Guidelines

441 entries

NDoH Hospital-level paediatric STG

Syphilis, Early CongenitalDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A50.9 *Notifiable condition DESCRIPTION Multi-organ infection caused by T. pallidum and acquired by vertical transmission via the transplacental route during pregnancy. DIAGNOSTIC CRITERIA Clinical Suspect if mother has syphilis or positive serology for syphilis and the baby a positive n→
Systemic Lupus Erythematosus (SLE)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: M32.9 DESCRIPTION Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease characterised by the presence of auto-antibodies directed against various cellular components, particularly DNA. It is often associated with antiphospholipid-antibodymediated hypercoagulability. In→
TB Preventive Therapy (TPT) For TB Exposure/ InfectionScreen all children in close contact with an infectious pulmonary TB case for TB disease. Screening includes clinical history and examination with appropriate investigations of children with suspected TB disease. Give full anti-tuberculosis treatment if the diagnosis of TB disease is confirmed or suspected. Indications for TB Preventive Therapy (TPT): All asymptomatic children and adolescents, i.→
Takayasu ArteritisDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: M31.4 DESCRIPTION Takayasu arteritis is a chronic inflammatory disease involving large vessels, including the aorta and its main branches and the pulmonary vasculature. Lesions are typically segmental – obliterative and aneurysmal. Symptoms reflect end-organ ischaemia. DIAGNOSTIC CRITERI→
TetanusDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A35 *Notifiable condition. DESCRIPTION Tetanus is an acute spastic paralytic illness caused by tetanospasmin, the neurotoxin produced by Clostridium tetani . The toxin prevents neurotransmitter release from spinal inhibitory neurons. Complications include: asphyxia, bronchopneumonia, deh→
Tetanus, NeonatalDescription Diagnostic criteria Referral ICD-10 code: A33 *Notifiable condition. DESCRIPTION Tetanus is an acute spastic paralytic illness caused by tetanospasmin, the neurotoxin produced by C. tetani. Neonatal tetanus is the most common form of the disease, usually caused by umbilical stump infections or contamination. The disease only occurs in infants of non-immunised mothers or mothers→
Tetralogy of FallotDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: Q21.3 DESCRIPTION Ventricular septal defect with aortic override, right ventricular outflow tract obstruction and right ventricular hypertrophy. Suspect tetralogy of Fallot in a child with cyanosis after the neonatal period. DIAGNOSTIC CRITERIA Clinical Child with central cyanosis. May b→
ThalassaemiaDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: D56 DESCRIPTION Hereditary single gene defect causing abnormal production or translation of beta-globin mRNA, resulting in foetal haemoglobin (HbF) production. Presents with pallor, jaundice, fever, failure to thrive, abdominal distension hepatosplenomegaly, and skeletal changes. DIAGNOSTIC CRITERIA Investigations Micr→
The HIV Exposed InfantDescription Management of HIV-Exposed Infants HIV Testing ICD-10 code: Z20.6 DESCRIPTION Infants and children born to mothers living with HIV until HIV infection in the infant or child is reliably excluded and the infant or child is no longer exposed through breastfeeding are defined as HIV-exposed. Transmission of HIV infection may occur during pregnancy, during delivery, or via breastfeed→
The HIV Infected Infant/Child (< 10 Years)Description General and supportive measures Standardised national monitoring for infants & children with HIV Medicine treatment ART Regimens Recommended regimen in ART-naïve Neonates, Infants, Children 0 to < 10 years of age Switching existing clients to DTG-containing regimens Transition from ABC/3TC/LPV/r to DTG based regimens Switching children on PI-containing regimens to DTG reg→
The HIV Infected Neonate (< 1 Month of Age)Description Medicine treatment ICD-10 codes: B20-B24 DESCRIPTION Defined as an infant < 1 month of age, in whom HIV infection has been confirmed with two appropriate tests. For confirmation of HIV infection, see: Human immunodeficiency virus infections . MEDICINE TREATMENT This treatment protocol is meant as a guide, and there is allowance for flexibility after discussion with→
The Infant Of A Diabetic Mother (IDM)Description Diagnostic criteria General and supportive measures Medicine treatment Referral DESCRIPTION Infants born to a mother with established or newly diagnosed diabetes mellitus. The foetus will be exposed to high levels of insulin in utero if maternal glycaemic control is not achieved, with foetal pancreatic hypertrophy as an adaptive measure. The infant of a diabetic mother is at increased→
Theophylline PoisoningDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T48.6 DESCRIPTION Agents such as aminophylline and caffeine have similar features in overdose. Sustained release preparations can cause prolonged toxicity. Toxicity can occur with therapeutic dosing. DIAGNOSTIC CRITERIA Clinical Mainly affects the gastrointestinal, cardiovascular and cen→
Thromboprophylaxis In ICUThe incidence of venous thrombosis is likely underappreciated in critically ill children. All children with at least one organ failure and central venous access likely require pharmacological prophylaxis against venous thrombo-embolism. Drug Dose Comments Low molecular weight heparin (LMWH), e.g. enoxaparin. < 2 months of age: 0.75 mg/kg/dose, SC, 12 hourly. > 2 months of age: 0.5 mg/kg/dos→
Thrombotic Thrombocytopaenic Purpura/Haemolytic Uraemic SyndromeDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: M31.1/D59.3 DESCRIPTION An acute syndrome that presents with diarrhoea/dysentery (although diarrhoea-negative cases are increasingly recognised) with varying combinations of the following: Non-immune microangiopathic haemolytic anaemia with fragmentation haemolysis (schistocytes), thrombocytopenia often with purpura, a→
Tic DisordersTic Disorders→
Tick Bite FeverDescription Diagnostic Criteria General and supportive measures Medicine Treatment Referral ICD-10 code: A79.9 DESCRIPTION A tick-borne febrile illness caused by Rickettsia conorii or africae . The rash appears on days 3–5 of the illness. It spreads from the extremities to the trunk, neck, face, palms, and soles within 36 hours. The lesions progress from macular to maculopapular and may per→
Tinea CapitisICD-10 code: B35.0 Refer to the Primary Healthcare Standard Treatment Guidelines and Essential Medicines List, 2020: Skin Conditions, Scalp infections – Tinea capitis. Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 5: Dermatology, 5.3 Macules And Papules, 5.3.8 Tinea Capitis→
Tonsillitis And PharyngitisICD-10 code: J03 See: Primary Healthcare Standard Treatment Guidelines and Essential Medicines List, Ear, Nose and Throat Conditions, Tonsillitis and Pharyngitis . Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 17: Ear Nose & Throat, 17.2 Tonsillitis And Pharyngitis Click here for 17.3 Tonsillitis, Compl→
Tonsillitis, Complicated (Peritonsillar Cellulitis, Peritonsillar Abscess)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J03.9 DESCRIPTION An infective process involving the tonsils with spread of infection into the adjacent tissue. It must be differentiated from hypertrophy of the tonsils without infection and a viral upper respiratory tract infection (these are associated with rhinorrhoea , nasal conges→
ToxoplasmosisDescription Diagnostic criteria Referral ICD-10 code: B58.9 DESCRIPTION Rarely occurs in children caused by infection with Toxoplasma gondii. Usually presents as encephalitis, with focal neurological abnormalities occurring in association with headache. Ocular and pulmonary disease is also seen. DIAGNOSTIC CRITERIA Investigations Diagnosis may be made on blood and CSF serology. CSF PCR for→
Traumatic Brain InjuryDescription Diagnostic Criteria General and Supportive Measures Referral ICD-10 code: S06.2 See Traumatic Brain Injury (TBI) and neuroprotection in the ICU DESCRIPTION Types: Concussion (minor), e.g. shaken baby. Contusion Penetrative Anoxic – commonest, e.g. falls, vehicle collusion, violence, sport injuries. DIAGNOSTIC CRITERIA Symptoms: Headache Eating/nursing habits. Unusual or easy irri→
Traumatic Brain Injury (TBI) And Neuro-Protection In The ICUDefinition Medicine treatment ICD-10 code: S06.2 DEFINITION Traumatic brain injury (TBI) is a form of Acquired Brain Injury. It is a nondegenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness. Se→
Treatment Of Children Who Were Previously Successfully Treated For TB (Retreatment)A child who was previously successfully treated for pulmonary TB is at increased risk for re-infection with TB. It is imperative to exclude drug-resistant TB by carrying out a sputum rapid TB molecular test (e.g. GeneXpert®) plus culture with drug susceptibility testing (DST), and also determine DST of any known TB source case. If the above does not indicate resistant TB, treat as drug susceptibl→
Treatment Of VTEThe duration of treatment (anticoagulation) depends on the cause of VTE: 3 months for CVC-related or secondary VTE and 6 months for idiopathic or recurrent VTE. Initial anticoagulation with LMWH or UFH for 5–10 days followed by maintenance warfarin or LMWH. Routine use of thrombolytic therapy is not recommended unless there is a major vessel occlusion. Protamine sulphate can be used to reverse th→
TriageEmergencies Priority signs Non-urgent (queue) Early recognition of life-threatening emergencies and rapid provision of appropriate care can prevent childhood deaths and reduce associated morbidity. Triage aims to identify those children most in need of resuscitation and emergency care. It involves the rapid examination of all sick children when they first arrive in hospital in order to appr→
Tricyclic Antidepressant PoisoningDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T43.0 DESCRIPTION Poisoning with tricyclic antidepressants (TCAs) represent a large portion of poisoning fatalities. There is a high risk of tricyclic antidepressant toxicity in children because of its narrow therapeutic index. Serious toxicity may occur with low doses in children. →
Tuberculosis and HIVDescription Medicine treatment ICD-10 codes: B20.0 DESCRIPTION TB and HIV are often comorbid conditions. Exclude TB by a history of TB contacts, clinical examination, chest X-ray, tuberculin skin test (TST), or lateral flow urine lipoarabinomannan (TB-lam), M tuberculosis PCR test and mycobacterial culture (where TB disease is suspected on clinical or radiological grounds) in all patients b→
Tuberculosis, PerinatalDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: P37.0 *Notifiable condition. DESCRIPTION Tuberculosis acquired in the first 3 months of life . Perinatal tuberculosis may be acquired in one of the following ways: Transplacental transmission – usually extrapulmonary or disseminated TB. Via the passage of swallowed maternal blood or amni→
Tuberculosis, Pulmonary In ChildrenDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A16.9 *Notifiable condition. DESCRIPTION A chronic, granulomatous disease of the lungs caused by M. tuberculosis. Most children acquire tuberculosis from infected adults by inhalation. Malnourished, immunosuppressed (HIV-infected) and children < 3 years of age with pulmonary tuberculo→
TyphoidDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A01.1 *Notifiable condition. DESCRIPTION A systemic disease caused by Salmonella typhi. DIAGNOSTIC CRITERIA Clinical Fever Anorexia Headache Vomiting Diarrhoea or constipation Ileus Abdominal pain or tenderness Epistaxis Cough Delirium Hepatomegaly and/or splenomegaly Meningismus Stupor→
Underweight For Gestational Age (UGA)Description Diagnostic criteria General and supportive measure Referral DESCRIPTION UGA is failure of an infant to achieve their genetic growth potential. This may be due to maternal, placental or foetal factors in utero. DIAGNOSTIC CRITERIA The birth weight of the underweight for gestational age infant plots below the 10th centile on the Fenton chart. Symmetrically wasted: weight, length and hea→
Urinary Tract Infection (UTI)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: N39.0 DESCRIPTION Bacterial infection of the urinary tract. Uncomplicated urinary tract infection (UTI) is an infection which is limited to the lower urinary tract and there are no associated urological anomalies. It is seen most commonly in girls over two years of age. Complicate→
UrticariaDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: L50.9 DESCRIPTION An itchy, inflammatory skin and mucosal condition recognised by wheal and flare reaction. May be acute or chronic, often due to irritants, insect bites or allergens. Secondary infective features include excoriation, vesicles and pigmentary changes. Chronic papular→
Varicella (Chicken Pox)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B01 DESCRIPTION An acute, highly contagious, viral disease caused by herpes varicella-zoster. It spreads by infective droplets or fluid from vesicles. One attack confers permanent immunity. Varicella is contagious from about 2 days before the onset of the rash until all lesions crusted.→
Venous Thrombo-Embolic DiseaseDescription Diagnostic criteria General and supportive measures Referral ICD-10 code: I82 DESCRIPTION An occlusive or non-occlusive thrombus in the venous circulation, with or without pulmonary embolus. Associated risk factors include central venous catheters, venous stasis, endothelial damage and hypercoaguable states, e.g. nephrotic syndrome. Causes include protein C and S deficiency, fac→
Volatile SolventsDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T53 DESCRIPTION Inhalants include: spray-paint, glue and paint thinners that may contain hydrocarbons such as toluene and/or n-Hexane. If these are ingested, hydrocarbon poisoning with possible chemical pneumonitis must also be considered. DIAGNOSTIC CRITERIA distinctive odour, euphoria,→
Von Willebrand DiseaseDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: D68.0 DESCRIPTION Von Willebrand disease is the most common congenital bleeding disorder and is due to reduced amounts or abnormal forms of von Willebrand factor. DIAGNOSTIC CRITERIA Clinical Recurrent epistaxis, prolonged bleeding from lacerations, easy bruising or gum bleeds, menorrhag→
WartsMedicine treatment Referral ICD-10 Code: B07 MEDICINE TREATMENT Common warts Salicylic acid 25% ointment, applied under plaster nightly. Protect surrounding skin with petroleum jelly. Repeat until the wart falls off. Genital warts Podophyllin resin 20%, applied under plaster nightly. Protect surrounding skin with petroleum jelly. Repeat until the wart falls off. REFERRAL Extensive warts involving→
Worm BolusDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B77 DESCRIPTION Partial or complete obstruction of the bowel by a 'knot' of Ascaris lumbricoides curled around each other. Usually presents with cramping abdominal pain with/without other evidence of obstruction. May occasionally lead to local necrosis and perforation of the small bowel.→
ZosterDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B02 DESCRIPTION A vesicular eruption in a dermatomal pattern, due to reactivation of varicella zoster virus. Occurs commonly in immunocompromised children and occasionally in immunocompetent children. DIAGNOSTIC CRITERIA Usually made on clinical grounds. Investigations Confirm diagnosis→