COVID-19 Management For 1 Month - 19 Years Old

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