Guidelines for the prevention and management of children and adolescents with COVID-19.

Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. CONCLUSION: This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged. WHAT IS KNOWN: • Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated. • We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence. WHAT IS NEW: • The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.

Erratum to rapid advice guidelines for management of children with COVID-19.

[This corrects the article DOI: 10.21037/atm-20-3754.].

Analysis and suggestions for the preview and triage screening of children with suspected COVID-19 outside the epidemic area of Hubei Province.

BACKGROUND: Since December 2019, a number of patients infected with COVID-19 (SARS-CoV-2) have been identified in Wuhan, Hubei, China. As the epidemic has spread, similar cases have also been found in other parts of mainland China and abroad. The main reason for this spread is the highly contagious nature of the virus and the fact that children can also become infected during its incubation period. This has made the virus a substantial challenge for the outpatient triage staff of children's hospitals outside the epidemic area of the Hubei Province. It is very important for the preview and triage personnel to accurately grasp the epidemiology of the virus and identify children's symptoms in the fever clinic. METHODS: We performed an analysis of our early preview and triage of suspected COVID-19 in 36 children presenting at fever clinics. Two specialists either excluded suspected cases or referred cases to the isolation ward for new nucleic acid testing. RESULTS: All 14 children who were transferred to the isolation ward had a fever, and 71.43% of them had a cough. Their nucleic acid testing results were negative. The suspected cases and excluded suspected cases had similar epidemiology history as well as complete blood count results. With reference to the diagnostic criteria in existing pediatric guidelines, we have further improved the triage screening questionnaire for children with fever in our hospital. CONCLUSIONS: According to the situation in our city and hospital, an evaluation questionnaire that is suitable for use with children in our hospital has been formulated to achieve the goals of early detection, isolation, diagnosis, and treatment. We provided an important basis for the next step in developing accurate preview and triage screening standards and appropriate guidelines for pediatric patients.