Bhubaneswar: The Directorate General of Health Services (DGHS) under the Health Ministry has recommended rational use of HRCT imaging (CT Scan) for seeing the extent and nature of lung involvement in COVID-infected children below 18 years of age.
Since 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, treating physicians should be highly selective in ordering the same for COVID-19 patients, the guidelines said.
It has discouraged the use of Remdesivir (an emergency use authorisation drug). “There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age,” it said.
Steroids are to be used only in hospitalised moderately severe and critically ill 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 added.
The guidelines said antimicrobials are not recommended for therapy or prophylaxis in asymptomatic and mild cases as COVID-19 is a viral infection and these have no role in the prevention or treatment of uncomplicated infection.
For mild infection, it has suggested paracetamol 10-15mg/kg/dose every 4-6 hours for fever. In case of cough, throat soothing agents and warm saline gargles have been recommended for older children and adolescents.
For those suffering from a moderate infection, the guidelines suggested 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.
In severe cases, antimicrobials can 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 added.
The guidelines also recommended a six-minute walk test for children above 12 years 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.
