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Guidelines urge higher standard of care for children with Ebola
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New guidelines published in The Journal of Pediatrics recommend a higher standard of care for children infected with Ebola in disadvantaged regions during an outbreak.
“We present a report of our experience caring for children at what was the largest [Ebola treatment unit (ETU)] in Port Loko, Sierra Leone, and a discussion of our protocols for caring for children with Ebola, with the hope of stimulating an international dialogue regarding the care of children with this disease,” Indi Trehan, MD, MPH, DTM&H, assistant professor of pediatrics at Washington University School of Medicine, and colleagues wrote. “These protocols represent the culmination of the accumulated experience and knowledge of our ETU health care staff.”
The new guidelines focus on an aggressive approach to treating Ebola in children, including giving children IV fluids, treating other infections, feeding children highly fortified foods and significantly increasing bedside care.
“We ideally would like to get [these patients] the same level of care they would get if they were flown back to the U.S.,” Trehan said in a press release.
To draft the guidelines, the authors drew from their experience working at a 106-bed ETU in Sierra Leone. Trehan and colleagues also examined published studies and reports on the ongoing outbreak and adapted existing WHO and Médecins Sans Frontières guidelines to compose guidelines that would be effective and practical.
The recommendations included:
- administering IV fluids to prevent patients’ veins from collapsing and to boost electrolytes;
- targeting other possible infections with antibiotics and antimalarials;
- providing medication to reduce vomiting;
- providing ready-to-use therapeutic foods to maintain good patient nutrition;
- manning the unit 24 hours per day to ensure patients are not left alone;
- training Ebola survivors, with antibodies to the virus, to provide psychological support to patients;
- providing pressure bags to ensure faster delivery of IV fluids;
- providing ultrasounds to assist with access to veins and determine if patients are properly hydrated; and
- improving infrastructure to ensure climate control within ETUs.
Although WHO officials recently declared West Africa Ebola-free, Trehan and colleagues warn that the virus’ return to the region is imminent.
“We know Ebola is going to come back,” Trehan said in the release. “But the next time an ETU is opened, the physicians, nurses and other health care providers shouldn’t have to start from scratch. Our goal in publishing our findings is so they can have something solid to start with. It may not be perfect — we invite others to build on it — but it’s from our collective experience. This is how we think children with Ebola should be cared for.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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