and severe cases. The recommended dose is as below: .

Dexamethasone 0.15 mg/kg per dose(maximum 6 mg) twice a day or equivalent dose of methylprednisolone may be used if dexamethasone is unavailable, for 5–14 days depending on clinical assessment on daily basis.

Anti-coagulants

Recommended dose in severe COVID-19 and MIS-C

Aspirin: 3 mg/ kg/day to 5 mg/kg/day max 81 mg/ day (if thrombosis or Coronary aneurysm score ≥ 2.5)

Low molecular weight heparin (Enoxaparin): 1mg/kg twice daily subcutaneously

Clotting factor Xa should be between 0.5–1 IU/ml (if patient has thrombosis or coronary aneurysm score >10 or LVEF <30%)

High-resolution CT (HRCT): Guidelines

The guidelines suggested rational use of High-resolution CT (HRCT) for seeing the extent and nature of lung involvement in patients with Covid-19.

“However, any additional information gained from HRCT scan of the chest often has little impact on treatment decisions, which are based almost entirely on clinical severity and physiological impairment.

“Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in Covid-19 patients,” the DGHS guidelines said.

Guidelines regarding Remdesivir

The DGHS has said that that Remdesivir (an emergency use authorization drug) is not recommended in children.

“There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age,” the guidelines stated.

Guide for using masks by children

Children aged 5 years and under should not be required to wear masks

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

Children aged 12 years and over should wear a mask under the same conditions as adults

Ensure hands are kept clean with soap and water, or an alcohol based hand rub, while handling masks

6-Minute Walk Test on children

The DGHS has recommended use of ‘6-Minute Walk Test’ on children above 12 to assess “cardio-pulmonary exercise tolerance”.

6-Minute Walk Test’ to be used in children above 12 years under supervision of parents/guardian

It is a simple clinical test to assess cardio-pulmonary exercise tolerance, and is used to unmask hypoxia

Attach pulse oximeter to his/her finger and ask the child to walk in the confines of their room for 6 minutes continuously

Positive test: any drop in saturation < 94%, or absolute drop of more than 3–5% or feeling unwell (lightheaded, short of breath) while performing the test or at end of 6 minutes

Children with positive 6-minute walk test may progress to become hypoxic and early admission to hospital is recommended (for observation and oxygen supplementation)

The test can be repeated every 6 to 8 hours of monitoring in home setting; avoid the test in patients with uncontrolled asthma.

Guidelines on antimicrobials

COVID-19 is a viral infection, and antimicrobials have no role in the prevention or treatment of uncomplicated coronavirus infection, the government said.

Asymptomatic and mild cases: Antimicrobials are not recommended for therapy or prophylaxis

Moderate and severe cases: Antimicrobials should not be prescribed unless there is clinical suspicion of a superadded infection; hospital admission increases risk of healthcare-associated
infections with multidrug-resistant organisms

Septic shock: Empirical antimicrobials (according to body weight) are frequently added to cover all likely pathogens based on clinical judgement, patient host factors and local epidemiology and
antimicrobial policy of the hospital, and are usually needed when there is leucocytosis with neutrophilia, very high inflammatory markers, or raised procalcitonin (which may also be raised in
severe trauma, burns, multiorgan failure, major surgery or chronic kidney disease).

 

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