Guidelines

441 entries

NDoH Hospital-level paediatric STG

Eye Infection, Complicated (Severe Eye Infection)Description General and supportive measures Medicine treatment Referral ICD-10 code: H44.0 DESCRIPTION Intensely painful eye infection characterised by a red eye with or without a discharge (excluding simple or non-painful conjunctivitis). Assess clinically for: Herpes conjunctivitis, indicated by vesicles on skin next to the eye. Loss of vision. Irregularity of the pupil. Haziness of the cornea.→
Febrile SeizuresDescription Diagnostic criteria General and supportive measures Medicine treatment Referral R56.0 DESCRIPTION Febrile seizures occur between the ages of 6 months and 6 years of age in association with a significant fever (>38.5°C) in the absence of an intracranial infection and are typically associated with viral upper respiratory tract infections. These are the most common type of seizures in→
Feeding and Eating DisordersFeeding and Eating Disorders→
Fluids In ICUFluids should be thought of as any other drug/medication in ICU; an under-resuscitated child as well as an overloaded child both have deleterious effects. Therefore, fluid therapy prescriptions must be tailored and appropriate for each child’s clinical condition. Fluids need to be considered under: Resuscitation – need for bolus therapy: 10–20 mL/kg, rapid administration, isotonic crystalloids. R→
Gastro-Oesophageal Reflux Disease (GORD)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: K21 DESCRIPTION Gastro-oesophageal reflux is repetitive regurgitation/reflux of gastric contents into the oesophagus. It is termed “Complicated GOR” or “GORD” if associated with the diagnostic criteria below. It should be differentiated from “Uncomplicated GOR” if the only symptom is fre→
General Anaesthesia - Induction of AnaesthesiaDescription Medicine treatment for induction of anaesthesia Induction should be learnt in an appropriate learning situation. DESCRIPTION Anaesthesia should only be administered by medical practitioners with appropriate training in anaesthesia. Induction of anaesthesia is the critical part of the transition from consciousness to general anaesthesia. This is a period which requires highly skil→
General Anaesthesia - Maintenance of AnaesthesiaDescription Medicine treatment DESCRIPTION After induction, the focus shifts to the maintenance of an adequate level of hypnosis, immobility and analgesia. Anaesthetic goals include maintaining normothermia and normoglycaemia, maintenance of cardiovascular stability, prevention of hypoxia and hyper/hypocapnia, providing appropriate analgesia, and the prevention of post-operative complications. ME→
General Anaesthesia - PreparationDescription General and supportive measures Medicine treatment DESCRIPTION All patients should be starved before general anaesthesia to prevent regurgitation and aspiration of gastric contents. The preoperative starvation period is: clear fluid: 1 hour, breast milk: 4 hours, and, solids, breast milk substitutes, non-human milk: 6 hours. Clear fluids include water, clear juices with→
Generalised Anxiety Disorders (GAD)Generalised Anxiety Disorders (GAD)→
Gingivitis, UncomplicatedDescription General and supportive measures Medicine treatment ICD-10 code: K05.1 DESCRIPTION Inflammation of the gum margin causing the gums to separate from the teeth. Pockets form between the gums and the teeth where pus and bacteria can collect, eventually causing periodontitis, a disease in the tissue that surrounds and supports the teeth – See: Periodontitis . Characteristics of→
Group B StreptococcusDescription Diagnostic criteria General and supportive measures Medicine treatment Referral DESCRIPTION Group B streptococcus is an encapsulated Gram-positive coccus that colonises the gastrointestinal and genitourinary tracts. Infection in the first 6 days of life is referred to as early-onset disease (EOD). Late-onset disease (LOD) refers to infection from day 7–89 of life. DIAGNOSTIC CRITERIA→
Growth DisordersDescription Diagnostic criteria General and supportive measures Referral ICD-10 Code: R62 DESCRIPTION Pathological growth failure may be suspected if a child is short relative to his/her peers, his/her parents and possibly disproportionate to his/her weight. It is confirmed by a reduced growth velocity. This could be due to endocrine causes, chronic or bone disease or dysmorphic syndromes. →
Guidelines for Management of Diabetics on Sick DaysDescription Diagnostic criteria General and supportive measures Medicine treatment Referral DESCRIPTION Illness associated with fever tends to raise blood glucose because of higher levels of stress hormones, gluconeogenesis and insulin resistance. Illness associated with vomiting and/or diarrhoea may lower blood glucose, with the possibility of hypoglycaemia and the development of starvation keto→
HIV Papular Pruritic EruptionDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T78.4 DESCRIPTION A chronic itchy condition with a relapsing course. In HIV-infected patients, insect bites may be severe and recalcitrant with post-inflammatory pigmentation and scarring. DIAGNOSTIC CRITERIA Initial lesion is a pruritic urticarial spot with a cen→
HIV in AdolescenceICD-10 codes: B20-24 DESCRIPTION Adolescence encompasses the period of physical and psychological development from the onset of puberty to maturity. HIV in adolescents may be due to: Vertical infection in infancy that presents as long term non-progressors; or Sexually acquired HIV from unprotected intercourse. Increasing numbers of perinatally infected infants are surviving to adolescence. Adoles→
Haemophilia A and BDescription Diagnostic criteria General and supportive measures Treatment guidelines Treatment – Acute management of bleeds ICD-10 code: D66.7/D66.8 DESCRIPTION Haemophilia A and B are lifelong chronic bleeding disorders caused by a lack of clotting factor VIII and clotting factor IX, due to mutations in the Factor VIII and Factor IX genes respectively. Acute bleeding presentation depends o→
Haemophilia A/Factor VIII Deficiency (No Inhibitors)Prophylaxis Treatment on-demand ICD-10 code: D66 PROPHYLAXIS Prophylaxis (primary and secondary) should be considered for patients with severe haemophilia A (<1% factor activity) who can access the health facility twice weekly for infusions, or have indwelling venous catheters and are candidates for home-based care. Primary prophylaxis: Prophylaxis started in the absence of documented jo→
Haemophilia B/Factor IX Deficiency (With No Inhibitors)Prophylaxis Treatment on demand ICD-10 code: D67 PROPHYLAXIS Prophylaxis (primary and secondary) should be considered for patients with severe haemophilia B (<1% factor activity) who can access the health facility twice weekly for infusions; or have indwelling venous catheters and are candidates for home-based care. Primary prophylaxis: Prophylaxis started in the absence of documented joi→
Haemophilia with InhibitorsRefer for assessment and planning with a haematologist. REFERRAL All cases with suspected or established haemophilia (prolonged aPTT and normal INR), for assessment, genetic counselling and planning of management, to a Haemophilia Treatment Centre. Click here to access the pdf . Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital_2023 edition_ Updated F→
Haemorrhagic Disease of the NewbornDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: P53 DESCRIPTION This is due to a deficiency of vitamin K-dependent clotting factors II, VII, IX and X. All newborns who did not receive vitamin K 1 at birth, especially preterm babies and breastfed babies, are at risk. Spontaneous bleeding may be from any site but is usually gastrointest→
Haemorrhagic Disease of the NewbornICD-10 code: P53 See: Haemorrhagic disease of the newborn. Click here to access the pdf . Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital_2023 edition_ Updated February 2025 Chapter 3: Blood and Blood Forming Organs, 3.6 Haemophilia A and B, 3.6.3 Haemophilia with Inhibitors→
HeadachesHeadaches→
Heart FailureDescription Diagnostic Criteria ICD-10 code: I50.9 DESCRIPTION Clinical syndrome reflecting the inability of the myocardium to meet the oxygen and nutritional/metabolic requirements of the body. Causes include: volume overload: L-R shunt lesions mitral/aortic regurgitation pump failure: myocarditis/cardiomyopathy high output failure: septicaemia severe anaemia DIAGNOSTIC CRITERIA Clinical A→
Heart Failure in NeonatesDescription Diagnostic criteria General and supportive measures Medicine treatment Surgical treatment Referral ICD-10 code: P29.0 DESCRIPTION Clinical syndrome reflecting the inability of the myocardium to meet the oxygen, nutritional or metabolic requirements of the body. Heart failure may be acute or chronic. The main causes of heart failure are: Congenital heart abnormalities: Left-sided→
Heart Failure, Acute With Pulmonary OedemaGeneral and supportive measures Medicine treatment ICD-10 code: I50.9 GENERAL AND SUPPORTIVE MEASURES Treat the underlying disorder/condition. Where the primary cause of acute pulmonary oedema is renal failure, treat as per renal failure. See: Acute kidney injury. Restrict fluids, beware of IV fluids. Place patient in an upright or semi-upright sitting position. Intubation and ventilation may be→
Heart Failure, Maintenance TherapyGeneral and supportive measures Medicine treatment Referral ICD-10 code: I50.9 GENERAL AND SUPPORTIVE MEASURES Recognise and treat the underlying condition, e.g. infection, hypertension, cardiac tamponade, fluid overload. Fluid restriction (75% of daily requirements) – but not at the expense of adequate caloric intake. Ensure adequate nutrition; tube-feeding may be necessary. Monitor blood→
Helminthiasis, IntestinalDescription Diagnostic criteria General and supportive measure Medicine treatment Referral ICD-10 code: B82.0 DESCRIPTION Infestation of the intestine with adult worms. The following species are commonly encountered: Ascaris lumbricoides (round worm). Enterobius vermicularis (pin worm). Trichuris trichiura (whipworm). Ancylostoma duodenale and Necator americanus (hookworm). Taenia saginatum→
Henoch-Schönlein PurpuraICD-10 code: D69.0 See: Rheumatology and Vasculitides, Henoch-Schönlein Purpura (HSP). Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 5: Dermatology, 5.4. Purpura, 5.4.2 Henoch-Schönlein Purpura→
Hepatitis B, ChronicDescription Diagnostic criteria Referral ICD-10 code: B18.1 DESCRIPTION Persistently elevated transaminases after hepatitis B infection. DIAGNOSTIC CRITERIA Transaminases are double upper limit of normal. Liver biopsy is characteristic. Hepatitis B serology positive. Interpretation of Hepatitis B Serological Test Results Susceptible: HBsAg negative Anti-HBc negative anti-HBs negative IgM an→
Hepatitis C, ChronicDescription Diagnostic criteria Referral ICD-10 code: B17.1 DESCRIPTION A chronic inflammation of the liver caused by vertical (perinatal) transmission of Hepatitis C virus from an infected mother. The disease is mostly mild in childhood and in up to 25% the virus can be spontaneously cleared from age 2 up to 7 years. DIAGNOSTIC CRITERIA Anti-HCV Elisa which detects IgG antibodies. Tr→
Hepatitis, Chronic, AutoimmuneDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: K75.4 DESCRIPTION Autoimmune induced hepatitis. DIAGNOSTIC CRITERIA Clinical Jaundice. Hepatosplenomegaly. Cutaneous features of chronic liver disease. Extrahepatic manifestations of the autoimmune process. Investigations Elevated bilirubin and transaminases. Hypoalbuminaemia and prolonged prothrombin time/INR. Auto-im→
Hepatitis, Toxin Induced, AcuteDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: K71.6 DESCRIPTION Liver damage attributed to a toxin or medicine. The most common herbal toxin in South Africa is atractyloside ( Impila ), which causes a Reye’s-like syndrome, with liver failure. Senecio ingestion is also seen but this causes endothelial damage in hepatic veins, resulti→
Hepatitis, Viral, AcuteDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B17.9 *Notifiable condition DESCRIPTION Acute inflammation of the liver with varying degrees of hepatocellular necrosis caused by hepatitis A, B and less commonly C, D and E viruses. DIAGNOSTIC CRITERIA Clinical Prodromal phase: nausea, malaise, vomiting, anorexia, fever, and &nbsp→
Herpes GingivostomatitisDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B00.2 DESCRIPTION Inflammation of the mouth structures with ulcers (which may be of various numbers and sizes), caused by Herpes simplex virus infection. The normal course of the disease is 7–10 days. DIAGNOSTIC CRITERIA Clinical General inflammation of the mouth with multiple small ulce→
Herpes Keratitis and ConjunctivitisDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B00.5 DESCRIPTION Herpes infection of the cornea and/or conjunctiva. DIAGNOSTIC CRITERIA There are three most common forms of this disease. Blepharoconjunctivitis Primary ocular infection involving the eyelids and/or conjunctivae. The condition is benign and self-limiting. May be associated wi→
Human Immunodeficiency Virus InfectionsDescription Diagnostic Criteria ICD-10 codes: B20-24 Comprehensive guidelines are available for ART and the care of children with HIV infection in the 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates . 1 DESCRIPTION Human Immunodeficiency Virus (HIV) is a retrovirus infecting immune cells, especially→
Hydatid DiseaseDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B67 DESCRIPTION The development of hydatid ( Echinococcus granulosus ) cysts follows ingestion of worm ova that are usually passed in the stools of dogs in sheep farming areas. Cysts may occur in any organ, but are most commonly found in the liver and lungs. DIAGNOSTIC CRITERIA Typical r→
Hyperbilirubinaemia, ConjugatedGeneral and supportive measures Medicine treatment Surgical treatment Referral Hepatocellular disease Bile duct obstruction - hepatitis* - total parenteral nutrition* - syphilis - other congenital infections - galactosaemia* - bile duct hypoplasia/atresia* - choledochal cyst - cystic fibrosis * May cause prolonged neonatal jaundice. Conjugated hyperbilirubinaemia is due to intra/ext→
Hyperbilirubinaemia, UnconjugatedGeneral and supportive measures Phototherapy Medicine treatment Excessive haemolysis Defective conjugation - ABO incompatibility - rhesus disease - enclosed haemorrhages - polycythaemia - infections* - spherocytosis - G6PD deficiency - prematurity - infection - hypoxia - hypoglycaemia - hypothyroidism* - breast milk jaundice* * may cause prolonged neonatal jaundice. GENERAL AND SUPPORTIVE→
HyperglycaemiaICD-10 code: R73.9 DESCRIPTION Critical illness is a state of metabolic stress associated with elevated serum catecholamines and is often associated with the use of continuous feeding. Hence the target blood glucose is 4–10 mmol/L. Serum glucose > 10 mmol/L is common, occurring in up to 20% of critically ill children. Clinical significance Increased morbidity and mortality. Osmotic diure→
HyperkalaemiaHyperkalaemia→
Hypertension in ChildrenDescription Diagnostic criteria General and supportive measures ICD-10 code: I10 DESCRIPTION Hypertension is defined as systolic and/or diastolic blood pressure ≥ the 95th percentile for gender, age and height percentile on at least three consecutive occasions. A sustained blood pressure of > 130/90 mmHg in a child older than 13 years is defined as hypertension. Measure blood press→
Hypertension, Acute SevereGeneral and supportive measures Medicine treatment Urgent referral ICD-10 code: I10 For acute or chronic hypertension, blood pressure needs to be lowered cautiously. Initiate medicines for sustained control as soon as possible to maintain the effect when the emergency measures are discontinued. Rate of BP reduction depends upon starting BP and age of the child. In the absence of central ner→
Hypertension, ChronicDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: I10 DESCRIPTION Primary/Essential hypertension Occurs most commonly in adolescents. The patient is often asymptomatic and well. It is diagnosed by excluding underlying causes of hypertension. Hypertension is confirmed by sustained high blood pressure measured on 3 follow-up occasions. Ch→
Hyperthyroidism, Graves DiseaseDescription Diagnostic criteria Medicine treatment Referral ICD-10 Code: E05.9 / E05.0 DESCRIPTION Hyperthyroidism is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormones. The most common cause is Grave’s disease, although thyroiditis may also present with thyrotoxicosis. DIAGNOSTIC CRITERIA Clinical Poor school performance. Warm moist hands. Tac→
Hypocalcaemia in ChildrenDescription Diagnostic criteria Medicine treatment Referral ICD-10 Code: E83.5 DESCRIPTION The main causes of hypocalcaemia in children are: vitamin D deficiency, calcium deficiency, magnesium deficiency, reduced parathyroid hormone production or resistance, impaired renal function, and hyperventilation. DIAGNOSTIC CRITERIA Clinical Signs and symptoms of tetany include: paraesthesia, positi→
Hypocalcaemic, NeonatalDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: P71.1 DESCRIPTION Acute symptomatic hypocalcaemia may present within the first 72 hours of birth (early hypocalcaemia) or after 72 hours of birth (late hypocalcaemia) with apnoea, irritability, seizures, jitteriness or prolonged QTc interval on ECG. Causes of early hypocalcaemia include: Prematurity. Respiratory distre→
HypoglycaemiaThe target blood glucose of critically ill children is 4–10 mmol/L. It is essential to check the blood glucose of all critically ill children as hypoglycaemia (< 3.5 mmol/L) is an emergency. Immediate treatment is with an IV glucose bolus and depends on the nature of the available IV access. Peripheral line: 5 mL/kg of a 10% dextrose solution. Central line: 2 mL/kg of a 25% dextrose solution.→
Hypoglycaemia in ChildrenDescription Diagnostic criteria Medicine treatment Referral ICD-10 Code: E16.2 DESCRIPTION Infants and small children have relatively limited glycogen stores with larger brain/body ratios than adults and are, therefore, at greater risk of hypoglycaemia during starvation. The causes of hypoglycaemia (outside the neonatal period) include: hypopituitarism, adrenal insufficiency, growth hormone defic→
Hypoglycaemia in DiabeticsHypoglycaemia in Diabetics→