Remdesivir and steroids not recommended for kids: Government issues guidelines for COVID-19 management in children

The Centre has released a list of guidelines for the management and care of COVID-19 in children late on Wednesday night. This is because the third wave of COVID-19 is said to have a greater impact on children. Under the Directorate General of Health Services (DGHS) guidelines for children, Remdesivir is not recommended for children. According to the guidelines Remdesivir (an emergency use authorization drug) is not recommended in children. As there is a lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age.

The rational use of High-resolution CT (HRCT) is suggested. “HRCT scan of the chest provides better visualization of the extent and nature of lung involvement in patients with COVID-19. However, any additional information gained from the 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,” the guidelines said.

It has also been said that children below the age of 5 years are not required to wear a mask.

The guidelines have been issued by the central government for children below 18 years of age. As per the guidelines, there is no need for any investigation in asymptomatic and mild category COVID-19 infected children. The investigation is necessary only if the problem is seen more in children. “For fever, give paracetamol 10-15mg/kg/dose; may repeat every 4-6 hours, for cough: throat soothing agents and warm saline gargles in older children and adolescents. Fluids and feeds: ensure oral fluids to maintain hydration and give a nutritious diet. No other COVID-19 specific medication needed. Antimicrobials are not indicated.  Maintain monitoring chart including counting of respiratory rate 2-3 times a day, look for chest indrawing, bluish discolouration of body, cold extremities, urine output, oxygen saturation, fluid intake, activity level, especially for young children,” it added.

The usage of steroids in the treatment of asymptomatic and mild cases of COVID-19 are harmful “it is indicated only in hospitalised 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,” DGHS guidelines added.

The guidelines also recommend a six-minute walk test for children above 12 years under the supervision of parents/guardian. “It is a simple clinical test to assess cardiopulmonary exercise tolerance and is used to unmask hypoxia. Attach pulse oximeter to his/her finger and ask the child to walk in the confines of their room for 6 minutes continuously. Positive test: any drop in saturation < 94%, or absolute drop of more than 3–5% or feeling unwell (lightheaded, short of breath) while performing the test or at end of 6 minutes. Children with a positive 6-minute walk test may progress to become hypoxic and early admission to the hospital is recommended (for observation and oxygen supplementation). The test can be repeated every 6 to 8 hours of monitoring in-home setting; avoid the test in patients with uncontrolled asthma,” the guideline reads.

(With inputs from DNA India)

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