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121. COVID-19 - paediatric scenarios

. Following transfer, the room should be chlorine cleaned. Special cases: children with febrile neutropenia and suspected COVID-19 Children should initially be assessed and tested in ED not the wards. Prompt administration of broad-spectrum antibiotics for the management of febrile neutropenia is essential. In the Oncology wards may wish to designate specific cubicles for patients with suspected COVID-19. All infectious disease precautions must be followed as for other COVID-19 patients as well

2020 Royal College of Paediatrics and Child Health

122. COVID-19 - guidance for neonatal settings

. The family should be advised to self isolate with the baby for 14 days from birth. Term or late preterm baby requiring additional care Well babies born to suspected/confirmed COVID-19 mothers and who require additional care (eg intravenous antibiotics) should be assessed in the labour ward and a decision made as to whether additional care can safely be provided at the mother’s bedside. Avoid NNU admission if possible and safe. Babies requiring admission to the NNU should be assessed in a designated area

2020 Royal College of Paediatrics and Child Health

123. COVID-19 - guidance for paediatric services

protective equipment should be worn, irrespective of whether the child has symptoms consistent with COVID-19 or not. Suspected tonsillitis in primary care or emergency departments During the COVID-19 pandemic, if a diagnosis of tonsillitis is suspected based on clinical history, the default becomes not examining the throat unless absolutely necessary. If using the to decide if antibiotics are indicated (validated in children 3 years and older), we suggest that a pragmatic approach is adopted (...) , and automatically starting with a score of 2 in lieu of an examination seems reasonable. Antibiotics should be considered in children with a total feverpain score of 4 or 5 (we suggest children with a score of 3 or less receive alone). Although this is likely to result in a temporary increase in antibiotic prescribing in children, we feel that this is preferable to healthcare staff being unnecessary exposed to COVID-19. Antibiotics rarely confer a benefit in children under 3 years with tonsillitis and should

2020 Royal College of Paediatrics and Child Health

124. COVID-19 - guidance for acute settings

for the . It outlines key principles for the medical management of children admitted to hospital with COVID-19, including: Radiology Fluids Antipyretics Respiratory support Antibiotics Antivirals Bronchodilators and treatment of children with asthma attacks Systemic steroids Liver dysfunction Hydroxychloroquine This guidance is based on literature review of published and unpublished data, expert opinion, and national/international guidelines, and is subject to updates as evidence becomes available. Discharging

2020 Royal College of Paediatrics and Child Health

125. Chronic obstructive pulmonary disease (COPD)

Workshops 5 Pharmacologic Treatment 6 Bronchodilator therapy 6 Medication guide 7 Oxygen therapy 7 Treatments that are not recommended 8 COPD Exacerbations 9 Treatment of COPD exacerbations 10 Prophylactic antibiotics for exacerbation prevention 11 Follow-up and Monitoring 12 Medication monitoring 12 Long-term steroid use and osteoporosis risk 12 Immunizations 12 Referral 13 Evidence Summary 14 References 16 Guideline Development Process and Team 18 Appendix 1. COPD Assessment Test (CAT). 19 Appendix 2 (...) symptom (increased dyspnea or increased sputum volume) is required for an exacerbation diagnosis. A chest X-ray is recommended for all patients with a suspected COPD exacerbation. Severity of exacerbation ? Mild exacerbation: the person has an increased need for short acting bronchodilators, which they can manage in their own normal environment. ? Moderate exacerbation: the person has a sustained worsening of respiratory status that requires treatment with systemic corticosteroids and/or antibiotics

2020 Kaiser Permanente Clinical Guidelines

127. Assisted Vaginal Birth

degree angle initiated when the head is distending the perineum. [New 2020] Grade of recommendation: B Aftercare following assisted vaginal birth Should prophylactic antibiotics be given? A single prophylactic dose of intravenous amoxicillin and clavulanic acid should be recommended following assisted vaginal birth as it significantly reduces confirmed or suspected maternal infection compared to placebo. [New 2020] Grade of recommendation: A Good standards of hygiene and aseptic techniques

2020 Royal College of Obstetricians and Gynaecologists

128. Coronavirus (COVID-19) infection and pregnancy

infection, all women should be prescribed at least 10 days of prophylactic LMWH.’ This is consistent with recommendations already made elsewhere in previous versions of this document. 9 13.5.20 4.6 (Now 3.6): Changed statement ‘Consider bacterial infection if the white blood cell count is raised (lymphocytes usually normal or low with COVID-19) and commence antibiotics’ to ‘Bacterial infection is an important differential diagnosis to COVID-19 infection. We advise blood cultures and a low threshold (...) for antibiotics at presentation, with early review and rationalisation of antibiotics if COVID-19 is confirmed.’ 9 13.5.20 3.6: Statement added: ‘A woman with moderate or severe COVID symptoms who happens to be pregnant but with no immediate pregnancy issue should be cared for by the same multidisciplinary team as a non-pregnant woman with additional input from the maternity team. The labour ward should not be the default location for all pregnant women.’6 1. Introduction7 1. Introduction The following advice

2020 Royal College of Obstetricians and Gynaecologists

130. The acute management of paediatric coronavirus disease 2019 (COVID-19)

[ ] [ ] . In cases of severe disease, additional pressure and ventilatory support may be required, including intubation [ ] . To optimize first-pass success, intubation should be performed by the most experienced provider, with the fewest possible number of health care providers exposed in the room. Antibiotics are not recommended to treat cases of COVID-19 without clinical suspicion of bacterial co-infection. Early studies in China found the rate of secondary bacterial infection to be low. However, when (...) there is evidence for a secondary infection, appropriate antibiotics should be administered pre-emptively, without waiting for confirmatory test results. For sepsis, treat with an IV third-generation cephalosporin, such as cefotaxime (50 mg/kg/dose every 6 h, to a maximum 2 g/dose or 8 g/day), or IV ceftriaxone (75 mg/kg/dose every 12 to 24 h, to a maximum 4 g/day), with the addition of IV vancomycin (15 mg/kg/dose every 6 h, to a maximum 500 mg/dose) for severe disease. For pneumonia, first-line treatment

2020 Canadian Paediatric Society

131. Management of patients with moderate to severe COVID-19

) if O2 saturations =92% or significantly below baseline. [Adapted from ASID] FLUID MANAGEMENT 1.9 A restrictive fluid management strategy is recommended. The aim is to reduce extravascular lung water. Where possible avoid ‘maintenance’ intravenous fluids, high volume enteral nutrition, and fluid bolus for hypotension. [ANZICS] SUPPORTIVE ANTI-INFECTIOUS THERAPY 49.7 Prescribe antibiotics for bacterial pneumonia if hypoxaemic ( 72h, as per eTG or local institutional pneumonia guidelines). [ASID] 49.8

2020 National COVID-19 Clinical Evidence Taskforce

132. Clinical management of children admitted to hospital with suspected COVID-19

recommended in some adult papers, the following medical treatments are likely to have more side-effects than beneficial effects in children and are not routinely indicated for empiric treatment of COVID-19, but should be used if otherwise clinically indicated: bronchodilators, systemic steroids, antibiotics, antivirals, and diuretics. Despite emerging concern about Angiotensin Converting Enzyme (ACE) Inhibitors and non- steroidal anti-inflammatory drugs (NSAIDs), there is insufficient evidence (...) Injury Consensus Conference Group.18 Supportive medical care This section covers: admission, radiology, fluids, antipyretics, respiratory support, antibiotics, bronchodilators / treatment of children with asthma attacks, and liver dysfunction. Admission Not all children with COVID-19 require admission. Many people with confirmed COVID-19 may be managed at home, in line with Public Health England guidance. Radiology Chest x-rays and CT scans may reveal non-specific findings even in asymptomatic

2020 Royal College of Paediatrics and Child Health

133. Updated SOGC Committee Opinion – COVID-19 in Pregnancy

and discontinuation of precautions should be determined in accordance with Public Health Agency of Canada guidelines,(15) and provincial and territorial guidance. • Health care providers can consider empiric antibiotic therapy for superimposed bacterial pneumonia in women with confirmed COVID-19 infection or severe respiratory disease. First-line antibiotics are oral amoxicillin for stable patients and ceftriaxone for severe disease, based on general recommendations for the management of pneumonia. • For maternal

2020 Society of Obstetricians and Gynaecologists of Canada

134. Management of Tick Bites and Lyme Disease During Pregnancy

with a tick bite or suspected Lyme disease should be managed similarly to non-pregnant adults, including the consideration of antibiotics for prophylaxis and treatment. The primary objective of this committee opinion is to inform practitioners about Lyme disease and provide an approach to managing the care of pregnant women who may have been infected via a blacklegged tick bite. Intended users Health care providers who care for pregnant women or women of reproductive age. Target population Women (...) series. BMC Infect Dis. 2009; 9 : 79 Warshafsky S Lee DH Francois LK et al. Efficacy of antibiotic prophylaxis for the prevention of Lyme disease: an updated systematic review and meta-analysis. J Antimicrob Chemother. 2010; 65 : 1137-1144 Cross R Ling C Day NP et al. Revisiting doxycycline in pregnancy and early childhood–time to rebuild its reputation?. Expert Opin Drug Saf. 2016; 15 : 367-382 National Institute for Health and Care Excellence (NICE) Lyme disease (NG95). NICE , London, United

2020 Society of Obstetricians and Gynaecologists of Canada

136. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children

countries and the UK in this decreasing phase of the epidemic. It is possible that more cases will be recognised as more countries enter this phase and more publicity is given to this syndrome. Clinical management Based on information from the reporting countries, management of PIMS-TS cases has been mostly supportive as they are at the severe end of the spectrum. As KD was part of the differential diagnosis, treatment with IVIG has been the predominant management option. Antibiotics, corticosteroids

2020 ICM Anaesthesia COVID-19

137. Guide for Completion of the Neonatal Transfer Record

at the beginning of the list. ? Car Bed added as an option in Environment for transfer. ? Care transferred to HART removed. Section 1: ? Maternal / Birth History: Free text box replaced with pertinent questions such as antenatal steroids, prophylactic antibiotics, and delivery type. Section 2: ? Newborn Exposure: Checkbox added to indicate if exposure is unknown. Summary of Changes WHAT’S NEW? The updated record was developed to reflect the recommendations of the BC Coroners report, the Provincial Patient (...) handover.BC Neonatal Transfer Record (PSBC 1995) 6 ABG Arterial Blood Gas ARO Antibiotic Resistant Organisms B Bottle BD Base Deficit BE Base Excess BP Blood Pressure BR Breast CBG Capillary Blood Gas CCHD Critical Congenital Heart Disease CPAP Continuous Positive Airway Pressure CVAD (CVC) Central Venous Access Device (Central Venous Catheter) EBM Expressed Breast Milk ETT Endotracheal Tube F female FiO 2 Fractional concentration of inspired oxygen GBS Group B Streptococcal GI/GU Gastrointestinal

2020 British Columbia Perinatal Health Program

138. Low-Risk Infant Ground Transport in the Care of a Registered Nurse: Practice Resource

transfer in the care of an RN, the following clinical parameters must be met: CLINICAL PARAMETER YES NO* N / A Gestational age = 32 weeks PMA Current weight = 1500 grams On supplemental oxygen by Low Flow Nasal Prongs (LFNP) not requiring additional pressure support for > 48 hours prior to transport If on caffeine, no major episodes of apnea requiring positive pressure ventilation for > 48 hours prior to transport Saline lock can be placed for transport if on intravenous (IV) fluid and / or antibiotics (...) ? Dextrose concentration greater than D12.5%W for hypoglycemia ? Medications for hypoglycemia ? Post op with enteral feeds less than full feeds ? Gastrostomy less than 10 days post-op ? Jejeunal tube ? Ileostomy ? Jejunostomy ? Post op with enteral feeds less than 50% ? Mucous fistula refeeds Other ? Phototherapy ? Post cesarean section ? Terminal palliative care, with no invasive interventions required ? Boarder baby ? Antibiotics in a well baby with risk factors ? ROP: less than weekly checks

2020 British Columbia Perinatal Health Program

139. Clinical guide for the management of critical care for adults with COVID-19 during the Coronavirus pandemic

therapies should only be administered within the context of a nationally approved trial. COVID-19 related clinical trials should be supported to rapidly develop an evidence base for this new disease. Routine antibiotics ? Routine antibiotics are not recommended for uncomplicated COVID-19. Treatment of other conditions in the context of COVID-19 ? Careful attention to antimicrobial stewardship: antibiotics should be considered if there is suspected bacterial super-infection. ? Take care not to neglect (...) antibiotics 8 Treatment of other conditions in the context of COVID-19 8 Impact of non-steroidal anti-inflammatory drugs (NSAIDs), ACE-inhibitors and ARBs on COVID-19 9 4 Clinical decision-making 9 General comments 9 Referral and admission to intensive care or palliative care 9 Treatment decisions 10 5 Management of respiratory failure 10 Oxygen therapy 10 High flow nasal oxygen 11 CPAP and NIV 11 Intubation 12 Mechanical ventilation 12 Management of early (pneumonitis) phase 14 Management of later

2020 ICM Anaesthesia COVID-19

140. Paediatric inflammatory multisystem syndrome temporally associated with COVID-19

screening investigations ( ). PIMS/MIS-C should also be considered in patients with ≥5 days of unexplained fever. Critically ill individuals should receive broad-spectrum antibiotic coverage pending results from their microbiological and hyperinflammatory work-up and be admitted to an ICU for inotropic support and mechanical ventilation, as required. For hospitalized patients with moderate to severe end-organ dysfunction, multidisciplinary team involvement is advised. This team may include general (...) presenting with shock or shock-like states. Patients presenting with or developing hypotension, severe cardiac dysfunction (including elevated troponin, NT-proBNP, abnormal ECG), or other shock-like states (including GI or neurologic presentations) can deteriorate very quickly and require rapid, judicious fluid resuscitation, inotropic support, and intubation. Initial broad-spectrum antibiotics are recommended because symptoms overlap with severe bacterial infections. Emergent cardiology and critical

2020 Canadian Paediatric Society

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