New Delhi: The central govt has announced comprehensive guidelines for the management and treatment of COVID-19 among children. The guidelines issued by the Directorate General of Health Services (DGHS) under the health ministry did not recommend Remdesivir and suggested rational use of HRCT imaging.
According to the guidelines, steroids are harmful in asymptomatic and mild cases of infection. The DGHS suggested the use of steroids only in hospitalised and moderately severe and critically ill COVID-19 cases under strict supervision. “Steroids should be used at the right time, in the right dose and for the right duration. Self-medication of steroids must be avoided,” it said.
Another guideline issued was regarding the use of Remdesivir (an emergency use authorization drug). It is not recommended in children. The guidelines said, “There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age.”
Guidelines were also issued regarding the rational use of High-resolution CT (HRCT) for seeing the extent and nature of lung involvement in patients with Covid-19. The guidelines said, “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.” They also said that Covid-19 is a viral infection, and antimicrobials have no role in the prevention or treatment of uncomplicated Covid-19 infection.
As per the guidelines, antimicrobials are not recommended for therapy or diagnosis for asymptomatic and moderate cases. Hospital admission increases the peril of healthcare-associated infections with multidrug-resistant organisms.
For asymptomatic infections in children, the guidelines do not recommend any specific medications and promote Covid-appropriate behavior (mask, strict hand hygiene, physical distance) and recommended providing a nutritious diet.
The guidelines announced that for mild infection paracetamol 10-15mg/kg/dose may be given every 4-6 hours for fever and throat comforting agents and warm saline gargles in older children and adolescents.
For moderate infection, the guidelines recommended starting immediate oxygen therapy. “Corticosteroids are not required in all children with moderate illness; they may be administered in rapidly progressive disease and anticoagulants may also be indicated,” the guidelines said.
And for severe COVID-19 among children, the guidelines said if Acute Respiratory Distress Syndrome (ARDS) occurs, necessary management to be started. “In case shock develops, necessary management should be initiated. Antimicrobials to be administered if there is evidence/strong suspicion of superadded bacterial infection. May need organ support in case of organ dysfunction, e.g. renal replacement therapy,” it said.
A 6-minute walk test for children above 12 years is recommended by the guidelines, under the supervision of parents/guardians. “It is a simple clinical test to assess cardiopulmonary exercise tolerance and is used to unmask hypoxia. Attach a pulse oximeter to his/her finger and ask the child to walk in the confines of their room for six minutes continuously,” it said.