Guidelines
441 entriesNDoH Hospital-level paediatric STG
- Hypoglycaemia, NeonatalDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: P70.4 DESCRIPTION Neonate presenting with whole blood glucose below 2.6 mmol/L. Risk factors include: prematurity, respiratory distress, small for gestational age, rhesus iso-immunisation, neonate of diabetic mother, hyperinsulinism, sepsis, post maturity, hypothermia/hyperthermia, feedi→
- HypokalaemiaHypokalaemia→
- HypopituitarismDescription Diagnostic criteria Medicine treatment Referral ICD-10 Code: E23.0 DESCRIPTION Multiple or isolated deficiencies of adrenocorticoid hormone (ACTH), luteinising hormone, thyroid stimulating hormone, prolactin, and growth hormone manifesting as hypoglycaemia, abnormal body proportions and failure to grow and develop. If the posterior pituitary is involved (ADH deficiency), then this con→
- Hypothyroidism in Older Children and AdolescentsHypothyroidism in Older Children and Adolescents→
- Hypothyroidism, CongenitalDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 Code: E03.1 DESCRIPTION Congenital deficiency of thyroid hormone due to: aplasia/hypoplasia or ectopia of the thyroid gland, thyroglobulin defects, defects in thyroid hormone biosynthesis, or intrauterine exposure to antithyroid medicines. Congenital hypothyroidism is one of the common treatable cau→
- Hypoxia-Ischaemia Of The Newborn (Perinatal Hypoxia/Hypoxic-Ischaemic Encephalopathy (HIE))Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: P21.9 DESCRIPTION Ischaemia and decreased oxygen delivery to the foetus/baby during the prepartum, intrapartum or immediate postpartum period, with hypoxic-ischaemic damage to the central nervous system and to other body systems. Complications include: Cardiovascular: heart rate and rhyt→
- ICU MedicationsAdrenaline (epinephrine) Amiodarone Atropine Dexamethasone Dobutamine Furosemide Glycopyrrolate Hydrocortisone IVIG (Intravenous polyvalent human immune globulin.) Labetalol Lidocaine (Lignocaine) Magnesium sulphate Salbutamol Drugs given in ICU are often diluted and given as an infusion. It is essential that one considers intravenous fluids to be drugs and as such need to consider compatibility→
- Immune Reconstitution Inflammatory Syndrome (IRIS)Description Diagnostic criteria Medicine treatment ICD-10 code: D89.3 DESCRIPTION Clinical deterioration can occur after starting ART due an improvement in the immune system response to organisms already causing infection, e.g. M bovis BCG, C. neoformans, M. tuberculosis (MTB), Aspergillus, M. avium complex, C. albicans, M. leprae, Human Herpes viruses, P. jiroveci, Human Papilloma virus, CMV, He→
- Immune Thrombocytopaenic Purpura (ITP)Description Diagnostic criteria General and supportive measures Medicine treatment Surgical treatment Referral ICD-10 code: D69.3 DESCRIPTION A common bleeding disorder of childhood due to the immune-mediated destruction of platelets. It occurs most frequently in children aged 2 to 5 years and often follows infection with viruses (including HIV) and medications. Chronic ITP (more than 6 months du→
- Immune Thrombocytopenic Purpura (ITP)ICD-10 code: D69.3 See: Blood and Blood Forming Organs, Immune thrombocytopaenic purpura (ITP) . Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 5: Dermatology, 5.4. Purpura, 5.4.3 Immune Thrombocytopenic Purpura (ITP)→
- Immunoglobulin A Vasculitis (previously Henoch Schönlein Purpura (HSP))Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: D69.0 DESCRIPTION Immunoglobulin A vasculitis is an acute leucocytoclastic vasculitis of small blood vessels usually involving skin, gastrointestinal tract, joints and the kidney. Aetiology is unknown. Complications include: acute severe abdominal pain, bowel infarction/perforation→
- ImpetigoICD-10 code: L01 Refer to the Primary Healthcare Standard Treatment Guidelines and Essential Medicines List, 2020: Skin Conditions, Impetigo . Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 5: Dermatology, 5.5. Vesicles And Pustules, 5.5.3 Impetigo→
- Infections - Varicella and ZosterICD-10 code: R23.8 / L08.9 See: Infective/Infectious Diseases, Varicella (Chickenpox) and Zoster. Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 5: Dermatology, 5.5. Vesicles And Pustules, 5.5.1 Infections→
- Inflammatory Polyneuropathy (Guillain-Barre Syndrome)Inflammatory Polyneuropathy (Guillain-Barre Syndrome)→
- Infrequent AsthmaAlthough infrequent asthma is thought not to exist in the adolescent and adults, it is still considered in the classification for children up to 12 years of age. To relieve symptoms: 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. Note: Failure to respond to 2 doses o→
- Ingestion of Caustic or Corrosive AgentsDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T54 DESCRIPTION Alkalis, e.g. sodium hydroxide, potassium permanganate. Acids, e.g. hydrochloric acid. The severity of the injury is dependent on the concentration and duration of exposure to the acid or alkali. DIAGNOSTIC CRITERIA Clinical Chief symptom is pain. Young children may prese→
- Inhalation, Foreign BodyDescription Diagnostic criteria General and supportive measures Referral ICD-10 code : T17.9 DESCRIPTION Accidental inhalation of a solid object that may obstruct the airway at any level. DIAGNOSTIC CRITERIA Ask specifically about a possible choking episode if there is any suspicion of a foreign body aspiration. Initial symptom is frequently sudden onset of choking followed by persist→
- Inotropes And VasopressorsChoice depends on desired effect. There is no ‘one size fits all’ strategy for inotrope/vasopressor choice. Each agent has dose-dependent effects on inotrope (improved contractility) or vasopressor effect (increasing the SVR). Important components of the cardiovascular system: Preload – is the child pre-load replete (not overfilled and not underfilled) – fluid therapy. Contractility – does the he→
- Insect Bites and StingsDescription General measures Medicine treatment ICD-10 code: T63.4 + (X29.99/X23.99) + External Cause Code (V,W,X,Y) DESCRIPTION Toxicity due to insect bites and stings usually results in local effects only; systemic effects are rare. Occasionally, hypersensitivity reactions are encountered, which may vary from minor local inflammation to acute anaphylaxis. Multiple bee stings can res→
- Intra-Osseous Infusion in EmergenciesIntra-Osseous Infusion in Emergencies→
- Intractable Diarrhoea - Paediatric Palliative CareDescription General and supportive measures Medicine treatment Referral ICD-10 code: R19.7 DESCRIPTION See: Persistent Diarrhoea and Diarrhoea, Chronic Other Than Post Infectious respectively. Although uncommon, intractable diarrhoea not amenable to any treatment may be encountered in paediatric palliative care. Examples of causes include: Short bowel syndrome in neonatal survivors of NEC (→
- Intractable Seizures - Paediatric Palliative CareDescription General and supportive treatment Medicine treatment Referral ICD-10 code: G41 For status epilepticus, see: Status Epilepticus (Convulsive). DESCRIPTION Intractable seizures in palliative care refer to seizures that do not respond to treatment and often occur at the end of life in children with severe CNS pathology who are not candidates for ventilation. These may range from repe→
- Iron PoisoningDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T45.4 DESCRIPTION Iron is widely available as an over-the-counter product and is commonly ingested accidentally by toddlers. DIAGNOSTIC CRITERIA Toxicity is related to the ingested dose of elemental iron. A single dose of elemental iron > 20 mg/kg requires hospital assessment and mana→
- Isoniazid PoisoningDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T37.1 DESCRIPTION INH interferes with pyridoxine and niacin metabolism, leading to impaired synthesis of gamma aminobutyric acid (GABA). Acute poisoning, which may follow intentional or accidental ingestions, may be severe. DIAGNOSTIC CRITERIA Clinical Triad of refractory seizures,→
- Jaundice, NeonatalDescription Diagnostic criteria Breastfeeding associated jaundice ICD-10 code: P58 DESCRIPTION Yellow discolouration of the skin and mucous membranes due to hyperbilirubinaemia. Bilirubin is formed mainly from haem catabolism. Jaundice develops when there is an overproduction of bilirubin, defective bilirubin metabolism and/or defective excretion of bilirubin from the body. DIAGNOSTIC CRITE→
- Jaundice, Neonatal, ProlongedDescription Diagnostic criteria General and supportive measures Medicine treatment Referral DESCRIPTION Jaundice (static or a rising bilirubin) present for more than 14 days in a term infant and 21 days in a preterm infant. The usual causes are: breast milk jaundice hypothyroidism hepatitis galactosaemia infections, e.g. UTIs. Breast milk jaundice may be confirmed by substituting breastfeeding wi→
- Juvenile Idiopathic Arthritis (JIA)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: M08.0 DESCRIPTION Juvenile Idiopathic Arthritis (JIA) is of unknown origin with unexplained symptoms for at least 6 weeks with onset before the age of 16 years. Other causes of arthritis must be excluded, e.g. infections, malignancy, trauma, other autoimmune disease. Different clinical s→
- Kaposi SarcomaDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: C46.9 DESCRIPTION Kaposi sarcoma is a vascular tumour that can present anywhere on the skin and oral mucosa. Lymph nodes and internal organs, primarily lungs and gastrointestinal tract, may also be involved. It is associated with human herpes virus 8 and occurs most commonly→
- Kawasaki Disease/Mucocutaneous Lymph Node SyndromeDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: M30.3 DESCRIPTION Kawasaki disease is an acute systemic vasculitis of unknown aetiology occurring predominantly in children. It involves small and medium arteries. The most serious complication is coronary artery aneurysms. Important: MIS-C, a complication of SARS-CoV-2, can mimic Kawasa→
- Laryngotracheobronchitis, Acute Viral (Croup)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J05.0 DESCRIPTION Potentially life-threatening airway obstruction in children and one of the most common causes of stridor in children aged between 6 months and 2 years. The most important viruses causing laryngotracheobronchitis (LTB) include: para-influenza virus (most common), measles→
- LeukocoriaDescription Diagnostic criteria Referral ICD-10 code: H44.53 DESCRIPTION Common causes of leukocoria (white pupil) include: retinoblastoma, cataract, persistent foetal vasculature, and end-stage ROP. DIAGNOSTIC CRITERIA A white appearance of the pupil instead of the usual black colour. An absent or diminished red-reflex of the fundus of the eye when examined with a direct ophthalmoscope or→
- Liver Failure, AcuteDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: K72.0 DESCRIPTION Acute liver failure is a devastating clinical syndrome which has a high mortality. It results from massive necrosis of liver cells leading to the development of hepatic encephalopathy. The clinical appearance can be deceptive and it is easy to underestimate how critical→
- Local and Regional AnaesthesiaDescription Medicine treatment DESCRIPTION Local anaesthesia is accomplished by either local infiltration of soft tissue or the instillation of local anaesthetic into potential or existing body spaces such as the epidural space, sub-arachnoid spinal spaces or around major nerves or plexuses. Appropriate care is always used to limit overdose and avoid toxicity. Use appropriate agents, avoid adrena→
- Loss of VisionDescription Referral ICD-10 code: H53.1 DESCRIPTION Causes of sudden loss of vision in an outwardly normal eye include: retinal detachment, occlusion of the retinal artery or retinal vein(s), vitreous haemorrhage, optic and retrobulbar neuritis, and choroiditis. Causes of gradual loss of vision in an outwardly normal eye include: refractive errors, cataracts, retinopathies, malignancies, an→
- Lumbar PunctureLumbar Puncture→
- Lung AbscessDescription Diagnostic criteria General and supportive measures Medicine treatment Surgical treatment Referral ICD-10 code: J85 DESCRIPTION A suppurative process that results from destruction of the pulmonary parenchyma and formation of a cavity. The cavity may be single, e.g. after aspiration or multiple, e.g. staphylococcal disease and cystic fibrosis. Lung abscess may follow pneumonia ca→
- Magnesium Abnormalities In ICU40–60% of ICU patients have hypomagnesaemia. Hypomagnesaemia: Clinical effects of hypomagnesaemia: Electrolyte abnormalities: Hypokalaemia Hypocalcaemia Hypophosphataemia Arrhythmias: Prolonged QT interval. Polymorphic VT – Torsade de pointes. Neurologic: Altered mentation, generalized seizures, tremors, hyper-reflexia, weakness. Click on image to enlarge Magnesium supplementation: IV: Ampoules o→
- MalariaDescription Diagnostic criteria ICD-10 code: B54 * Notifiable disease. DESCRIPTION Malaria is transmitted by the bite of an infected female Anopheles mosquito. The incubation period varies with the species of the parasite, Plasmodium falciparum being shortest, usually 7–21 days, and P. malariae the longest. The incubation period may be prolonged by use of malaria prophylaxis or certain anti→
- Malaria ProphylaxisMalaria chemoprophylaxis should be used in moderate-risk malaria-endemic areas in South Africa from September to May, both together with preventive measures against mosquito bites. Risk maps are provided in the National Guidelines for the Prevention of Malaria (2018). It is recommended that persons intending to travel to malaria-endemic areas outside of South Africa take the relevant chemoprophyl→
- Malnutrition, Severe AcuteDescription Diagnostic Criteria ICD-10 code: E40–E43 Z-scores For practical purposes a 'z-score' is the number of standard deviations (SD) below or above the mean. 2 SD or 2 z-scores above the mean (+2) equates fairly closely to the 97 th percentile and 2 SD or 2 z-scores below the mean (–2) equates fairly closely to the 3 rd percentile. 3 SD or 3 z-scores above or below the mean would→
- Malodorous Fungating Wounds/ Tumours - Paediatric Palliative CareDescription General and supportive measures Medicine treatment DESCRIPTION Non-healing fungating tumours that are often secondarily infected and smelly causing social ostracization and distress to child and family. Examples include exophytic retinoblastoma, infected bedsores, rhabdomyosarcoma, osteosarcoma or Kaposi’s sarcoma. GENERAL AND SUPPORTIVE MEASURES Supportive counselling. Set realistic→
- Management of Anaesthetic and Post-Anaesthetic ComplicationsDescription Medicine treatment DESCRIPTION Various events may occur during and after anaesthesia, which require management. MEDICINE TREATMENT Laryngospasm Maintain a good seal and attempt bag-mask ventilation, maintaining continuous positive pressure. Deepen the level of anaesthesia with a volatile anaesthetic agent (if laryngospasm is partial) – may overcome laryngospasm without the need for su→
- Management of PainManagement of pain→
- Massive Haemorrhage With Massive Transfusion of BloodDefinition Diagnostic Criteria Medicine Treatment Referral DEFINITION Massive blood loss in children is recognised when a child requires a blood transfusion to replace 50% of total blood volume in 3–4 hours (40 mL/kg) or > 100% of total blood volume in 24 hours or receives replacement of 10% of total blood volume/minute. The rapid recognition is important to maintain tissue oxygenation by rest→
- MeaslesDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B05 *Notifiable condition DESCRIPTION The following case definition is an epidemiological and not a diagnostic tool: Fever and maculopapular rash with any one of the following: cough, coryza/runny nose, conjunctivitis. Suspect measles in any child fulfilling the case definition. An acute→
- Meningitis Bacterial, NeonatalDescription Diagnostic criteria Special Investigations General and supportive measures Medicine treatment Referral ICD-10 code: G01 DESCRIPTION A bacterial infection of the meninges in the first month of life. Consider meningitis in any neonate being evaluated for sepsis or infection, as most organisms implicated in neonatal sepsis also cause neonatal meningitis. The most common causative o→
- Meningitis, Acute BacterialDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: G00 * Notifiable condition. (N. meningitidis and H. influenzae) This guideline applies to children > 60 days old. For the management of neonates, See: Meningitis bacterial, neonatal . DESCRIPTION Bacterial meningitis most commonly results from haematogenous dissemination of micr→
- Meningitis, CryptococcalDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: G02.1 DESCRIPTION An uncommon childhood meningitis that may occur in older HIV-infected children with severe CD4 T-cell depletion. Pulmonary and skin involvement can occur. DIAGNOSTIC CRITERIA Clinical Acute or chronic headache in an older HIV-infected child. Meningism need not be presen→
- Meningitis, Tuberculous (TBM) In ChildrenDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A17.0 *Notifiable condition. DESCRIPTION Tuberculous meningitis is an infection of the meninges caused by M. tuberculosis. Early diagnosis and treatment improves the prognosis. Differentiation from acute bacterial meningitis may be difficult. If in any doubt, treat for both conditions. C→
- Meningo-Encephalitis/Encephalitis, Acute ViralDescription General and supportive measures Medicine treatment Referral ICD-10 code: A86 DESCRIPTION A number of viruses cause infection of the brain and meninges. Herpes simplex is the most important because it is treatable. A high mortality and morbidity is associated with untreated herpes meningo-encephalitis. Complications include: increased intracranial pressure, permanent neurological→