Paediatrician Southland Hospital Clinical features Asymptomatic in one third Mild symptoms in most others Rarely deteriorate after day 5 of illness PIMSTS rare complication can occur up to 6 weeks after COVID19 ID: 1045194
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1. COVID in childrenParag TambePaediatrician Southland Hospital
2. Clinical featuresAsymptomatic in one thirdMild symptoms in most othersRarely deteriorate after day 5 of illnessPIMS-TS rare complication can occur up to 6 weeks after COVID-19Risk of hospitalisation- all age risk 2.5 times higher for Māori and 3 times higher for Pacific people over othershttps://southern.communityhealthpathways.org/931295.htm
3. Disease severity
4. Risk assessment
5. Risk assessment
6. Care levelsCOVID-19 Care 1 (Case has mild symptoms and low risk of complications and no social risk factors):Telehealth clinician contact every other dayDaily monitoring of symptoms by caregiver, more frequent if there are emergent concernsCOVID-19 Care 2 (Case has moderate symptoms or at risk of complications or has social risk factors):Telehealth clinician contact every dayMonitoring of symptoms by caregiver with at least twice daily pulse oximetry readings if indicated
7. Home monitoringAt risk children- infants, premature, IDDM, Severe obese, immunocompromisedHome pulse oximetryFor high risk childrenCyanotic congenital heart diseaseNeuromuscular disease- Duchenne’s, Cerebral palsyChronic respiratory disease- cystic fibrosis, severe asthmaDarker skin affects accuracy of pulse oximetry- falsely high readings up to 3-7% in mixed ethnic and African descent
8. Escalation triggers- Care 1 to Care 2Triggers for moving from COVID-19 Care 1 to COVID-19 Care 2Escalate care if the patient develops features indicating moderate severity:Moderate respiratory distressStill drinking, but fluid intake less than half of normalFrequent vomiting or diarrhoeaModerate dehydrationOxygen saturation (SpO2) 92 to 96%Other clinical concern
9. Escalation triggers- hospital transferClinical signs or suspicion of pneumonia PLUS any of the followingBlue lips or tongueSevere respiratory distressSpO2 less than 92% or drop by 3% of pre-existing levelRapid breathingGeneral danger signs- inability to breast feed, poor urine output, lethargy, difficult to rouse, convulsionFever above 38° in an infant < 6 weeks
10. PIMS-TSRare complication can happen up to 6 weeks after COVID-191 per 3200 infections in patients with COVID infection <21 yearsNZ- expected to be about 344 children- before immunisationHigh risk in coloured race4 paediatric deaths in NZ due to MISC-TS
11. PIMS- TSClinical featuresPersistent fever >3 daysUnexplained fever >5 daysSimilar to Kawasaki’s diseaseClinical featuresSepsis, Toxic shock syndrome- hypotensionGI symptoms- abdominal pain, diarrhoea, vomiting- 80-90%
12. Treatment- mild at home Coughrecommended not to lie on the back>1 year honey can be givenFeverParacetamol or IbuprofenDrink plenty of oral fluidsDexamethasone- if need oxygen or ventilator supportRemdesivirhttps://starship.org.nz/guidelines/covid-19-disease-in-children
13. Treatment
14. RemdesivirConsider if risk factors/co-morbidities- next slide<5 days since SARS-COV2 PCR positiveSpecial authority access criteriaChildren hospitalised with confirmed COVID-19Age ≥12 yearsWeight ≥40 kgChildren requiring supplemental oxygen
15. Risk factors/co-morbidities
16. Remdesivir
17. Remdesivir contraindicationseGFR≤30ml/min OR ALT is raised ≥ 5 times the upper limit of normal at baseline.Remdesivir should only be started within 5 days of symptom onset.If the patient has already been intubated/ventilated
18.