COVID-19 Management For 1 Month - 19 Years Old
- Dr Mohsin Gani
- Apr 26, 2021
- 3 min read
COVID-19 Management For 1 Month - 19 Years Old: Statement by Indian Academy of Pediatrics (April 2021)
Whom to test?
Testing is recommended ideally for all the suspect cases (to avoid transmission to other household members)
Prior to any procedure/ hospitalization
However, if resources are scarce, then testing may be deferred for both asymptomatic contacts and children with mild symptoms AND no comorbidities# AND a known positive family member (Should be isolated)
Such children may be presumed to be COVID-19 infected and be managed as per the guidelines in this document
When to suspect COVID-19?*
Fever, headache, myalgia, fatigue, tiredness, coryza, cough, sore throat, rapid breathing (anyone) OR
Diarrhea, vomiting, abdominal pain OR
Poor feeding in an infant, loss of taste or smell (>8 year) OR
Rash, conjunctival congestion, mucositis, shock OR
Asymptomatic but has a close/household contact with a COVID-19 case
Which tests?
Testing should be done as soon as possible after onset of symptoms
Rapid Antigen Test (RAT) in nasopharyngeal swabs (low sensitivity, so if negative, RT-PCR should be done)
RT-PCR in nasopharyngeal ± oropharyngeal swabs (Xpert SARS-CoV-2 and Truenat give faster results)
SARS-CoV-2 antibodies also, if features of MIS-C
* Symptoms and signs of COVID-19 are nonspecific and mimic any viral illness. #Chronic kidney disease/congenital heart disease/chronic liver disease/ neurodisability/morbid obesity/severe malnutrition/current malignancy/ immunocompromised state/diabetes Children with symptoms suggestive of COVID-19 but negative RT-PCR test, should undergo repeat RT-PCR and evaluated for other illnesses. If symptoms are protracted and RT-PCR is negative, CT chest may be done. If no alternative diagnosis, treat as per COVID-19
CLASSIFICATION OF DISEASE SEVERITY*
Mild Disease
Moderate Disease
Severe Disease
Pneumonia with any of these:
<90%
Increased respiratory effort
Grunting, severe retractions
Lethargy, seizures, and somnolence
Severe diarrhea, vomiting, and abdominal pain
Critical disease (a subset of severe disease) is defined, if any of these is present:
ARDS
Shock
Multiorgan dysfunction syndrome
Acute thrombosis
Fever, sore throat, rhinorrhea, cough, diarrhea, vomiting
AND
No fast breathing (age-based)
Fast breathing (age- based) OR Presence of hypoxia (SpO2 90–94% on room air) AND
Nosignsofseveredisease
* Including children who have high index of suspicion because of a family member testing positive; but child’s test result is awaited.
Multi-system Inflammatory Syndrome in Children (MIS-C): Statement by Indian Academy of Pediatrics (April 2021)
DEFINITION OF MIS-C (WHO)
AND
Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19
Definition of MIS-C (WHO)
0–19-years-old child with fever >3 days
AND—Two of the following:
Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet).
Hypotension or shock
Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP)
Evidence of coagulopathy (by PT, PTT, elevated d-Dimers)
Acute gastrointestinal problems (diarrhea, vomiting, or abdominal pain) Elevated ESR, C-reactive protein, or procalcitonin No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes.
ANDAND
Chairperson Convenor Co-Convenor Ex-Officio Prof Piyush Gupta Dr Tanu Singhal Dr Vijay N Yewale Dr Dhanya Dharmapalan Prof Jayashree Muralidharan Prof Rakesh Lodha Dr Dhiren Gupta Dr Shyam Kukreja Dr Bakul Jayant Parekh Dr Remesh Kumar R Dr S Balasubramanian Dr Jagdish Chinnapa Prof Ashok Deorari Dr Deepti Agarwal Prof Arun Bansal Dr Vinod H Ratageri Dr Digant D Shastri Dr Deepak Chawla Prof Santosh T Soans Dr Jaydeep Choudhury Dr Vipin M Vashishtha Prof Basavaraja GV Dr Kheya Uttam Ghosh Dr Yagnesh O Popat Dr Vivek Singh Dr Rajesh Mehta
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