COVID19 Inflammatory Syndrome
As referring clinicians will already be aware, a small number of children have recently been identified who develop a significant systemic inflammatory response in response to presumed COVID19 infection. The RCPCH has produced guidance for the identification, investigation and management of suspected cases. These can be accessed here:-
COVID19 Inflammatory Syndrome RCPCH Guidance
It is agreed that this group of children will benefit from specialist management in a tertiary centre. We ask that all suspected cases fulfilling the case definition are referred via the WATCh team on 0300 0300 789.
- Cardiff and Bristol will accept these children either onto HDU/PICU or through General Paediatrics if deemed well enough to be on a general ward, in recognition of the need for urgent and often multidisciplinary specialist input and management;
- WATCh will triage these calls and coordinate a teleconference which will involve consultants in PICU, HDU or General Paediatrics as appropriate , together with Paediatric Cardiology and Infectious Diseases (if available);
- WATCh will also coordinate how the child is transferred (by WATCh or local team) and the timing of the transfer, ensuring that important treatment that can be commenced locally – such as IVIG – is not delayed.
ICU Management of COVID19 +ve Infants and ChildrenMany of our referring centres have asked for guidance in the current climate, in case they have to ventilate an infant or child in the short term as transport services become stretched. We realise that the acute pressure will be on adult services and are still expecting to take children to PICU wherever possible, but it is likely that there may be some delay in our response times. To this end, the South West England Paediatric Critical Care ODN has republished simple, one-page guidance on the management of ventilated children in general ICUs. This guidance can be downloaded here. Please continue to refer and discuss all children requiring critical care support with WATCh in the normal way, by calling 0300 0300 789.
Transport of parents/carersOn the advice of the Paediatric Critical Care Society Advanced Transport Group (PCCS-ATG), we have made the decision that we are currently unable to offer parents transport with the team in the ambulance. This applies to all children being transferred irrespective of their clinical presentation / need for critical care. We appreciate that this may cause some anxiety for parents, but we are implementing this both for their own safety and that of the whole transport team; people can be asymptomatic with COVID19, and a journey within the confined space of an ambulance is an increased risk for all involved. We will review this decision as soon as social distancing restrictions are eased.
Several of our referring centres have asked for COVID19 specific guidance to be made available. At WATCh we are acutely aware that there are huge amounts of guidance being produced very rapidly, from local, regional and national sources. We do not wish to add to, or appear to contradict, any local procedures you have in place.
We have reproduced some simple guidance here that is in use within the region:-
COVID19 Intubation Guidance
Links to the COPE app, which offers rapid guidance to paediatric intubators in an electronic format: