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Communique

Weekly Communique # 18

13 August, 2020

WEEK IN REVIEW

New pregnancy and perinatal care recommendation: Skin-to-skin contact This week the Pregnancy and Perinatal Care Panel made a consensus recommendation on skin-to-skin contact between parent and child:

Early skin-to-skin contact after birth and during the postnatal period is supported, irrespective of the presence of COVID-19. However, parents with COVID-19 should use infection prevention and control measures (mask and hand hygiene).

Early skin-to-skin contact refers to placing the naked baby prone on the parent’s bare chest immediately after birth.

Skin-to-skin contact should be encouraged and continue as per usual practice in other postnatal and neonatal settings, such as neonatal ICU and postnatal wards, providing infection prevention and control measures are maintained.

Note on caring for children and adolescents in the context of COVID-19

The Taskforce’s Paediatric and Adolescent Care Panel have emphasised the importance of putting children and families at the centre of clinical care

The Taskforce regards child- and family-centred care indispensable in managing the health and wellbeing of children and adolescents, and urges continuity of child-centred services, with a particular focus on equity of access. We support efforts to ensure children are able to remain in contact with parents, carers and families despite COVID-19 and recognise this may require specific attention to infection control management practices and may involve adjunctive use of technology such as video-calling. Health facilities should have plans to manage these issues for children and adolescents. We endorse the approach and goals established by the United Nations Policy Brief: the impact of COVID-19 on children.

Child-centred services include among others: schooling, nutrition programs, maternal and newborn care, immunisation services, sexual and reproductive health services, HIV treatment, mental health and psychosocial services, birth registration, community-based child protection programs, out-of-home
care, and case management for children requiring supplementary personalised care, including those living with long-term medical conditions, disabilities and victims of abuse or family violence. Particularly relevant for the Australian context is to ensure continuity of Aboriginal and Torres Strait Islander child services.

Watch and wait on evidence for post-COVID care

A number of questions posed to the Taskforce recently relate to best-practice management of patients during the medium to long-term recovery phase of COVID-19, and we acknowledge that this is an extremely important topic for patients and clinicians.

Among the key challenges of treating a novel virus are the lack of insight into its natural history and the lack of disease-specific evidence to guide clinical care over and above standard best-practice for similar illnesses (such as severe pneumonia). There is a large body of research underway across the world to document the natural history of COVID-19 and test treatment strategies to improve follow-up care and long-term outcomes. The Taskforce will continue to monitor the literature daily so that we are able to update our guidance rapidly as this evidence begins to emerge.

 


QUICK STATISTICS

  • COVID-19 research pipeline
    15,926 studies published or registered in Cochrane COVID-19 Study
    Register, 727 added this week
  • 1,554 randomised controlled trials registered (data from Covid-nma site), 29 added this week
  • 1,912 systematic reviews registered in PROSPERO, 63 added this week
  • 36 randomised controlled trials published (data from Covid-nma site), 3 added this week

 


NEW OR UPDATED RECOMMENDATIONS

Version 17.0

Non-invasive ventilation
The evidence base and strength of recommendations have been updated for non-invasive ventilation in patients treated in single rooms or shared ward spaces with cohorting of patients with confirmed COVID-19, in shared wards or emergency department cubicles, during inter-hospital patient transfer/retrieval and in patients with COVID-19 and alternative clinical presentation.

Respiratory management of the deteriorating patient
The wording of the recommendation has been updated for clarity with no change to the direction or strength of the recommendation. Key information and remarks have been added.

Skin-to-skin
New consensus recommendation

Early skin-to-skin contact after birth and during the postnatal period is supported, irrespective of the presence of COVID-19. However, parents with COVID-19 should use infection prevention and control measures (mask and hand hygiene).

Breastfeeding
The associated remarks have been updated for clarity with no change to the direction or strength of the recommendation.

Child and adolescent care
New information which provides an agreed definition of PIMS-TS has been added:

PIMS-TS case definition adapted from the Royal College of Paediatrics and Child Health (United Kingdom):
1. A child presenting with persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with additional features*. This may include children fulfilling full or partial criteria for Kawasaki disease.
2. Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus (waiting for results of these investigations should not delay seeking expert advice).
3. SARS-CoV-2 PCR testing may be positive or negative. All stable children should be discussed as soon as possible with specialist services to ensure prompt treatment (paediatric infectious disease / cardiology / rheumatology). There should be a low threshold for referral to paediatric intensive care using normal pathways.

The Taskforce is continually monitoring research to update recommendations weekly as new evidence accumulates.

 


CLINICAL FLOWCHARTS

Five clinical flowcharts have been developed by the Taskforce to cover:

  • Assessment for suspected COVID-19
  • Management of adults with mild COVID-19
  • Management of adults with moderate to severe COVID-19
  • Management of adults with severe to critical COVID-19
  • Respiratory support for adults with severe to critical COVID-19 UPDATED
  • UPDATEDUPDATED

Changes to flowcharts this week reflect:

  • Updated strength of NIV recommendations
  • Updated recommendation on respiratory management of the deteriorating patient

 


 EVIDENCE UNDER REVIEW

We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:

  • Anticoagulants for pregnant women NEW
  • Respiratory support for children and adolescents NEW
  • Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)
  • Overarching principles of care for people who are receiving palliative care or frail older people
  • Cardiac arrest
  • Prone positioning
  • Non-invasive ventilation

 


NEWS & EVENTS

RANZCOG
RANZCOG will host a public zoom webinar featuring president Dr Vijay Roach, Co-Chair of the Taskforce Pregnancy and Perinatal Care Panel, together with fellow panel members Dr Michelle Giles and Dr Clare Whitehead.

Fireside Chat with RANZCOG – COVID-19 and Pregnancy: What you need to know.
Date: Tuesday, August 18
Time: 6.00-7.00pm AEST
Register here

 


NEW TOPICS & QUESTIONS

Each week we collect suggestions for new clinical questions or topics for consideration by the Taskforce. A document that lists all of the suggested questions, topics and new patient groups that we have received to date is updated each week and available here.

Please encourage your clinical colleagues to provide their insights via the website.

 


 

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