-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.covid19treatmentguidelines.nih.gov/management/clinical-management-of-children/special-considerations-in-children/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Guidelines: Special Considerations in Children
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
NIH Guidelines<br />Key considerations:<br />
<ul>
<li>SARS-CoV-2 infection is generally milder in children than in adults, and a substantial proportion of children with the infection are asymptomatic.</li>
<li>Most nonhospitalized children with COVID-19 will not require any specific therapy.</li>
<li>Observational studies describe associations between severe COVID-19 and the presence of ≥1 comorbid conditions, including cardiac disease, neurologic disorders, prematurity (in young infants), diabetes, obesity (particularly severe obesity), chronic lung disease, feeding tube dependence, and immunocompromised status. Age (<1 year and 10–14 years) and non-White race/ethnicity are also associated with severe disease.</li>
<li>Most children hospitalized for severe COVID-19 have not been fully vaccinated or are not eligible for COVID-19 vaccination.</li>
<li>Data on the pathogenesis and clinical spectrum of SARS-CoV-2 infection are more limited for children than for adults.</li>
<li>Vertical transmission of SARS-CoV-2 appears to be rare, but suspected or probable cases of vertical transmission have been described.</li>
<li>A small subset of children and young adults with SARS-CoV-2 infection may develop multisystem inflammatory syndrome in children (MIS-C). Many patients with MIS-C require intensive care management. The majority of children with MIS-C do not have underlying comorbid conditions.</li>
<li>Data on the prevalence of post-COVID conditions in children are limited but suggest that younger children may have fewer persistent symptoms than older children and adults.</li>
</ul>
Creator
An entity primarily responsible for making the resource
NIH
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-08-08
Contributor
An entity responsible for making contributions to the resource
2022-07 by Andi, Special Populations Treatment & Care group (suggested to replace 931)
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - note "constantly updated"
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-01
Children
COVID-19
Example
Pediatrics
R-SP
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/ventilation.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ventilation in Schools and Childcare Programs
Subject
The topic of the resource
Infection Control
Description
An account of the resource
How to use CDC building recommendations in your setting
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-02-26
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-10-06
Contributor
An entity responsible for making contributions to the resource
2024-03-28 by J. Mundy – not yet reviewed asset – bumping first review 1 year
Children
COVID-19
Pediatrics
Public Health
R-SP
School
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-childcare-guidance.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Operational Guidance for K-12 Schools and Early Care and Education Programs to Support Safe In-Person Learning
Subject
The topic of the resource
Infection Control
Description
An account of the resource
On This Page <br />
<ul>
<li>Introduction</li>
<li>Strategies for Everyday Operations</li>
<li>COVID-19 Community Levels and Associated Prevention Strategies</li>
<li>Considerations for Prioritizing Strategies</li>
</ul>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-10-05
Contributor
An entity responsible for making contributions to the resource
2022-07 by Andi, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - note "constantly updated"
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-31
Children
COVID-19
Example
Mask
Masks
Pediatrics
Public Health
R-SP
-
https://repository.netecweb.org/files/original/e2f0df641ee70a26ff78d6187f9e90e6.png
4cf17b29ba7b6db239dc5fe3cd70aa33
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Xia, ShengLi, YunTao Zhang, YanXia Wang, Hui Wang, YunKai Yang, George Fu Gao, WenJie Tan, GuiZhen Wu, Miao Xu, ZhiYong Lou, WeiJin Huang, WenBo Xu, BaoYing Huang, Wei Wang, Wei Zhang, Na Li, ZhiQiang Xie, Xiujuan Zhu, Ling Ding, WangYang You, YuXiu Zhao, Jun Zhao, LiLi Huang, XueZhong Shi, YongLi Yang, GuangXue Xu, WenLing Wang, PeiPei Liu, Meng Ma, YuLing Qiao, SuHua Zhao, JingJing Chai, QinQin Li, Hui Fu, Ying Xu, XiaoTong Zheng, WanShen Guo, and XiaoMing Yang. 2021. "Safety and immunogenicity of an inactivated COVID-19 vaccine, BBIBP-CorV, in people younger than 18 years: a randomised, double-blind, controlled, phase 1/2 trial." The Lancet Infectious Diseases.
Abstract
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">Although SARS-CoV-2 infection often causes milder symptoms in children and adolescents, young people might still play a key part in SARS-CoV-2 transmission. An efficacious vaccine for children and adolescents could therefore assist pandemic control. For further evaluation of the inactivated COVID-19 vaccine candidate BBIBP-CorV, we assessed the safety and immunogenicity of BBIBP-CorV in participants aged 3–17 years.</div>
<h3>Methods</h3>
<div class="section-paragraph">A randomised, double-blind, controlled, phase 1/2 trial was done at Shangqiu City Liangyuan District Center for Disease Control and Prevention in Henan, China. In phases 1 and 2, healthy participants were stratified according to age (3–5 years, 6–12 years, or 13–17 years) and dose group. Individuals with a history of SARS-CoV-2 or SARS-CoV infection were excluded. All participants were randomly assigned, using stratified block randomisation (block size eight), to receive three doses of 2 μg, 4 μg, or 8 μg of vaccine or control (1:1:1:1) 28 days apart. The primary outcome, safety, was analysed in the safety set, which consisted of participants who had received at least one vaccination after being randomly assigned, and had any safety evaluation information. The secondary outcomes were geometric meant titre (GMT) of the neutralising antibody against infectious SARS-CoV-2 and were analysed based on the full analysis set. This study is registered with <a href="http://www.chictr.org.cn" target="_blank" rel="noreferrer noopener">www.chictr.org.cn</a>, ChiCTR2000032459, and is ongoing.</div>
<h3>Findings</h3>
<div class="section-paragraph">Between Aug 14, 2020, and Sept 24, 2020, 445 participants were screened, and 288 eligible participants were randomly assigned to vaccine (n=216, 24 for each dose level [2/4/8 μg] in each of three age cohorts [3–5, 6–12, and 13–17 years]) or control (n=72, 24 for each age cohort [3–5, 6–12, and 13–17 years]) in phase 1. In phase 2, 810 participants were screened and 720 eligible participants were randomly assigned and allocated to vaccine (n=540, 60 for each dose level [2/4/8 μg] in each of three age cohorts [3–5, 6–12, and 13–17 years]) or control (n=180, 60 for each age cohort [3–5, 6–12, and 13–17 years]). The most common injection site adverse reaction was pain (ten [4%] 251 participants in all vaccination groups of the 3–5 years cohort; 23 [9·1%] of 252 participants in all vaccination groups and one [1·2%] of 84 in the control group of the 6–12 years cohort; 20 [7·9%] of 252 participants in all vaccination groups of the 13–17 years cohort). The most common systematic adverse reaction was fever (32 [12·7%] of 251 participants in all vaccination groups and six [7·1%] of 84 participants in the control group of the 3–5 years cohort; 13 [5·2%] of 252 participants in the vaccination groups and one [1·2%] of 84 in the control group of the 6–12 years cohort; 26 [10·3%] of 252 participants in all vaccination groups and eight [9·5%] of 84 in the control group of the 13–17 years cohort). Adverse reactions were mostly mild to moderate in severity. The neutralising antibody GMT against the SARS-CoV-2 virus ranged from 105·3 to 180·2 in the 3–5 years cohort, 84·1 to 168·6 in the 6–12 years cohort, and 88·0 to 155·7 in the 13–17 years cohort on day 28 after the second vaccination; and ranged from 143·5 to 224·4 in the 3–5 years cohort, 127 to 184·8 in the 6–12 years cohort, and 150·7 to 199 in the 13–17 years cohort on day 28 after the third vaccination.</div>
<h3>Interpretation</h3>
<div class="section-paragraph">The inactivated COVID-19 vaccine BBIBP-CorV is safe and well tolerated at all tested dose levels in participants aged 3–17 years. BBIBP-CorV also elicited robust humoral responses against SARS-CoV-2 infection after two doses. Our findings support the use of a 4 μg dose and two-shot regimen BBIBP-CorV in phase 3 trials in the population younger than 18 years to further ascertain its safety and protection efficacy against COVID-19.</div>
<h3>Funding</h3>
<div class="section-paragraph">National Program on Key Research Project of China, National Mega projects of China for Major Infectious Diseases, National Mega Projects of China for New Drug Creation, and Beijing Science and Technology Plan.</div>
<h3>Translation</h3>
<div class="section-paragraph">For the Chinese translation of the abstract see Supplementary Materials section.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online through Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00462-X/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00462-X/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Safety and immunogenicity of an inactivated COVID-19 vaccine, BBIBP-CorV, in people younger than 18 years: a randomised, double-blind, controlled, phase 1/2 trial
Subject
The topic of the resource
Research
Description
An account of the resource
Although SARS-CoV-2 infection often causes milder symptoms in children and adolescents, young people might still play a key part in SARS-CoV-2 transmission. An efficacious vaccine for children and adolescents could therefore assist pandemic control. For further evaluation of the inactivated COVID-19 vaccine candidate BBIBP-CorV, we assessed the safety and immunogenicity of BBIBP-CorV in participants aged 3–17 years.
Creator
An entity primarily responsible for making the resource
Xia, ShengLi, YunTao Zhang, YanXia Wang, Hui Wang, YunKai Yang, George Fu Gao, WenJie Tan, GuiZhen Wu, Miao Xu, ZhiYong Lou, WeiJin Huang, WenBo Xu, BaoYing Huang, Wei Wang, Wei Zhang, Na Li, ZhiQiang Xie, Xiujuan Zhu, Ling Ding, WangYang You, YuXiu Zhao, Jun Zhao, LiLi Huang, XueZhong Shi, YongLi Yang, GuangXue Xu, WenLing Wang, PeiPei Liu, Meng Ma, YuLing Qiao, SuHua Zhao, JingJing Chai, QinQin Li, Hui Fu, Ying Xu, XiaoTong Zheng, WanShen Guo, and XiaoMing Yang.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-09-15
Type
The nature or genre of the resource
Publication
2019-nCoV
Children
Coronavirus
COVID-19
Pediatrics
R-Res&Pub
Vaccine Study
-
https://repository.netecweb.org/files/original/eb5c3d1f2ed416fd049148aa0160b701.png
6591d9720139ed4cf752d51a02619e88
https://repository.netecweb.org/files/original/4c59097afdf59894786edd2c616bc034.pdf
4c29b3e72969766dd5bd70c41ff2cc5f
PDF Text
Text
NETEC COVID-19 Webinar Series:
Pediatric Surge Responses
and
Crisis Standards of Care
�Content Outline (TOC)
Welcome
Shelly Schwedhelm, MSN, RN, NEA-BC
�Overview
Welcome: Shelly Schwedhelm, MSN, RN, NEA-BC
Crisis Standards of Care: Abbey Lowe, MA
The Pediatric Planning Process: Rachel Lookadoo, JD
Adult Critical Care in Support of Pediatric Patients:
Ryan C. Maves, MD, FCCP, FCCM, FIDSA
Questions and Answers with NETEC
NETEC Resources: Shelly Schwedhelm, MSN, RN, NEA-BC
�NETEC Vision
NETEC sets and advances the gold standard for
special pathogen preparedness and response across
health care delivery systems with the goals of driving
best practices, closing knowledge gaps, and
developing innovative resources.
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�Areas of Focus
Consultation
Education
Research Network
Deliver didactic and handson simulation training via
Build
Meet Fred
Empower hospitals to gauge
their readiness using
Self-Assessment
In-Person Courses
Measure facility and healthcare
worker readiness using
Central IRB Process
for rapid implementation of
clinical research protocols
Provide self-paced education through
Online Trainings
Metrics
Provide direct feedback to hospitals via
On-Site Assessment
Compile
Online Repository
Provide
of tools and resources
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
On-Site and Remote Guidance
Provide
Emergency On-Call
Mobilization
Develop customizable
Exercise Templates
based on the HSEEP model
Cross-Cutting, Supportive Activities
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Crisis Standards of Care (CSC)
Abbey Lowe, MA
�Crisis Standards of Care (CSC)
Demand for health care services and supply of resources
as a function of time after disaster onset
https://www.nap.edu/read/13351/chapter/2#42
�A Systems Approach
r
https://www.nap.edu/read/13351/chapter/2#32
�Nebraska Healthcare Surge Structure
r
�Nebraska Medical Emergency Operations Center
Monitoring the Pandemic
Transfer Center
The MEOC served as a touch point for data transparency across the
state, providing data at a local and healthcare coalition level for bed
availability, COVID hospitalizations, supply and equipment needs
and resources (see figure 3). Work groups were formed via the
MEOC to address challenges such as movement of COVID
recovered patients to bolster hospital capacity for surge, address
staffing challenges, and disseminate best practice information.
The NE State COVID-19 Transfer Center provided a 24/7 service designed
to facilitate patient load balancing. Hospitals seeking to transfer
suspected or confirmed COVID-19 patients were strongly encouraged to
use the State Transfer Center, where clinical staff sought placement at the
nearest hospital with capability and capacity to care for the patient. Due
to the significant rise in COVID-19 and corresponding impact on hospitals
across the state, patient preference was not a primary consideration in
determining transfer location. Data on transfer times and
acceptance/denial were reported via the MEOC.
Crisis Standards of Care Surge Team
Public Health Orders Implementing NPIs
The surge team conducted educational sessions across the state,
working with the healthcare coalition leaders and facilities that
reached out for training on CSC and triage decision-making. While
providers and healthcare leaders across the state were eager for
support in CSC planning, the language (e.g., SOFA scoring,
continuum of care, triggers, etc.), guidance documents, and
algorithms proved to be a steep learning curve for the already taxed
medical community.
During the first two major waves of the COVID-19 pandemic in Nebraska
used a series of directed health measures (DHMs) to attempt mitigate
community spread of the disease. These DHMs were implemented with
the explicit purpose of reducing the burden on healthcare facilities and
preventing the need to deviate from routine standards of care. DHMs
were not statewide but were targeted for specific geographic regions in
the state and included provisions that limited gathering size, restricted
occupancy levels of restaurants and businesses, specified distancing
requirements, detailed isolation and quarantine directions, required face
masks for certain situations, and placed limitations on hospital elective
procedures that were tied to hospital capacity.
�Crisis Standards of Care (CSC)
Nebraska CSC
CSC plan drafted and reviewed by numerous clinicians and
stakeholders across the state
CSC plan based on the Massachusetts CSC plan
11/24/2020 – Nebraska Hospital Association and Nebraska Medical
Association both endorsed the final plan
Pediatric, Critical Access, and EMS specific plans were developed
Education on CSC across the state
Coalition planning initiated on CSC triage and how to operationalize
the plan regionally across the state
�Content Outline (TOC)
Pediatric Planning Process
Rachel Lookadoo, JD
�Pediatric Planning Process
Nebraska Pediatric CSC Workgroup
Workgroup of physicians, nurses, EMS workers, and
representatives from the state health department and
education agencies
Representatives from rural and urban settings across the state
Group met bi-weekly during plan formation
• Reconvened during Delta surge
�Pediatric Planning Process
Pediatric Planning Process
Needed a pediatric annex to the general CSC plan that considered
the unique needs and concerns of children/pediatric populations
Adaptation of WRAP-EM CSC Template and existing plans
from Children’s Hospital in Omaha
Supplement to general Nebraska Healthcare Crisis Protocol document
�Pediatric Planning Process
Pediatric Triage Scoring
Use of different triage scoring systems (PELOD-2 vs. SOFA)
Multi-principle Strategy to
Allocate Critical Care/Ventilators
During a Public Health Emergency
�Pediatric Planning Process
Rural Versus Urban Planning Concerns
Assumption of pediatric ICU bed availability
Needs of critical access hospitals and smaller facilities
who may have to treat children
Staff needed for triage team decision-making
�Pediatric Planning Process
Prevailing Concerns During Fall 2021 Wave
Transfer availability
Staffing
Communications with the public and other healthcare providers
Solutions that are readily available
�Content Outline (TOC)
Adult Critical Care in Support of
Pediatric Patients
Ryan C. Maves, MD, FCCP, FCCM, FIDSA
�r
�Adult Critical Care in Support of Pediatric Patients
COVID-19 and Children
Initial waves of COVID-19 pandemic have largely
spared children
Typically, less severe in children
Pediatric hospitals provided support to adult ICUs
earlier in the pandemic:
• Increased age cutoffs for PICU admission
• Provided care for younger adults
�abcd
r
https://covid.cdc.gov/covid-data-tracker/#demographicsovertime
�COVID-19 and Children
“Pandemic of the
unvaccinated”
No vaccines currently
available for children
<12 years of age
r
PICU capacity
overwhelmed by
increased demand in
many regions
https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-vaccination-trends/
�r
�Adult Critical Care in Support of Pediatric Patients
PICUs and Crisis Standards of Care
84,000 staffed non-neonatal ICU beds in the USA
5,115 (6.0%) are pediatric ICU beds
• Concentrated in urban areas
• Fewer healthcare workers (HCWs) skilled in care of younger children
• Pediatric supplies not available at all hospitals
How can adult ICUs (with greater surge capacity)
support pediatric care?
�Adult Critical Care in Support of Pediatric Patients
PICUs and Crisis Standards of Care
Categories:
Conventional
Normal operations
Contingency
Additional resources utilized but usual standards of care
Crisis
Severe limitations lead to modification in standards of care
Critical care surge strategies seek to increase hospital capacity,
keep hospitals in a “contingency” status, and avoid crisis.
�Adult Critical Care in Support of Pediatric Patients
PICUs and Crisis Standards of Care
PICU support to adult ICUs in 2020:
• Underlying concepts in respiratory failure, shock, sepsis care
are similar in older children and younger adults
• Increased admission age to 26 years
• Adult hospitalist support for adult chronic needs;
ICU issues managed by pediatric intensivists
• Invasive procedures managed by clinicians with experience
in adult and pediatric care (e.g., pediatric surgeons and
anesthesiologists)
�PICUs and Crisis Standards of Care
C.S. Mott Children’s Hospital (Ann Arbor, Michigan):
• Common protocols for broad age ranges
across ICUs (e.g., ventilator liberation,
ECMO)
• Prioritizing transfer of adult patients to
PICUs with single-system illness
r
• Overlapping skill sets where possible
• Twice-daily multidisciplinary rounds to
review PPE availability, protocol
changes, bed status
• Central management of schedules and
clinical staffing based on demand
�Adult Critical Care in Support of Pediatric Patients
How can adult ICUs return the favor?
�Adult Critical Care in Support of Pediatric Patients
Goals
Focus of this contingency strategy is to preserve pediatric
systems of care for those children who depend on PICUs’
unique skills
Not all pediatric diagnoses are suitable for adult ICU transfer
�Adult Critical Care in Support of Pediatric Patients
Category
Age Cutoffs
Conventional
18 years and older
Contingency
Crisis
15 years and older
12 years and older
AND >40 kg
Comments
•
Standard adult ICU admission criteria
•
Equipment size and medical dosing will
be generally the same as in adult,
consistent with trauma system practices
•
Using a Broselow measurement cutoff of
12 years and 40 kg, one can typically use
adult medication doses and equipment
sizes
�Adult Critical Care in Support of Pediatric Patients
Equipment, Supply and Management
Older children: ≥12 years and 40 kg)
• Adult-size equipment is usually adequate, e.g., ETT size 6.5-7.0 cuffed
tube, 7.5 French CVC
• Similar indications for NIV, IMV, CVC placement in older children and
adults
• Similar strategies for volume resuscitation, management of shock, initial
vasopressor management with norepinephrine
• ARDSnet / low-tidal volume ventilation
�Common PICU Diagnoses
Suitable for Adult ICU
•
•
•
•
•
•
•
•
Community-acquired sepsis
Cystic fibrosis
Sickle cell disease
Post-solid organ and hematopoietic stem
cell transplantation
Diabetes mellitus
Adolescent trauma (if the adult ICU is
part of a trauma center) and poisonings
Critical illness due to COVID-19
pneumonia
Multisystem inflammatory syndrome in
children (MIS-C)
Not Suitable for Adult ICU
r
•
Congenital heart diseases with
residual disease
•
Active pediatric malignancy
•
Chronic kidney disease and
end-stage kidney disease
•
Significant developmental delay
•
Rare genetic diseases
�Adult Critical Care in Support of Pediatric Patients
Pediatric Decision-Making
Critically-ill children unable to communicate are treated similar to adults:
• Emergency care rendered first
• Goals of care established with parents/guardians, care team, and patient
• Issues of assent versus consent
Ethics consultations for discordant opinions between parents,
care team, and patient
Child protective services for suspected harm and neglect
�Adult Critical Care in Support of Pediatric Patients
Visitations, Family Support and Staff Wellness
Greater emphasis on family visitation during COVID-19 for children
Consider permitting two adult visitors be authorized per day
Emotional impact of dying children on adult ICU staff
Palliative and end-of-life care
Brain death evaluations similar in children but require a second
confirmatory examination after >12 hours of observation
�Adult Critical Care in Support of Pediatric Patients
Pediatric Subspecialty Consultation
Need to develop systems to ensure available consultant support
Role of telemedicine
Specific specialties:
• General surgeons and anesthesiologists likely able to manage routine pediatric
needs, outside of specific congenital disorders and highly subspecialized areas
• Adult cardiologists may be able to manage general ICU issues (e.g., cardiac
function assessment), but pediatric expertise needed for many conditions
• Bronchoscopy in younger patients requires pediatric pulmonary or critical care
assistance
• Pediatric neurologic disease in the ICU differs in presentation and therapy (e.g.,
seizures and epilepsy)
• Electrolytes, fluid management, and dialysis catheter insertion in children ≤12
years need specialist input in the setting of CKD and AKI
�Adult Critical Care in Support of Pediatric Patients
Summary
More similarities than differences
Adult ICUs can care for well-selected pediatric patients
Need clear admission criteria and protocols, plus availability of
pediatric-specific consultation
Goal is to preserve effective care for all children
�Adult Critical Care in Support of Pediatric Patients
My Gratitude to:
Mary A. King, MD, MPH
Renee I. Matos, MD, MPH
Mitchell T. Hamele, MD
Matthew A. Borgman, MD
Luke A. Zabrocki, MD
Samir K. Gadepalli, MD
Vikram Mukherjee, MD
Asha Devereaux, MD, MPH
Jeffrey Dichter, MD
And many, many others
�r
Thank you again for the opportunity
to speak to you all today.
STAY SAFE
rmaves@wakehealth.edu
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Shelly Schwedhelm, MSN, RN, NEA-BC
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Monday, October 11, 2021 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/dmwuduZWNiQ
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/dmwuduZWNiQ?autoplay=0" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (10/11/21): Pediatric Surge Responses and Crisis Standards of Care
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Join us Monday, October 11th, at 1pm EDT / 12pm CDT for the next NETEC COVID-19 Webinar Series presentation, Pediatric Surge Responses and Crisis Standards of Care. Join our presenters as they discuss the impact of the pediatric surge during the COVID-19 pandemic. Topics will include pediatric crisis standards of care planning, concerns, and surge strategy to preserve pediatric systems of care. Questions from the audience will be welcome during the webinar.
Webinar slides attached.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-10-11
Contributor
An entity responsible for making contributions to the resource
2022-07 by Kari, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group (3 yr) C&C
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-31
Type
The nature or genre of the resource
Webinar only
2019-nCoV
Children
Contingency and crisis capacities
Coronavirus
COVID-19
Critical Care
Epidemic
Pandemic
Pediatrics
R-SP
Surge
Treatment and Care
-
https://repository.netecweb.org/files/original/d8535b5528c22f8f20bc2c253e24a12a.png
22346d228eb638376a055d691a29b32b
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
00:15:21
URL
https://player.captivate.fm/episode/b310f16d-ef25-4a2f-b139-f472d2b6ca17
Alternate URL
Other URLs if necessary.
https://netec.org/podcast/
Player
Field for the html for a video player.
<br /><iframe width="100%" title="Kids coping with COVID" src="https://player.captivate.fm/episode/b310f16d-ef25-4a2f-b139-f472d2b6ca17"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Transmission Interrupted Podcast: Kids Coping With COVID-19
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
<p>The COVID-19 pandemic continues to affect the pediatric community. With the return to school and the surge in pediatric COVID-19 cases, young children face challenges they’ve never met before, both at school and home. Join host Vanessa Raabe and special guest Abby Hollis, a Certified Child Life Specialist at Children’s Healthcare of Atlanta, as they discuss the challenges facing young children today and highlight various strategies and resources that parents, teachers, and healthcare workers can use to help kids cope with COVID-19 during the pandemic.</p>
<p>Questions or comments for NETEC? Contact us: <a href="mailto:info@netec.org" target="_blank" rel="noreferrer noopener">info@netec.org</a></p>
<p>Find us on the web: <a href="https://netec.org/" target="_blank" rel="noreferrer noopener">netec.org</a></p>
<h2 style="line-height:1.4;" class="fusion-responsive-typography-calculated">Host</h2>
<p>Vanessa N. Raabe, MD</p>
<p>Adult and Pediatric Infectious Disease Physician at NYU Grossman School of Medicine</p>
<h2 style="line-height:1.4;" class="fusion-responsive-typography-calculated">Guest</h2>
<p>Abby Hollis</p>
<p>Certified Child Life Specialist at Children’s Healthcare of Atlanta</p>
<h2 style="line-height:1.4;" class="fusion-responsive-typography-calculated">Resources</h2>
<p>Association of Child Life Professionals: <a href="https://www.childlife.org/" target="_blank" rel="noreferrer noopener">https://www.childlife.org</a></p>
<p>Coronavirus, a Book for Children, written by Elizabeth Jenner, Kate Wilson and Nia Roberts. FREE DOWNLOAD at <a href="https://stayhome.candlewick.com/" target="_blank" rel="noreferrer noopener">https://stayhome.candlewick.com</a></p>
<p>NETEC COVID-19 Novel Coronavirus Resources: <a href="https://repository.netecweb.org/exhibits/show/ncov/ncov" target="_blank" rel="noreferrer noopener">https://repository.netecweb.org/exhibits/show/ncov/ncov</a></p>
<p>NETEC COVID-19 Webinar Series Playlist: <a href="https://www.youtube.com/playlist?list=PL5JyGXQ8MP0TZXU2Ldy-jzjLuUNfFX8JZ" target="_blank" rel="noreferrer noopener">https://www.youtube.com/playlist?list=PL5JyGXQ8MP0TZXU2Ldy-jzjLuUNfFX8JZ</a></p>
<p>NETEC Resource Repository: <a href="https://repository.netecweb.org/" target="_blank" rel="noreferrer noopener">https://repository.netecweb.org</a></p>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-09-29
Contributor
An entity responsible for making contributions to the resource
2022-07 by Kari, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group (3 yr)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-09-31
Type
The nature or genre of the resource
Podcast
2019-nCoV
Children
Coronavirus
COVID-19
Mental Health
Pediatrics
R-SP
-
https://repository.netecweb.org/files/original/53ccd7128a832e51075e02372ce5913f.png
1c130177859f2e43b0dd4035866760b1
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.npdcoalition.org/resources/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pediatric COVID-19 Resources
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
This page contains links to: Pediatric COVID-19 JIT Resources, Clinical Pathways and Guidance, and Crisis Standards of Care.
Creator
An entity primarily responsible for making the resource
National Pediatric Disaster Coalition
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Contributor
An entity responsible for making contributions to the resource
2022-07 by Kari, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - note "Constantly updated Excellent resource"
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-31
Relation
A related resource
Y
2019-nCoV
Children
Coronavirus
COVID-19
Example
Just in Time training (JIT)
Pediatrics
R-SP
-
https://repository.netecweb.org/files/original/2d10f7950e919d98a260c1fb3bee7fa7.png
34f7eaaa04d754efe0cbf6ec972338eb
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://emscimprovement.center/education-and-resources/toolkits/pediatric-disaster-preparedness-toolbox/covid-19-coronavirus/domainspreparednesscoronavirus-covid-19ppe/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE, Calculators & Essential Skills
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
This page gathers a collection of tools related to PPE, Calculators & Essential Skills for clinicians.
Creator
An entity primarily responsible for making the resource
Emergency Medical Services for Children Innovation and Improvement Center (EIIC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Contributor
An entity responsible for making contributions to the resource
2022-07 by Kari, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - note "Constantly updated Excellent resource"
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-31
2019-nCoV
Children
Coronavirus
COVID-19
Example
Pediatrics
Personal Protective Equipment (PPE)
R-SP
-
https://repository.netecweb.org/files/original/3dac18a07e51233294db7e37cd306c75.png
f8f9dcde5ace64892f813ef646ca29dd
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://wrap-em.org/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Crisis Standards of Care Resources
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
A site including several resources for consideration in your crisis standards of care planning, and links to recent Crisis Standards of Care Open discussions hosted by the Eastern Great Lakes Pediatric Consortium for Disaster Response and WRAP-EM.
Creator
An entity primarily responsible for making the resource
Western Regional Alliance for Pediatric Emergency Management (WRAP-EM)
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Contributor
An entity responsible for making contributions to the resource
2022-07 by Kari, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - note "Constantly updated Excellent resource"
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-31
Children
Crisis Standards of Care
Example
Pediatrics
R-SP
Standard of Care
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Abstract
<div>
<div>
<p><strong> Background: </strong> Multisystem inflammatory syndrome in children (MIS-C) is a severe clinical phenotype of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that remains poorly understood.</p>
<p><strong> Methods: </strong> Hospitalized children <18 years of age with suspected coronavirus disease 2019 (COVID-19) (N = 53) were recruited into a prospective cohort study; 32 had confirmed COVID-19, with 16 meeting the US Centers for Disease Control criteria for MIS-C. Differences in nasopharyngeal viral ribonucleic acid (RNA) levels, SARS-CoV-2 seropositivity, and cytokine/chemokine profiles were examined, including after adjustments for age and sex.</p>
<p><strong> Results: </strong> The median ages for those with and without MIS-C were 8.7 years (interquartile range [IQR], 5.5-13.9) and 2.2 years (IQR, 1.1-10.5), respectively (P = .18), and nasopharyngeal levels of SARS-CoV-2 RNA did not differ significantly between the 2 groups (median 63 848.25 copies/mL versus 307.1 copies/mL, P = .66); 75% of those with MIS-C were antibody positive compared with 44% without (P = .026). Levels of 14 of 37 cytokines/chemokines (interleukin [IL]-1RA, IL-2RA, IL-6, IL-8, tumor necrosis factor-α, IL-10, IL-15, IL-18, monocyte chemoattractant protein [MCP]-1, IP-10, macrophage-inflammatory protein [MIP]-1α, MCP-2, MIP-1β, eotaxin) were significantly higher in children with MIS-C compared to those without, irrespective of age or sex (false discovery rate <0.05; P < .05).</p>
<p><strong> Conclusions: </strong> The distinct pattern of heightened cytokine/chemokine dysregulation observed with MIS-C, compared with acute COVID-19, occurs across the pediatric age spectrum and with similar levels of nasopharyngeal SARS-CoV-2 RNA.</p>
</div>
<p><strong> Keywords: </strong> COVID-19; MIS-C; SARS-CoV-2; coronavirus; viral RNA.</p>
</div>
<p>© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on journal site and Pub Med Central
URL
https://pubmed.ncbi.nlm.nih.gov/34398245/
Read Online
Online location of the resource.
https://academic.oup.com/jid/article/224/4/606/6283764
Citation
Citation information for the publication itself.
Peart Akindele, N., T. Kouo, A. H. Karaba, O. Gordon, K. Z. J. Fenstermacher, J. Beaudry, J. H. Rubens, C. C. Atik, W. Zhou, H. Ji, X. Tao, D. Vaidya, H. Mostafa, P. Caturegli, P. W. Blair, L. Sauer, A. L. Cox, and D. Persaud. 2021. "Distinct Cytokine and Chemokine Dysregulation in Hospitalized Children With Acute Coronavirus Disease 2019 and Multisystem Inflammatory Syndrome With Similar Levels of Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 Shedding." The Journal of infectious diseases 224 (4):606-15.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Distinct Cytokine and Chemokine Dysregulation in Hospitalized Children With Acute Coronavirus Disease 2019 and Multisystem Inflammatory Syndrome With Similar Levels of Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 Shedding
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Multisystem inflammatory syndrome in children (MIS-C) is a severe clinical phenotype of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that remains poorly understood.
Creator
An entity primarily responsible for making the resource
Peart Akindele N, Kouo T, Karaba AH, Gordon O, Fenstermacher KZJ, Beaudry J, Rubens JH, Atik CC, Zhou W, Ji H, Tao X, Vaidya D, Mostafa H, Caturegli P, Blair PW, Sauer L, Cox AL, Persaud D.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-08-16
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-07 by Amyna, Special Populations Treatment & Care group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-31
2019-nCoV
Children
Coronavirus
COVID-19
Pediatrics
R-Res&Pub
R-SP
SARS-CoV-2
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
McArdle, Andrew J., Ortensia Vito, Harsita Patel, Eleanor G. Seaby, Priyen Shah, Clare Wilson, Claire Broderick, Ruud Nijman, Adriana H. Tremoulet, Daniel Munblit, Rolando Ulloa-Gutierrez, Michael J. Carter, Tisham De, Clive Hoggart, Elizabeth Whittaker, Jethro A. Herberg, Myrsini Kaforou, Aubrey J. Cunnington, and Michael Levin. 2021. "Treatment of Multisystem Inflammatory Syndrome in Children." New England Journal of Medicine.
Abstract
<h2 class="a-article-h2 f-h12">Background</h2>
<p class="f-body">Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2.</p>
<h2 class="a-article-h2 f-h12">Methods</h2>
<p class="f-body">We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation.</p>
<h2 class="a-article-h2 f-h12">Results</h2>
<p class="f-body">Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups.</p>
<h2 class="a-article-h2 f-h12">Conclusions</h2>
<p class="f-body">We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue. (Funded by the European Union’s Horizon 2020 Program and others; BATS ISRCTN number, <a class="ext-link" href="https://www.isrctn.com/search?q=ISRCTN69546370" target="_blank" rel="noreferrer noopener">ISRCTN69546370<span class="sr-only">. opens in new tab</span></a>.)</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM.
URL
https://www.nejm.org/doi/full/10.1056/NEJMoa2102968
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMoa2102968
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Treatment of Multisystem Inflammatory Syndrome in Children
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2.
Creator
An entity primarily responsible for making the resource
the BATS Consortium
Source
A related resource from which the described resource is derived
McArdle, Andrew J., Ortensia Vito, Harsita Patel, Eleanor G. Seaby, Priyen Shah, Clare Wilson, Claire Broderick, Ruud Nijman, Adriana H. Tremoulet, Daniel Munblit, Rolando Ulloa-Gutierrez, Michael J. Carter, Tisham De, Clive Hoggart, Elizabeth Whittaker, Jethro A. Herberg, Myrsini Kaforou, Aubrey J. Cunnington, and Michael Levin.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-06-16
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group (to archive)
2022-07 by Amyna, Special Populations Treatment & Care group (said 2 years - in SPORSA went with SP)
Relation
A related resource
Y
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07
2019-nCoV
Children
Coronavirus
COVID-19
Example
Pediatrics
R-Res&Pub
R-SP
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Son, Mary Beth F., Nancy Murray, Kevin Friedman, Cameron C. Young, Margaret M. Newhams, Leora R. Feldstein, Laura L. Loftis, Keiko M. Tarquinio, Aalok R. Singh, Sabrina M. Heidemann, Vijaya L. Soma, Becky J. Riggs, Julie C. Fitzgerald, Michele Kong, Sule Doymaz, John S. Giuliano, Michael A. Keenaghan, Janet R. Hume, Charlotte V. Hobbs, Jennifer E. Schuster, Katharine N. Clouser, Mark W. Hall, Lincoln S. Smith, Steven M. Horwitz, Stephanie P. Schwartz, Katherine Irby, Tamara T. Bradford, Aline B. Maddux, Christopher J. Babbitt, Courtney M. Rowan, Gwenn E. McLaughlin, Phoebe H. Yager, Mia Maamari, Elizabeth H. Mack, Christopher L. Carroll, Vicki L. Montgomery, Natasha B. Halasa, Natalie Z. Cvijanovich, Bria M. Coates, Charles E. Rose, Jane W. Newburger, Manish M. Patel, and Adrienne G. Randolph. 2021. "Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes." New England Journal of Medicine.
Abstract
<h2 class="a-article-h2 f-h12">Background</h2>
<p class="f-body">The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy.</p>
<h2 class="a-article-h2 f-h12">Methods</h2>
<p class="f-body">We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 U.S. hospitals between March 15 and October 31, 2020. The effectiveness of initial immunomodulatory therapy (day 0, indicating the first day any such therapy for MIS-C was given) with intravenous immune globulin (IVIG) plus glucocorticoids, as compared with IVIG alone, was evaluated with propensity-score matching and inverse probability weighting, with adjustment for baseline MIS-C severity and demographic characteristics. The primary outcome was cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use of vasopressors) on or after day 2. Secondary outcomes included the components of the primary outcome, the receipt of adjunctive treatment (glucocorticoids in patients not already receiving glucocorticoids on day 0, a biologic, or a second dose of IVIG) on or after day 1, and persistent or recurrent fever on or after day 2.</p>
<h2 class="a-article-h2 f-h12">Results</h2>
<p class="f-body">A total of 518 patients with MIS-C (median age, 8.7 years) received at least one immunomodulatory therapy; 75% had been previously healthy, and 9 died. In the propensity-score–matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%; risk ratio, 0.56; 95% confidence interval [CI], 0.34 to 0.94). The risks of the components of the composite outcome were also lower among those who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). The use of adjunctive therapy was lower among patients who received IVIG plus glucocorticoids than among those who received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65), but the risk of fever was unaffected (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13). The inverse-probability-weighted analysis confirmed the results of the propensity-score–matched analysis.</p>
<h2 class="a-article-h2 f-h12">Conclusions</h2>
<p class="f-body">Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. (Funded by the Centers for Disease Control and Prevention.)</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM.
URL
https://www.nejm.org/doi/full/10.1056/NEJMoa2102605
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMoa2102605
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy.
Creator
An entity primarily responsible for making the resource
the Overcoming COVID-19 Investigators
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-06-16
Type
The nature or genre of the resource
Publication
Source
A related resource from which the described resource is derived
Son, Mary Beth F., Nancy Murray, Kevin Friedman, Cameron C. Young, Margaret M. Newhams, Leora R. Feldstein, Laura L. Loftis, Keiko M. Tarquinio, Aalok R. Singh, Sabrina M. Heidemann, Vijaya L. Soma, Becky J. Riggs, Julie C. Fitzgerald, Michele Kong, Sule Doymaz, John S. Giuliano, Michael A. Keenaghan, Janet R. Hume, Charlotte V. Hobbs, Jennifer E. Schuster, Katharine N. Clouser, Mark W. Hall, Lincoln S. Smith, Steven M. Horwitz, Stephanie P. Schwartz, Katherine Irby, Tamara T. Bradford, Aline B. Maddux, Christopher J. Babbitt, Courtney M. Rowan, Gwenn E. McLaughlin, Phoebe H. Yager, Mia Maamari, Elizabeth H. Mack, Christopher L. Carroll, Vicki L. Montgomery, Natasha B. Halasa, Natalie Z. Cvijanovich, Bria M. Coates, Charles E. Rose, Jane W. Newburger, Manish M. Patel, and Adrienne G. Randolph.
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group (to archive)
2022-07 by Amyna, Special Populations Treatment & Care group (said 3 years - in SPORSA went with SP)
Relation
A related resource
Y
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-07
2019-nCoV
Children
Coronavirus
COVID-19
Outcomes
Pediatrics
R-Res&Pub
R-SP
SARS-CoV-2
Therapeutics
-
https://repository.netecweb.org/files/original/840a5b3eb0d83e90f0f487520d270e08.pdf
28ad95255890051ba0ae6c9f36764dbe
PDF Text
Text
NETEC COVID-19 Webinar Series:
Pediatric Perspectives During a Pandemic
�Content Outline (TOC)
Welcome
Amanda Grindle, MSN, RN
�Overview
Welcome: Amanda Grindle, RN, MSN
Pediatric Perspective During a Pandemic: Andi Shane, MD, MPH, MSc
Multi-System Inflammatory Disease in Children (MIS-C):
The CHOA Experience : Preeti Jaggi, MD
COVID-19 and the Heart: A Pediatric Perspective: Matt Oster, MD, MPH
NETEC Resources: Amanda Grindle, RN, MSN
Questions and Answers with NETEC:
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Pediatric Perspective During a Pandemic
Andi Shane, MD, MPH, MSc
�Comparative Epidemiology of Acute COVID-19 in Children and Adults
r
https://covid.cdc.gov/covid-data-tracker; updated 02 Oct 2020
�Pediatric Perspectives During a Pandemic
Infection and Transmission Among Children
What we don’t know:
• Are children as susceptible to infection by SARS-CoV-2 compared with adults?
• Can children transmit SARS-CoV-2 as effectively as adults?
• Does transmission result in infection, and does infection result in disease?
What we do know:
• Children likely have the same or higher viral loads in their nasopharynx
compared with adults
• Children can transmit SARS-CoV-2 effectively in households and camp settings
�Pediatric Perspectives During a Pandemic
Burden of COVID-19 in Children
Less likely to develop severe illness compared with adults
Children still at risk of developing severe illness and complications
Rate of hospitalization among children is low (8.0 /100,000) compared with
adults (165 /100,000 population); may be increasing
Children have lower rates of mechanical ventilation and death than adults
Of the children who have developed severe illness, most with underlying medical
conditions including obesity, diabetes, asthma and chronic lung disease
Most who are infected with SARS-CoV-2 do not usually develop severe illness
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html accessed 02Oct2020
�Pediatric Perspectives During a Pandemic
Hospitalization Associated with Acute COVID-19 in Children
Hospitalization rates in the United States are higher among Hispanic/Latino children and
black, non-Hispanic children and non-Hispanic black children compared with white
children
• May be related to higher rates of obesity and other underlying conditions among
these populations
Similar to adults, children with severe COVID-19 may develop respiratory failure,
myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure
Some children have developed appendicitis, intussusception or diabetic ketoacidosis
Children infected with SARS-CoV-2 are also at risk for developing multisystem
inflammatory syndrome in children (MIS-C)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html accessed 02Oct2020
�Clinical Management
Treatment of COVID-19 in children is mostly supportive; intervention may be needed in
some who are hospitalized
Remdesivir, with variable results in clinical trials in adults, is now available for purchase
r
The safety and effectiveness of Remdesivir for treatment of COVID-19 is being evaluated in children
(NCT04431453)
The National Institutes of Health (NIH) suggests that dexamethasone may be beneficial in pediatric
patients with acute COVID-19 respiratory disease who are receiving mechanical ventilation1
Children infected with SARS-CoV-2 can present with other serious conditions such as diabetic
ketoacidosis or intussusception, and a broad differential must be maintained
1
https://files.covid19treatmentguidelines.nih.gov/guidelines/section/section_45.pdf accessed 02Oct2020
�Pediatric Perspectives During a Pandemic
Challenges to Family Centered Care
Visitor restrictions
Essential personnel only in room
Common areas for siblings closed
PPE frightening to children
Decreased ability to communicate wearing masks
Children unable or unwilling to wear masks
�Pediatric Perspectives During a Pandemic
Advocate for Children in Treatment and Prevention Trials
Advocacy for children’s participation in treatment trials
• 107 current studies listed in COVID-19 Studies from the World Health
Organization Database
• 383 current studies in ClinicalTrials.gov
Advocacy for inclusion of children in vaccine studies
�Well Child Care
Shelter-in-place orders resulted in declines in outpatient pediatric visits and fewer vaccine doses
administered during the early COVID-19 pandemic
Clinicians should work with families to keep children up to date with all recommended vaccinations by
identifying children who have missed well-child visits and/or recommended vaccinations and contact
them to schedule in-person appointments, with prioritization of infants, children age < 24 months and
school-aged children
Developmental surveillance and early childhood screenings, including developmental and autism
r
screening, should continue along with referrals for early intervention services
All newborns should be seen by a pediatric healthcare provider shortly after hospital discharge (three to
five days of age in-person, to evaluate feeding and weight gain, check for dehydration and jaundice,
ensure all components of newborn screening were completed with appropriate confirmatory testing and
follow-up, and evaluate maternal well-being
Clinicians should educate patients and families about infection prevention
in clinics, emergency departments, hospitals, and clinics
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html accessed 02Oct2020
�K-12 School Closures
Status of COVID-19 Pandemic-Associated Public K-12 School Closures –
United States, February 18 – June 30, 2020 (Archived)
r
https://covid.cdc.gov/covid-data-tracker; updated 13 Aug 2020
�Pediatric Perspectives During a Pandemic
Return to School
Children with symptoms of any infectious disease should not attend school
The length of isolation depends on the most likely etiology of illness
Return to school policies for children with COVID-19 based on local epidemiology
A negative test or excuse note should not be required for return to school upon
completion of the 10 days of isolation with improvement of symptoms
If a child is assessed to likely not have COVID-19 by a clinician, he/she should be allowed
to return to school according to existing school policies for non-COVID illnesses
(resolution of fever without antipyretics for 24 hours for non-COVID viral illnesses or
after initiation of antibiotics for bacterial illnesses, if indicated)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html accessed 02Oct2020
�Content Outline (TOC)
Multi-System Inflammatory Disease in
Children (MIS-C): The CHOA Experience
Preeti Jaggi, MD
�Background
SARS CoV-2 generally causes less severe acute illness in children
April 27, alert from the NHS: cases of severe myocardial dysfunction, some with
features of Kawasaki disease, and several with shock requiring vasopressive
medications as supportive care
Later this was described in NYC and throughout
areas in the US
r
Features similar to Kawasaki disease
Conjunctival injection, rash, coronary dilation
Similar
Different Older age, higher percentage with shock
Features similar to toxic shock syndrome
Similar
Different
Diffuse rash, shock, thrombocytopenia, multi-system involvement
Rash mostly not diffuse erythroderma
�Background: Toxic Shock Syndrome
Toxic Shock Syndrome
r
Date of download: 8/5/2015 Copyright © 2015 American Academy of Pediatrics
�Multi-System Inflammatory Disease in Children (MIS-C):
The CHOA Experience
Background
Features similar to rheumatologic illness
• HLH/macrophage activation syndrome: cytopenia, hyper-inflammatory state
• State seen in underlying rheumatologic illness such as JIA, SLE
MIS-C: Most greater than 5 years of age
Abdominal complaints (pain, diarrhea, vomiting) in about half
Most are otherwise healthy
Epidemiology seems to follow approximately one month after peaks of
community COVID-19 cases
�Health Department – Reported Cases of Multisystem Inflammatory Syndrome
in Children (MIS-C) in the United States (N=935)
r
42% Hispanic, 33% Black/non Hispanic, 14% White
non-Hispanic, 2% Asian
55% Males
Over 50% are 5-14 years of age
�MIS-C: Likely Many Scenarios
Serology +
MIS-C
Mild or no COVID-19
r
Severe COVID-19
predominantly respiratory
MIS-C
Kawasaki disease (PCR or serology positive)
Other illness (PCR or serology positive)
Meet MIS-C Case Definition
PCR +
Fever
Evidence of
inflammation
2 organ systems
“Severe” illness
No other plausible
diagnosis
Evidence of
serologic
conversion,
contact, or NP +
�12-Year-Old..
12 y/o: Day 2 of illness: Came to ED with fevers, vomiting
Day 3 of illness: Returned to ED with persistent fevers, new cough
Day 5 of illness: Returned to ED with fevers, SOB
• 39.6oC HR 129 BP 108/63 RR 26-40 89% O2 saturation
• Due to increased distress on HFNC 15L 100%, transferred to PICU for BiPAP
r
HD #1
HD #3
Patel; Pediatrics, 2020
�7-Year-Old..
1
• Fevers ranged from 102-104F
• Abd pain is constant, diarrhea, vomiting
• NBNB emesis 1-2 episodes per day
• Rash: “red dots like mosquito bites” on palms
D#1
2
• Progresses to have conjunctival injection and dry, cracked lips
• Rx Zofran for presumed AGE r
• Rash progressed à red and splotchy on shoulders, arms, back
D#2
3
D#5
• Neck pain
• Hypotension
• Decreased left ventricular function
• Admitted to ICU, treated with IVIG and eventually improves
�COVID-19 and Kawasaki Disease: Novel Virus and Novel Case
6 mo with fever, fussiness, decreased PO
Rash on day 2
Figure 1. Bulbar conjunctival injection.
Irritability, limbic-sparing conjunctivitis,
and dry lips on day 4
Swelling of hands on day 5
Left shift, anemia, elevated CRP and ESR,
low albumin
Treated with IVIG and high dose ASA
Echo normal
SARS-CoV-2 RT-PCR positive from
admission
Jones, VG, Hospital Pediatrics 2020
Image shared with parental permission.
r
�CHOA Cases
Symptomatic, NP SWAB +
MIS-C Cases
r
�Demographics in Acute COVID versus MIS-C
MIS-C
(n=57)
Acute COVID (n=952)
Age, median (IQR)
10.26 (2.5-15)
Gender, % male
P value
8.26 (5.9-11.9)
NS
52.5%
59.6%
NS
Ethnicity, Hispanic
364 (38.2%)
16 (28%)
NS
Race, Black
376 (39.4%)
38 (67%)
p<0.001
r
�Severity of Illness in Children with MIS-C
Total
Length of stay, days
7, median (IQR 4-9)
% requiring ICU care
74% (41/55)
r
Myocardial dysfunction
60%
Immunomodulators (anakinra, tocilizumab)
8.6%
Vasoactive medications
57%
�Multi-System Inflammatory Disease in Children (MIS-C):
The CHOA Experience
Preliminary Observations
MIS-C is probably a collection of syndromes
• Acute infection with severe disease
• Post infection after an undetectable initial illness
MIS-C may disproportionately affect Black children
• Don’t know infection rates in asymptomatic children
MIS-C is associated with severe illness
Using quantitative serology, MIS-C appears most similar to
convalescent COVID
�Content Outline (TOC)
COVID-19 and the Heart:
A Pediatric Perspective
Matt Oster, MD, MPH
�Proposed Mechanisms of Cardiac Injury
Immunopathology
Hyperinflammation
Biomarkers of injury
SARS-CoV-2
Direct Myocardial Injury
r
Arrhythmias
Acute Coronary Syndromes
HFpEF, HFrEF
Respiratory failure,
Hypoxemia
Akhmerov and Marbán. Circulation Research 2020
Children’s Healthcare of Atlanta | Emory University
�COVID-19 and Cardiac Involvement
Acute involvement
• Not seeing a lot in children
(but are we really checking?)
r
Long-term
• Myocarditis?
• Arrhythmias?
• Sinus bradycardia?
et al. Heart Rhythm 2020.
Children’s Healthcare of Atlanta |Siripanthong
Emory University
�Acute Effects in Children
r
Kim et al. MMWR 2020
Children’s Healthcare of Atlanta | Emory University
�Multisystem Inflammatory Syndrome: Cardiac Involvement
r
Godfred-Cato
Children’s Healthcare of Atlanta | Emory
University et al. MMWR 2020
�COVID-19 and the Heart: A Pediatric Perspective
What is Myocarditis?
Inflammatory disease of the heart muscle
Male predominance
Primarily young adults
Dasgupta et al. CHD 2019.
�COVID-19 and the Heart: A Pediatric Perspective
Why Do We Care About Myocarditis?
Cause of death in 9% of athletes in whom a cardiovascular event was
documented1
Of 243 analyzed cases of sudden death in ages 1-17yo in 2015-2016, 19
(8%) had myocarditis or endocarditis2
1
Maron et al. Circulation 2009.
2
Burns et al. Journal of Pediatrics 2020.
�COVID-19 and the Heart: A Pediatric Perspective
Myocarditis in Adults
German study of 100 adults
• Median age 49
• 1/3 hospitalized, 2/3 at home (with 18 asymptomatic)
• MRI 2-3 months after COVID infection
• Cardiac involvement by MRI in 78%, with 60% with ongoing inflammation
Puntmann et al. JAMA Cardiology 2020
�COVID-19 and the Heart: A Pediatric Perspective
Myocarditis in College Athletes
26 college athletes, 4 of whom met CMR criteria for myocarditis
• 0/10 females had myocarditis, 4/16 males)
12 subjects had mild symptoms during acute infection (2 of the 4 with eventual
myocarditis)
0 subjects had ST/T wave changes on ECG, elevated troponin, or abnormal ventricular
size or function by echo
Rajpal et al. JAMA Cardiology 2020
�Hospitalized?
NO
Asymptomatic or mild
COVID-19 symptoms?
(no fever and <3d of sx)
YES
NO
Cardiac involvement
during
hospitalization
Normal physical exam
and ECG
NO
(at PCP or cardiology)?
YE
S
Does not need
further cardiac
evaluation.
Cleared for sports.
YE
S
Cardiology follow-up
not needed.
Cleared for sports.
YE
S
Cardiology follow-up
not needed.
Cleared for sports.
NO
Manage accordingly
based on other
potential cardiac
conditions.
OR
Diagnosed with
MIS-C?
YES
NO
Cardiology workup as
indicated by
r Normal?
cardiologist.
NO
Follow up with
Cardiology 2 weeks
after Discharge
Myocarditis?
YE
S
Follow myocarditis
protocol. Restricted
from sports until
cleared by cardiology.
�MIS-C Follow-up Plan
ECG
Echo
2 weeks
6 weeks
3 months
6 months
All
All
All
All
All
Only if persistent
coronary involvement at
6 weeks
All
All
r
MRI
Stress Test
If EVER cardiac
dysfunction
TBD if abnormal
cardiac MRI findings
at 3 months
If at least 8yo and EVER
cardiac dysfunction
TBD if abnormal
stress test at 3
months
Children’s Healthcare of Atlanta | Emory University
�COVID-19 and the Heart: A Pediatric Perspective
Conclusions
Cardiac involvement during acute COVID-19
infection is not common in children
Heart involvement is VERY common in MIS-C
Follow-up varies by type of infection and degree
of heart involvement
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Amanda Grindle, MSN, RN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
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Title
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Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, October 16, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below
URL
https://youtu.be/mseYyxUrMk4
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Pediatric in Pandemic Webinar" src="https://www.youtube.com/embed/mseYyxUrMk4?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-peds2" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-peds2</a>
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Title
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NETEC COVID-19 Webinar Series (10/16/20)/Online Course: Pediatric Perspectives During a Pandemic
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
In this webinar, we’ll describe the epidemiology of acute COVID-19, including post-infectious manifestations and the unique aspects of caring for children during a pandemic. We will also discuss the features of MIS-C and how to devise a diagnostic and acute management plan and integrate potential post-recovery complications into the development of follow-up plans for a child with MIS-C.<br /><br />Webinar slides attached.<br /><br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-peds2" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
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NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-16
Coverage
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2024-04-27
Contributor
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2022-09-27 - general asset review - Treatment & Care group
2022-07 by Amyna, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - skipped - bump to next review
Relation
A related resource
Y
Y - D0.1Tx/D0.2Tx Qualtrics # 811, original # 3b
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
CEU
CEUs
Children
Clinical Care
Complications
Coronavirus
COVID-19
Online Course
Pandemic
Pediatrics
R-SP
R-T&C
Treatment and Care
Webinar
-
https://repository.netecweb.org/files/original/89346b06216b2fd95fb4b030ef234c49.pdf
79240f3cdc279bcbd507561fbb312eea
PDF Text
Text
Como ayudar los niños a usar máscaras
Usar una máscara puede ser difícil para todos.
¿Como puedes ensenar y ayudar un niño a usar una máscara?
PLANIFICA PARA EL ÉXITO
• Tener varias máscaras
• Busque personajes o diseños que el niño disfrute al comprar o hacer máscaras.
• Pruebe diferentes tipos de máscaras para encontrar el ajuste adecuado para el niño.
PRACTIQUEN
JUNTOS
SÉ SENSIBLE A SUS
EMOCIONES
• Da el ejemplo y usa tu
mascara de manera
correcta.
• Practica con sus
compañeros de clase,
amigos, vecinos y su
familia.
• Deje el niño ayudarte a
poner la máscara.
• Practique cuando el niño
esté bien descansado,
alimentado y de buen humor.
• Planifique pausas,
especialmente si el niño está
abrumado o no colabora.
• Reconozca la frustración.
¡QUE SEA DIVERTIDO! NIÑOS APRENDEN A TRAVÉS DEL JUEGO
• Hazlo un juego basado en los tipos de actividades que el niño disfruta.
• Pida al niño que dibuje máscaras sobre algunas imágenes de sus personajes favoritos o que
ponga una máscara en su muñeca o peluche favorito.
• Adopte una posición de refuerzo positivo con puntos o premios para cosas que son difíciles para el
niño. Por ejemplo, no tocar la máscara debe ser alentado y ganar elogios o recompensas.
• Mantega una actitud positiva y celebrar los éxitos.
• Tratar los fallos como una oportunidad para intentarlo de nuevo.
08-06-20
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
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Title
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Como ayudar los niños a usar máscaras
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
Spanish Language version of <a href="https://repository.netecweb.org/items/show/1276">Helping Children Wear Masks</a>. Wearing a mask can be difficult for all of us. How can you teach and help a child to wear a mask? <br /><br />Usar una máscara puede ser difícil para todos. ¿Como puedes ensenar y ayudar un niño a usar una máscara?
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-21
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Children
Coronavirus
COVID-19
Español
Mask
Masks
Pediatrics
R-SP
Respiratory Pathogen
Spanish
-
https://repository.netecweb.org/files/original/d82467093edfde3c8151f15c8bf2d3fa.pdf
b8bd1416c648c1a28d38b4c71fdb8853
PDF Text
Text
Cuidado de pacientes con COVID-19 pediátricos
Limita citas en consultorio
Cuando es posible, lleva acabo citas y
visitas virtualmente.
Provee cubre bocas.
Utilizar cubre bocas donde no sea posible
mantener una sana distancia y ante la
presencia de poblaciones vulnerables.
• Citas y cuidados de parte de familia y
médicos.
• Consultas con trabajadores sociales y
equipo de gestión de la atención.
Examina a todo visitante y personal.
Esta instalación esta bajo restricciones de
visitas. No se permite la entrada a visitantes
enfermos.
Limita servicio al cuarto.
Descubre alternativas creativas para
servicios pediátricos.
• Utiliza la ventana como jugo de mesa.
• Substituye música y lectura en vivo
por música grabada y audiolibros.
Limita visitas.
Permite un solo tutor primario
para la manutención.
Previene las vistas innecesarias al hospital.
Herramientas de evaluación pediátrica en línea
pueden ayudar a padres a identificar los pasos a
tomar si algún hijo muestra síntomas o sido
expuesto al SARS-CoV-2.
Limita el movimiento de pacientes y tutores.
Agrupa casos confirmados por laboratorio y
casos sospechosos para limitar el movimiento de
tutores e hijos en el hospital.
06-29-20
Provee personal adicional en salas de emergencias y
cuidados intensivos.
Existe la posibilidad de un alza en problemas de salud
conductual, abuso, suicidio, y trauma en cuanto los niños
son confinados en casa en lugar de atender a la escuela.
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
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Title
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Cuidado de pacientes con COVID-19 pediátricos
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
<a href="https://repository.netecweb.org/items/show/1229">Caring for Pediatric Patients with COVID-19</a> in Spanish.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-29
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Children
Coronavirus
COVID-19
Emergency Department
Español
Hospital Rooms
Pediatrics
R-SP
Spanish
-
Dublin Core
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Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Jiang, Li, Kun Tang, Mike Levin, Omar Irfan, Shaun K. Morris, Karen Wilson, Jonathan D. Klein, and Zulfiqar A. Bhutta. 2020. "COVID-19 and multisystem inflammatory syndrome in children and adolescents." The Lancet Infectious Diseases.
Abstract
<h2 class="top" id="seccestitle10"><span class="top__text">Summary</span></h2>
<div class="section-paragraph">
<div class="section-paragraph">As severe acute respiratory syndrome coronavirus 2 continues to spread worldwide, there have been increasing reports from Europe, North America, Asia, and Latin America describing children and adolescents with COVID-19-associated multisystem inflammatory conditions. However, the association between multisystem inflammatory syndrome in children and COVID-19 is still unknown. We review the epidemiology, causes, clinical features, and current treatment protocols for multisystem inflammatory syndrome in children and adolescents associated with COVID-19. We also discuss the possible underlying pathophysiological mechanisms for COVID-19-induced inflammatory processes, which can lead to organ damage in paediatric patients who are severely ill. These insights provide evidence for the need to develop a clear case definition and treatment protocol for this new condition and also shed light on future therapeutic interventions and the potential for vaccine development.</div>
<h3>Translations</h3>
<div class="section-paragraph">For the French, Chinese, Arabic, Spanish and Russian translations of the abstract see Supplementary Materials section.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30651-4/fulltext
Read Online
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https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30651-4/fulltext
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Title
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COVID-19 and multisystem inflammatory syndrome in children and adolescents
Subject
The topic of the resource
Research
Description
An account of the resource
As severe acute respiratory syndrome coronavirus 2 continues to spread worldwide, there have been increasing reports from Europe, North America, Asia, and Latin America describing children and adolescents with COVID-19-associated multisystem inflammatory conditions.<br /><br />A response to this article was published:<br /><ul><li>Schwartz, Michael. 2020. "<a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30786-6/fulltext" target="_blank" rel="noreferrer noopener">MIS-C: post-infectious syndrome or persistent infection?</a>" The Lancet Infectious Diseases.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Jiang, Li, Kun Tang, Mike Levin, Omar Irfan, Shaun K. Morris, Karen Wilson, Jonathan D. Klein, and Zulfiqar A. Bhutta.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-17
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-07 by Amyna, Special Populations Treatment & Care group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-31
Relation
A related resource
Y
2019-nCoV
Children
Clinical Care
Coronavirus
COVID-19
Neonates
Pediatrics
R-Res&Pub
R-SP
Treatment and Care
-
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Title
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Develop
Description
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.strong4life.com/~/media/files/Strong4Life/Programs/School-Programs/back-to-school-2020/childrens-reopening-toolkit-youth-organizations.pdf
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Title
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Children's Reopening Toolkit for Youth Organizations
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
As we reopen, children—and those who serve them—need support more than ever. Use the resources in this toolkit as a steppingstone to help protect the kids and staff within your organization. <br /><br />Find this and related resources: <a href="https://www.strong4life.com/en/landing-pages/schools-reopening" target="_blank" rel="noreferrer noopener">https://www.strong4life.com/en/landing-pages/schools-reopening</a>
Creator
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Children's Healthcare of Atlanta (CHOA)
Date
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2020-08
Contributor
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2022-07 by Nicole, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-31
2019-nCoV
Children
Contingency and crisis capacities
Coronavirus
COVID-19
Emergency Management
Epidemic
Example
Pandemic
Pediatrics
R-EM
R-SP
-
https://repository.netecweb.org/files/original/2cc0ae08fcb655ce947e7ac33a7c5749.pdf
86a044583f193ce7f5fa0ade46189c5f
PDF Text
Text
08-06-20
�
Dublin Core
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Title
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Develop
Description
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
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Title
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Helping Children Wear Masks
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Wearing a mask can be difficult for all of us. How can you teach and help a child to wear a mask?
Creator
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NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-06
Contributor
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2022-07 by Clayton, Special Populations Treatment & Care group
Coverage
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2025-07-31
2019-nCoV
Children
Coronavirus
COVID-19
Mask
Masks
Pediatrics
R-SP
-
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.strong4life.com/~/media/files/Strong4Life/Programs/School-Programs/back-to-school-2020/how-to-screen-your-child-for-covid-19-symptoms-checklist.pdf
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How to Screen Your Child for COVID-19 Symptoms
Subject
The topic of the resource
Infection Control
Description
An account of the resource
As parents, we’re always mindful of how our children are feeling before they go to school. But this year we’ll have to pay more attention than ever to do our part to minimize the spread of germs. <br />Printable flyer. <br />See this and related resources:<br /><a href="https://www.strong4life.com/en/landing-pages/parent-resources" target="_blank" rel="noreferrer noopener">https://www.strong4life.com/en/landing-pages/parent-resources</a>
Creator
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Children's Healthcare of Atlanta (CHOA)
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-07
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change to R-SP)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
2019-nCoV
Checklist
Children
Coronavirus
COVID-19
R-SP
Screening Tool
-
https://repository.netecweb.org/files/original/038ce2ef4b41e365813ddd102d0807b0.pdf
f2f9c17ac236a9f041547f92caf0a188
PDF Text
Text
Unique Considerations
in the Management of Children
with Ebola Virus Disease
Andi L. Shane MD MPH MSc and Ted Cieslak MD
Kari Simonsen MD
Jaime Mukherjee MSN
�Kids: Not Just Little Adults
�Definitions:
Who is a Child?
Term
Age
Neonate
0-28 days
Infant
1-12 months
Toddler
1-2 years
Child
2-11 years
Early
Adolescent
12-14 years
Mid
Adolescent
15-17 years
Late
Adolescent
18-20 years
Adult
21 & up
SAM Guidance
Up to 23
Obamacare
Up to 26
�How do Children
differ from Adults?
Physiology
Anatomy
Therapy
Pathology
Maturity
Policy
�Physiologic Differences
• Increased surface-area-to-volume ratio
– More susceptible to consequences of fluid
loss
• Increased minute ventilation
• Higher cardiac output
• Greater metabolic rate
– Greater caloric requirements
• Thinner epidermis
• Under-keratinized epidermis
• Immature blood-brain barrier
�Pediatric Body Surface Considerations
•
•
•
•
Surface Area ~x2
Volume ~x3
Thus, ↑V > ↑SA
Relative Head Size
�Developmental
Considerations
• Caregivers in PPE likely
to be frightening
• Children unable to
cooperate with care
• Children may tug and
pull at PPE
• May not be able to
distinguish reality from
fantasy
• Children may be more
prone to PTSD
�Therapy & Policy
Considerations
• Some therapeutics that may be indicated for
adults are contraindicated
– providers are unfamiliar with dose and use
– unavailable in a preparation that could be
consumed by children
• Use of therapeutics under IND may be
challenging due to regulations related to
minors
• Pediatric equipment may not be available
• EMS crews may be uncomfortable with the
transport of children
• Pediatric-specific HLCC beds are lacking
• Doctrine is sparser than for adults
• Data is limited for management of infants and
children
�Pediatric Ebola in
Endemic Settings
• Children have been under-represented
in infected populations in outbreak
settings
• Children may be less likely to acquire
EVD through intra-familial spread
– less likely to provide direct care to infected family
member
– less likely to be involved in burial rites
• EVD in children may go unreported
• Breastfeeding is a transmission risk
�On the Other Hand……
• children have more
complex social
networks
• children have a higher
number of
interpersonal contacts
• children are housed in
schools and day care
centers
• children are more likely
to transmit infections
�Ebola Epidemiology
Zaire (Kikwit), 19951
– 27/315 cases (9%)
Uganda (Gulu),
20002
– 20/218 cases (9%)
– M/F = ¾
– CFR 40%
Guinea, 20143
1Pediatr
Infect Dis J 1996;15:189
2African Health Sciences 2001;1:60
3JAMA Pediatr 2014;168:1087
– 147/823 cases (18%)
– CFR 74% in <15yo
�Differences in Pediatric Presentation
• 100% febrile, but…
• only 16% have
hemorrhage
• Respiratory &
gastrointestinal
symptoms common
• Neurological symptoms
rare
• Thus…Ebola looks like African Health Sciences 2001;1:60
influenza-like-illness
�Screening for Ebola
during flu season
�Additional insight into
clinical presentations
of Ebola in children
• Respiratory symptoms are more common, and….
• CNS manifestations are less common than in adults
• Maculopapular rash on the face and torso at day 4-5
• Conjunctival injection & subconjunctival hemorrhages
• Laboratory abnormalities
• hepatic dysfunction (AST > ALT)
• hypo- kalemia, natremia, calcemia, magnesemia
• Microvascular instability occurs at ~ day 7 of illness
• Pediatric mortality
• fatal around day 10-12
• usually from septic shock and end organ failure
�Ebola
in the Fetus and Neonate
• Approximately 30% of pregnant
women with EVD present with
hemorrhage and spontaneous
abortion.
• Maternal mortality approaches 90% if
infection occurs in the 3rd trimester.
• ALL neonates delivered to mothers
with active EVD to date have died.
• Full cause of death investigations
are lacking on these infants.
�Ebola & Pets
• Ebola can be transmitted via
blood, fluids, or meat of an
infected animal
– Limited evidence that dogs
become infected with Ebola
virus
– No reports of dogs or cats
becoming symptomatic
with or transmitting Ebola
• Spanish experience—dog
euthanized
• Dallas experience—dog
quarantined and released after
21 days
http://www.newsweek.com/ebola-infectednurses-dog-bentley-tests-negative-virus279217
�Yet Another Tragedy: Ebola Orphans
3500
Pediatric
Cases
1200
Pediatric
Deaths
10,000
Orphans
UNICEF
Guinea, Liberia, Sierra Leone
as of December 2014
�Pediatric-Specific
Preparedness
�Key Participants
in Pediatric Healthcare
– Child
– Family – parents/siblings
– Pediatric/PICU nurses and technicians
– Pediatric physicians
– Pediatric phlebotomists
– Pediatric Respiratory therapists
– Pediatric pharmacists
– Child Life Specialists & teachers
– Occupational therapists
�Pediatric Nurses
•
•
Pediatric Nurses must:
– Adapt assessment skills to
suit the different age ranges
of children
– Be aware signs/symptoms of
organ dysfunction/failure
– Respond immediately
The Pediatric Nurse is essential
in mitigating stress for the child
and his/her family
– Nurses spend more time with
the child and family than any
other health care team
member
– Nurses provide valuable
input to other team members
in how to approach the child
and family
– Nurses are in a key position
to help the child and family
with coping strategies
�Emory & Nebraska Pediatric
Planning:
Two Systems; One Goal
Emory/CHOA
UNMC
�For the Engineers
CHOA
UNMC
�Equipment must be
procured, prepared,
tested, and exercised in
advance
�Preparation:
Age-Specific Stockage
Lists
Supply List 0-1 Years
Infant/Pediatric stethoscope
Isolette//Warmer/Crib and crib linen
Age appropriate toys
Diapers sizes newborn-3 (depending upon weight)
Infant scale; Diaper scale
Sterile bottles and regular -flow nipples/Sippy cups/pacifiers
*consider use of donor human milk if mom breastfeeding
Oral syringes 1ml,3ml,5ml,10ml
EGG leads and Cable
6F, 8F, 10F NG tubes
Feeding tubing
10ml syringes with blunt tip connectors for indirect blood draws
Infant ambu bag
20-60ml IV syringes
Small mask
Pediatric Code Cart
NICU/PEDS Alaris Pumps (mamas and babies)
Alaris 3 port IV tubing
24G 5/8” and 24G 7/8” Insyte IV catheters
CHG CL dressing change kits w/o dressing; order size 1660 CHG dressing separately
NC/O2 tubing
Sterile water for humidified O2
Emergency Drug Sheet
�Regular Drills
Some drills test the
ability to don & doff
full PPE and to
function in it for
prolonged periods
The Stethoscope should
not be here; it cannot be
used in full PPE
This particular drill examined staff ability to perform assessments in
triple gloves
�Emory CHOA “PUI”
Experience
Date
Age &
Sex
Origin
Exposure Symptoms
Diagnosis
8/14, IP
4 mo M
Sierra
Leone
None
Fever,
known; in anorexia,
US x 12 d cough
EV D68
9/14, UC
5
children;
2-10 yo
Nigeria
Nurse in
Nigeria
x 3 wks
Two with
emesis,
fever,
diarrhea
AGE
10/14, ED
10 yo F
“West
Africa”
Classmat
e from
Africa
Nausea,
emesis
AGE (NoV)
11/14, ED
9 yo M
Mali
Travel to
Africa
Fever,
lethargy,
abd pain
Malaria
(24%)
11/14, ED
4 yo F
Liberia
GM from
Liberia
Fever,
anorexia
SC Crisis
�Lessons from PUIs
1. Take a detailed history
- exposure history is KEY
2. Use contacts to help assess
- are siblings ill?
3. Consider the differential
- malaria, influenza, EV-D68, norovirus, typhoid
4. Consider the impact
-
of providers in PPE
of the media
5. Ebola can be stigmatizing
- plan ahead for this
6. Internal and external communications are
critical
�Care of the Neonate
Born to Woman with
EVD (1)
•
•
•
•
•
•
Neonates delivered to mothers with confirmed
EVD should be considered to be PUIs
Local health authorities should be alerted
Neonates and mothers ideally should be
immediately separated and cared for in an
isolation unit for 21 days
HCW should employ PPE as for confirmed EVD
Resuscitation should occur with adherence to
isolation precautions, environmental safety, and
worker safe practices
Discharge decisions of asymptomatic PCRnegative infants should be made in
collaboration with the local health department
�Care of the Neonate
Born to Woman with
EVD (2)
• The neonate with EVD
exposure is still a neonate
• Need routine care and
immunizations
• Require evaluation for
febrile illness (hospital
and community acquired
infections)
• Require evaluation for
concomitant infections
(acquired internationally)
• Circumcision should be
delayed for 21-day
observation period or EVD
negative PCR testing
�Breastfeeding
• Breastfeeding contraindicated for infants
born to women with confirmed or
suspected EVD
• Ebola virus detected in human milk 15 days
after onset of symptoms
• Minimal data exists on transmission of
Ebola from mother to infant via human milk
and on occupational risks from exposure to
human milk from a woman with EVD
• PPE is recommended for anyone handling
expressed breast milk
• Expressed breast milk is Category A waste
�Care of the Neonate
Born to a PUI Woman
• Neonate is in same risk category as
mother
• Neonate can remain in same room with
mother unless mother or neonate
becomes symptomatic separation
• Neonate should be monitored with q12
rectal temperatures and symptom
screens
• Mother may breastfeed as long as she
and infant are asymptomatic
• Dyad should be monitored for 21 days
after mother’s potential exposure
�The Toughest Question:
Parental Presence
• Visitors are permitted for neonates born to
asymptomatic mothers with potential
Ebola virus exposure
• Visitors are generally not permitted with
neonates born to women with confirmed
EVD or for PUIs until status confirmed
• Visitors are generally not permitted with
children with confirmed EVD
• Exceptions must carefully weigh risks and
benefits
• Visual observation or videoconference
technology generally preferred at present
�Family-Centered Care
�Parenting via Skype
�Questions?
��
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
In Person Course
Document relating to an in person course.
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Title
A name given to the resource
Unique Considerations in the Management of Children with Ebola Virus Disease
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
NETEC past class slides 2015-2016
Creator
An entity primarily responsible for making the resource
NETEC
Source
A related resource from which the described resource is derived
Andi L. Shane MD MPH MSc and Ted Cieslak MD <br />Kari Simonsen MD <br />Jaime Mukherjee MSN
Date
A point or period of time associated with an event in the lifecycle of the resource
2016
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
Children
Ebola
Pediatrics
R-T&C
Treatment and Care
Viral Hemorrhagic Fever