Guidelines

441 entries

NDoH Hospital-level paediatric STG

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→
RabiesDescription Diagnostic criteria General and supportive measures Medicine treatment to prevent infection Referral ICD-10 code: A82.9 *Notifiable condition. (Inform state veterinarian or local veterinary official.) DESCRIPTION A viral infection of the central nervous system following transmission of the rabies virus from the saliva of affected animals through bites or contamination of mucosa→
Raised Intracranial PressureRaised Intracranial Pressure→
Rapid Sequence Intubation (RSI)Description Medicine treatment Healthcare professionals engaged in intensive care must undergo appropriate training, with junior doctors working under appropriate supervision. Endotracheal intubation should usually be performed using the rapid sequence technique and must be undertaken by the most experienced clinician during emergencies. For Neonatal Care see: Prematurity and Neonatal Conditions.→
Recurrent Abdominal PainDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: R10.4 DESCRIPTION Recurrent abdominal pain for which no cause can be found occurring at least monthly for 3 consecutive months with severity that interferes with routine function of the child. DIAGNOSTIC CRITERIA Clinical Peri-umbilical pain associated with belching, bloating with negative fin→
Recurrent PneumoniaDescription Diagnostic criteria General and supportive management Medicine treatment Referral ICD-10 code: J18.9 DESCRIPTION Recurrence of parenchymal and bronchial airways infection clinically and radiologically after a similar episode had completely resolved during that year. Must be distinguished from persistent pneumonia where there is clinical non-recovery of parenchymal ± bronchial in→
References1 G C White 2nd, Rosendaal F, Aledort LM, Lusher JM, Rothschild C, Ingerslev J0; Factor VIII and Factor IX Subcommittee. Definitions in hemophilia. Recommendation of the scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the International Society on Thrombosis and Haemostasis. Thromb Haemost. 2001 Mar;85(3):560. 2 South African National Blood S→
References - Adolescence1. Constitution of the Republic of South Africa, Act 108 of 1996. Section 28(3). Children’s Act 38 of 2005. Section 1. Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 24 Adolescence, References→
References - Alimentary TractReferences→
References - Anaestheticstandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, Updated for the 2023 Edition→
References - Cardiovascular SystemAdenosine Dose: South African Medicines Formulary (SAMF), 13th Edition. Division of Pharmacology, Faculty of Health Sciences, University of Cape Town. 2020. Kleinman ME, et.al. Pediatric Life Support: Part 14. Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122: S876-S908. Barrington KJ. The Myth of a Minimum Dose for Atropine. Pediatrics. 2011;1→
References - Child and Adolescent PsychiatryReferences - Child and Adolescent Psychiatry→
References - DermatologyReferences: Flucloxacillin dose: The British National Formulary for Children 2014-2015. BMJ Group, Pharmaceutical Press, RCPCH Publication Ltd. AND South African Medicines Formulary. 11th Edition. Division of Clinical Pharmacology. University of Cape Town. 2014 Cetirizine: South African Medicines Formulary. 11th Edition. Division of Clinical Pharmacology. University of Cape Town. 2014. Psoriasis→
References - Drug AllergiesReferences - Drug Allergies→
References - Ear, Nose and ThroatReferences - Ear, Nose and Throat→
References - Emergencies And Trauma Kartha GB, Rameshkumar R, Mahadevan S. Randomized Double-blind Trial or Ringers Lactate versus Normal Saline in Pediatric Acute Severe Diarrheal Dehydration. Journal of Pediatric Gastroenterology and Nutrition. 2017, (6):621-626. Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 1: Emergencies and Trauma, 1.1 Paedi→
References - Endocrine SystemReferences→
References - Eye Conditions1. Aciclovir: Wilhelmus KR. (2015). Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. The Cochrane database of systematic reviews, 1, CD002898. https://doi.org/10.1002/14651858.CD002898.pub5 2. White ML, Chodosh J. Herpes Simplex Virus Keratitis: A Treatment Guideline. Hoskins Center for Quality Eye Care and American Academy of Ophthalmology We→
References - HIVSouth African National Department of Health. 2023 Antiretroviral Therapy Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates. April 2023. Nielsen-Saines K, et. al. Three Postpartum Antiretroviral Regimens to prevent Intrapartum HIV infection. NEJM. 2012;366:2368-2379. Capparelli EV, and Pediatric AIDS Clinical Trials Gr→
References - Infective/Infectious Disease1. Fluconazole dose: South African Medicines Formulary. 12th Edition. 2016. 2. Artesunate, IV (dosing for < 20 kg): Hendriksen IC, Mtove G, Kent A, Gesase S, Reyburn H, Lemnge MM, et al. Population pharmacokinetics of intramuscular artesunate in African children with severe malaria: implications for a practical dosing regimen. Clin Pharmacol Ther. 2013 May;93(5):443-50. https://pubmed.ncbi.nlm→
References - Intensive Care and AnaestheticsMocan M, Terheș L, Blaga S. Difficulties in the diagnosis and management of hyponatremia. Medicine and Pharmacy Reports [Internet]. 28Oct.2016 [cited 14Sep.2022];89(4):464-9. Available from: https://medpharmareports.com/index.php/mpr/article/view/619 Schapkaitz E, Sherman GC, Jacobson BF, Haas S, Buller HR, Davies V, et al. Paediatric anticoagulation guidelines. S Afr J Med. 2012;102(3):171-175 S→
References - Nephrological / Urological DisordersMorphine Dose: South African Medicines Formulary (SAMF), 12th Edition. Division of Pharmacology, Faculty of Health Sciences, University of Cape Town. 2016. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short compared with standard duration of antibiotic treatment for urinary tract infection: A Systematic Review of Randomised Controlled Trials. Arch Dis Child. 2002; 87: 118-12→
References - Palliative CareLoperamide dose: South African Medicines Formulary (SAMF), 12th Edition. Division of Pharmacology, Faculty of Health Sciences, University of Cape Town. 2016. Association for Paediatric Palliative Medicine Formulary available from URL. https://www.appm.org.uk/_webedit/uploadedfiles/All%20Files/Event%20Resources/2020%20APPM%20Master%20Formulary%202020%20pro tected.pdf A comparative analysis of ceti→