COVID IN CHILDREN –KKCTH ACTIVITIES
·We received accreditation as a COVID-19 designated hospital from the Government of Tamilnadu in March 2020. A dedicated team of doctors from various specialities headed by Dr.Sulochana Putlibai our Head Of lab Services was formed and protocols for managing these children were put in place.
· All children with suspected COVID or with symptoms suggestive of COVID were seen in a dedicated Fever Surveillance Clinic where they were seen by medical officers with full PPE. If they needed admission they were shifted to 5th floor where these children were admitted and managed pending COVID-19 reports.Those who required Intensive Care treatment were shifted to PICU and managed.
· In the last 6 months our hospital has seen 3932 patients in Fever Surveillance clinic. 600 patients with suspected COVID were admitted. A total of 103 children with COVID-19 infection and 65 children with MIS-C (Multisystem Inflammatory Syndrome) were successfully treated. MIS-C is seen as a complication of COVID out of which only around 10 were RTPCR +. The remaining children had IgG antibodies. However mortality was nil in our series.
· A dedicated Phone number with Whatsapp Video call facility (8925686299) was made available in our ER 24/7 which was answered by senior pediatric Postgraduates, Registrars and consultants. This facility was very useful for parents from our neighbouring states with chronic illness who could not come for followup due to complete lockdown. All queries of parents related to COVID were answered patiently by our ER physicians.
COVID-19 in Neonates: KKCTH Experience
(Dr Chandrakumar, Dr Vaanathi)
Ever since the COVID19 pandemic began globally, our management of the disease has constantly been evolving, with improved understanding and newer insights into the pathophysiology of the virus. We share proudly our clinical experience in managing COVID19 in neonates, spectrum of clinical picture and outcomes and various logistic concerns involved in enforcing infection control policies in mother–newborn dyads.
All neonates admitted to our Level 3 NICU from March 2020 are considered as potential COVID19 suspects, and are being initially received, screened, and assessed in a committed triage. They are then managed in dedicated isolation wards in isolettes to minimize aerosol generation unless medically required. Being an out born facility, in majority of cases the mother was unavailable at admission, and hence baby was kept isolated. Pasteurized human donor milk was given to all neonates.
RTPCR testing as per national guidelines, was done at 48 hours of life or at admission whichever was later. We recorded demographics, neonatal clinical presentation of all COVID19 positive cases, as well our infection control practices, highlighting the logistic concerns and clinical impact with the same.
So far, we have treated 7 COVID19 positive neonates. Of them, 5 (70%) were term and 2 (30%) preterm; 4 (60%) were males and 3 (40%) females. Median (range) age at presentation was 10 (4, 26) days. Amongst the clinical profile, 2 (25%) were asymptomatic, 4 (60%) had fever. Two infants required respiratory support (1- COVID MIS-C and other unrelated). Three had unrelated neurological issues (1-meningitis, 1-neonatal seizures, 1- Vein of Galen malformation). One neonate developed multisystem inflammatory syndrome (MIS-C). Except for the one neonate with MIS-C who needed IVIG, the rest required only supportive management.
All (100%) babies including the one with MIS-C recovered. We did not encounter any infection in the health care workers caring for these infants.
COVID Publications…
Epidemiological and Clinical Profile of Pediatric Inflammatory Multisystem Syndrome- Temporally Associated with SARS CoV2 (PIMS-TS) in Indian Children
K Dhanalakshmi, Aishwarya Venkataraman, S Blasubramanian, Manoj Madhusudan, Sumanth Amperayani, Sulochana Putlibai, Kalaimaran Sadasivam, Bala Ramachandran, AV Ramanan
2.Hyperinflammatory Syndrome in Children Associated with COVID-19: Need for Awareness
Chandrika Bhat, Latika Gupta, S Balasubramanian, Surjith Singh, Athimalaipet V Ramanan
3. Coronavirus Disease (CIVID-19) in Children- What We Know So Far and What We Do Not?
S Balasubramanian, Neha Mohan Rao, Anu Goenka, Marion Roderick, Athimalaipet V Ramanan
4.Hyperinflammatory Syndrome in a Child With COVID-19 Treated Successfully With Intravenous Immunoglobulin and Tocilizumab
S Balasubramanian, TM Nagendran, B Ramachandran, AV Ramanan
5. Does a Crying Child Enhance the Risk for COVID-19 Transmission
Somu Sivabalan, MV Srinath
6.Impact of the COVID-19 Pandemic on Admissions To The Pediatric Emergency Department in a Tertiary Care Hospital
Radhika Raman, Manoj Madhusudan
Accepted for publication in IJP
7.Neurological Manifestations of COVID-19 in Children
Lakshan Raj, Vasanthi T, Revanth Baineni, Somu Sivabalan
Accepted for Publication in Indian Pediatrics
8. Intussusception in a child during COVID-19 Pandemic.
Dr Ashitha K Unny, Dr Lakshmi Sundararajan, Dr S. Balasubramanian
Journal of Indian association of pediatric surgeons (JIAPS)
Current Facilities for COVID
- COVID Triage: Situated in the ground floor, in the entrance to Emergency room, all children with fever, cough, cold, breathing difficulties are seen here by dedicated staff. Children with symptoms suggestive of COVID are not allowed to go to normal OPD in First floor to avoid spreading of infection. Patients are requested to cooperate.
- COVID Inpatient ward & SARI- Severe acute respiratory infection ward & COVID- suspect ward: This is situated in fifth floor. Suspected COVID patients are initially admitted here until final results.
- COVID vaccination: Started in seventh floor for above 45 years. But currently not operational because of non availability of vaccine.
- Adult COVID Treatment: Recently started in collaboration with Mehta Hospital.