Guidelines
46 entriesNDoH Hospital-level paediatric STG
- P. Ovale/P. Vivax & P.MalariaeICD-10 code: B53.0/B51.9/B52.9 Chloroquine, oral, 10 mg base/kg as a single dose. Follow with 5 mg base/kg given 6, 24 and 48 hours after the first dose. PLUS (for P. ovale and/or P. vivax) To eradicate the organism: Primaquine, oral, 0.25 mg base/kg/day for 14 days (obtained using section 21 approval). Continue chloroquine once weekly until primaquine is obtained. Note: Exclude G6PD defici→
- P.Falciparum Malaria, Non-Severe, UncomplicatedDescription Medicine treatment ICD-10 code: B50.9 DESCRIPTION A child with uncomplicated malaria is alert, can tolerate oral medication, has an age-appropriate level of consciousness and has no clinical or laboratory evidence of severe malaria. Ideally, treatment should be started in hospital. Initial doses should be directly observed. Observe for 1 hour to ensure dose is not vomited. MEDIC→
- P.Falciparum Malaria, Severe, Complicated (Or If Repeated Vomiting)Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B50.0/B50.8 DIAGNOSTIC CRITERIA Clinical Unable to drink or breast feed. Vomits everything. Renal failure. Cerebral malaria: manifests with convulsions, which may be subtle, and/or any change in mental state, ranging from irritability, lethargy to coma, stiff neck or bulging fontanelle. Respiratory→
- PICAPICA→
- Paediatric Emergencies: IntroductionNDoH STG Paeds 2023→
- Paediatric Palliative Care - Symptom Control And Principles For PrescribingICD-10 code: Z51.5 DESCRIPTION The World Health Organisation (WHO) defines paediatric palliative care as the active total care of the child’s body, mind and spirit that also involves giving support to the family. Palliative care should begin when illness is diagnosed and continue regardless of whether or not a child receives treatment directed at the disease. Healthcare providers must evalu→
- Pain ControlDescription Pain management General and supportive measures Non-medicine pain management strategies ICD-10 code: R52.9 DESCRIPTION Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage, or described in terms of such damage. Pain is an inherent part of the pathology of most medical and surgical diseases.→
- Paracetamol PoisoningDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: T39.1 DESCRIPTION Poisoning due to paracetamol by adolescents is generally due to intentional ingestion. The accidental ingestion of paracetamol elixir preparations by toddlers very rarely causes toxicity. Toxicity can be due to acute ingestions or repeated supratherapeutic ingestion (RSTI). Toxicity due to IV paraceta→
- Parenteral NutritionComplications of PN Dose and duration of PN infusion Average daily parenteral requirements Parenteral nutrition (PN) should be prescribed and administered under the supervision of a medical specialist and dietician. PN should be used only when it is not possible to meet nutritional requirements enterally or when there is gastrointestinal dysfunction resulting in inability to tolerate enteral nutr→
- Patent Ductus Arteriosus (PDA) in the NewbornDescription Diagnostic criteria General and supportive measures Medicine treatment Surgical treatment Referral ICD-10 code: Q25.0 DESCRIPTION Patent ductus arteriosus (PDA) is the extra-uterine persistence of the normal foetal vessel that joins the pulmonary artery to the aorta. DIAGNOSTIC CRITERIA Clinical Depending on size of PDA: A systolic or continuous murmur at the upper left sternal→
- Penetrating Eye Injury With/Without a Foreign BodyDescription Diagnostic criteria General and supportive measures Surgical treatment Referral ICD-10 code: S05.5 / S05.6 DESCRIPTION Penetration through the cornea or sclera to deeper structures with/without a foreign body still present. DIAGNOSTIC CRITERIA Urgently refer the patient with a penetrating eye injury or a severely contused eye to an ophthalmic specialist to avoid endoph→
- Peptic Ulcer DiseaseDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: K27 DESCRIPTION Varying degrees of gastritis or frank ulceration of the stomach or duodenum due to acid and pepsin-laden stomach contents on the gastric and duodenal mucosa in the face of inability of mucosal defence mechanisms to prevent these effects. Peptic ulcers may be primary (e.g.→
- Pericardial EffusionDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: I30 DESCRIPTION Accumulation of fluid in the pericardial space, usually secondary to pericarditis. DIAGNOSTIC CRITERIA Clinical Most patients present with a prolonged history of: low cardiac output, distended neck veins, muffled or diminished heart sounds. Patients with HIV may be asympt→
- PericarditisDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: I30.9 DESCRIPTION An inflammation of the pericardium. Causes include viral or bacterial and autoimmune disease. The commonest cause is viral but the clinician should entertain a high index of suspicion for tuberculous and bacterial pericarditis as these require specific antimicrobial treatment. DIAGNOSTIC CRITERIA Infl→
- PeriodontitisDescription General and supportive measures Medicine treatment Referral ICD-10 code: K05.4 DESCRIPTION Progressive gingivitis to the point where the underlying bone is eroded, is characterized by teeth becoming loose in their sockets. It is a cause of tooth loss in adults. GENERAL AND SUPPORTIVE MEASURES Advice on improving and maintaining oral hygiene. See: Gingivitis, uncomplicated→
- Persistent AsthmaMild persistent asthma Moderate persistent asthma Severe persistent asthma Referral MILD PERSISTENT ASTHMA When needed for acute exacerbations: ß 2 -agonist (short-acting), e.g.: Salbutamol, inhalation, 100–200 µg , as required 3–4 times daily using a metered-dose inhaler with a spacer device until symptoms are relieved. PLUS For daily maintenance treatment: Low dose inhaled corticosteroids→
- Persistent DiarrhoeaDescription General and supportive measures Medicine treatment DESCRIPTION Persistent diarrhoea is a diarrhoeal episode of presumed infectious aetiology that begins acutely but has a prolonged duration lasting more than 14 days. GENERAL AND SUPPORTIVE MEASURES Treatment strategy includes a stepwise approach with modification of the diet, which are not mutually exclusive and are applied according→
- Persistent/ Chronic Pain (Non-Cancer Pain)ICD-10 code: R52.2 Persistent/chronic pain is pain that lasts longer than the expected time for healing, and does not always have an obvious physical cause. Best practices for the management of chronic pain in children as recommended by the World Health Organization include: Use a comprehensive biopsychosocial assessment to inform pain management and planning. Screen for and monitor pain in→
- PertussisDescription Diagnosis General and supportive measures Medicine treatment Referral ICD-10 code: A37.9 * Notifiable condition DESCRIPTION A communicable respiratory infection classically causing a paroxysmal cough followed by an inspiratory whoop (absent in young infants) with associated vomiting. Subconjunctival haemorrhages may be present. The cough can persist for 3 months or longer with t→
- Petrochemical PoisoningDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T53.6 DESCRIPTION Accidental ingestion of paraffin, particularly by toddlers, is common in South Africa. DIAGNOSTIC CRITERIA Clinical Paraffin is volatile and inhalation of the fumes or aspiration of liquid can cause respiratory distress due to chemical pneumonitis. CNS symptoms: d→
- Phosphate Abnormalities In ICUHypophosphataemia: Incidence is 60–80% of septic ICU patients. Mortality increases 30% in patients with severe hypophosphataemia (< 0.32 mmol/L). Clinical presentation of hypophosphataemia can include: Confusion, coma, seizure. CCF Respiratory failure. Shift of Hb-dissociation curve left (hypoxia). Haemolysis, rhabdomyolysis. Treatment of hypophosphataemia: Intravenous replacement is recommend→
- Pneumocystis Jiroveci Pneumonia (PCP)ICD-10 code: B20.6 See: Pneumonia in HIV Exposed or Infected Children . Click here for the pdf . Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024 Chapter 8: Infective/Infectious Diseases, 8.17 Pneumocystis Jiroveci Pneumonia (PJP)→
- PneumoniaDescription Diagnostic criteria General and supportive measures Medicine treatment Modification of antimicrobial therapy Referral ICD-10 code: J18.9 DESCRIPTION Infection of the lung parenchyma characterized by inflammation and consolidation of lung tissue. Management depends on the clinical assessment and classification of severity. For bacterial pneumonia Empiric antibiotics are indicated→
- Pneumonia Due To Anaerobic InfectionDescription Diagnostic criteria Medicine treatment DESCRIPTION Often seen in comatosed patients with aspiration syndromes or children who inhaled a foreign body that has been misdiagnosed for a period of time. DIAGNOSTIC CRITERIA Putrid odour from mouth and foul smelling sputum. Investigations Sputum and blood culture using anaerobic media. MEDICINE TREATMENT Empiric antibiotic therap→
- Pneumonia in HIV Exposed or Infected ChildrenDescription Diagnostic criteria General and supportive measures Medicine treatment Referral DESCRIPTION In additional to common bacterial and viral pathogens causing pneumonia, opportunistic micro-organisms in a ‘polymicrobial mix’ are common in these children. Many of these children may fail to respond to the standard antibiotic treatment for pneumonia. Micro-organisms commonly involved are: P.→
- Pneumonia, NosocomialDescription General and supportive measures Medicine treatment ICD-10 code: J18.9 DESCRIPTION Children acquiring pneumonia 48–72 hours after hospitalisation. The common pathogens are: ß-lactamase producing pathogens, Extended spectrum ß-lactamase producing Klebsiella pneumoniae , P. aeruginosa , Multidrug resistant Acinetobacter species, Methicillin resistant S. aureus , Respiratory→
- Pneumonia, Viral InfectionDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J12.9 DESCRIPTION The commonest cause of pneumonia in children is viral infection. Respiratory syncyctial virus, adenovirus, cytomegalovirus, influenza, parainfluenza, adenovirus, herpes, human metapneumovirus and measles are the common viruses responsible for infections of the respirato→
- PoisoningPoison Information Centre Contact Details Description Diagnostic criteria Treatment Referral Secondary prevention For advice contact: POISON INFORMATION CENTRES Poisons Information Helpline (National service) 24 hours/day, every day for poisons queries 0861 555777 Red Cross War Memorial Children’s Hospital Poisons Information Centre Email: poisonsinformation @uct.ac.za http://www.pae→
- Poliomyelitis (Acute Flaccid Paralysis)Description Diagnostic criteria General and supportive measures Referral ICD-10 code: A80.3 *Notifiable condition Also see: Inflammatory Polyneuropathy (Guillain-Barré Syndrome). DESCRIPTION Poliomyelitis is eradicated in South Africa. Most cases of acute flaccid paralysis (AFP) are caused by Guillain-Barré Syndrome, but all cases of AFP must be notified as the clinical signs are indistingu→
- Polycystic Ovary SyndromeDescription Diagnostic criteria General and supportive measures Referral ICD-10 Code: E28.2 DESCRIPTION Characterised by excessive androgen activity, with many having abnormal insulin activity. DIAGNOSTIC CRITERIA Clinical Hirsutism Acne Oligomenorrhoea or amenorrhoea due to chronic anovulation. Female pattern alopecia. Overweight or obese. Investigations Polycystic ovaries on ultrasound. G→
- Portal HypertensionDescription Diagnostic criteria General and supportive measures Referral ICD-10 code: K76.6 DESCRIPTION Increased portal venous pressure above vena cava pressure. Most commonly secondary to cirrhosis, but causes without cirrhosis may be divided into prehepatic portal vein obstruction, intra-hepatic (pre-or post-sinusoidal) and post-hepatic causes. DIAGNOSTIC CRITERIA Clinical Splenomegaly w→
- Post Cardiac-Arrest SyndromeSee: Post resuscitation care. Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 23: Paediatric Intensive Care, 23.4 Post Cardiac-Arrest Syndrome→
- Post Exposure Prophylaxis Following Alleged Penetrative Sexual AbuseSee: Standard Treatment Guidelines and Essential Medicines List for Primary Health Care. Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 9: Human Immunodeficiency Virus Infections, 9.4 Post-exposure Prophylaxis Following Alleged Penetrative Sexual Abuse→
- Post Operative CareDescription Medicine treatment Referral DESCRIPTION Vital signs should be monitored more frequently in the immediate post-operative period after discharge from the recovery area. Inadequately treated pain has adverse effects on multiple organ systems. Pain management should be individualised for each patient – according to the expected severity and type of pain. Analgesia should be prescribed reg→
- Post Resuscitation CareOnce children have been successfully resuscitated and emergency treatment provided, they remain at high risk for death or disability. In order to optimise outcomes, the following principles of care apply: Admit or refer to ward with appropriate monitoring facilities e.g. high care or intensive care unit as soon as possible. Identify and manage underlying pathology. Maintain normoxia (avoid both h→
- Post Traumatic Stress Disorder (PTSD)Post Traumatic Stress Disorders (PTSD)→
- Post-Streptococcal GlomerulonephritisDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: N00.9 DESCRIPTION Acute post-streptococcal glomerulonephritis (APSGN) is a disorder of the kidneys caused by an immunological response of the kidney to nephritogenic strains of streptococci. It develops one to three weeks after a streptococcal throat or skin infection. Immune complexes a→
- Potassium Abnormalities In ICURapid changes in serum potassium result in the critical clinical features, mainly cardiac and therefore, absolute values may not reflect commonly described clinical changes associated with absolute levels, e.g.: children with chronic renal failure may tolerate very high levels of potassium with little clinical effect. Click on image to enlarge Hypokalaemia: See: Diarrhoea, acute . Normal potassiu→
- Prematurity/Preterm NeonateDescription General and supportive measures Medicine treatment Referral ICD-10 code: P07.3 DESCRIPTION Neonate born before 37 completed weeks of pregnancy. GENERAL AND SUPPORTIVE MEASURES Admit unwell/unstable infants to a neonatal high/intensive care facility. Temperature control: Kangaroo mother care: Initiate if baby is well and vital signs are stable. Provide a neutral thermal environme→
- Preseptal and Orbital CellulitisDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: H05.019/H05.012 DESCRIPTION Preseptal cellulitis (cellulitis of the tissues anterior to the orbital septum) is generally a mild condition that rarely leads to serious complications, whereas orbital cellulitis (involving the tissues posterior to the orbital septum, including the fat and muscle within the bony orbit) may cause→
- Prevention Of Mother To Child Transmission (PMTCT)ICD-10 code: Z20.60 See: The HIV exposed infant Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 19: Prematurity And Neonatal Conditions, 19.5 Infections, 19.5.6 Prevention Of Mother To Child Transmission (pmtct)→
- Principles For the Safe and Effective Prescribing of Psychotropic MedicationPrinciples For the Safe and Effective Prescribing of Psychotropic Medication→
- Procedural Sedation and AnalgesiaGoals of procedural sedation and analgesia General and supportive measures Medicine treatment Children in hospital are exposed to a variety of painful diagnostic and therapeutic procedures. The aim of procedural pain management is to minimise physical discomfort, pain, movement, and psychological disturbance, without compromising patient safety. Failure to provide adequate preventative pain measu→
- Pruritus - Paediatric Palliative CareDescription General and supportive care Medicine treatment Referral ICD-10 code: R29.9 DESCRIPTION An unpleasant cutaneous sensation that provokes the desire to scratch. Can interfere with sleep and activities of daily living. Scratch marks may lead to skin excoriation and secondary infections. May be difficult to control with incurable conditions. Commonly seen in cholestasis, renal failur→
- PsoriasisDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: L40.9 DESCRIPTION An inflammatory condition of the skin and joints. DIAGNOSTIC CRITERIA Scaly, red, itchy papules and plaques over scalp, perineum, and skin folds and extensor surfaces. Nails may be opaque, deformed and crumbling. Occasional pustules are seen. GENERAL AND SUPPORTIV→
- Psychiatric Presentations in HIV Infected Children and AdolescentsPsychiatric Presentations in HIV Infected Children and Adolescent→