key: cord-0953503-hpp8e8yp authors: Wu, Xiaobin; Li, Xuemei title: Management plan of a paediatric outpatient department during the SARS‐CoV‐2 epidemic date: 2020-08-11 journal: Pediatr Pulmonol DOI: 10.1002/ppul.25000 sha: a46380fca6b771c25d556d623629eb1a4dd21181 doc_id: 953503 cord_uid: hpp8e8yp With the novel coronavirus (2019-nCoV) infection outbreak and spread, serious cases of infection and neonatal infection have been reported. Moreover, children show milder cases and a better prognosis than adults. The outpatient Department of Paediatrics has played a crucial role in the prevention and control of novel coronavirus (2019-nCoV) infection in children. Based on previous experience and existing diagnosis and treatment guidelines, we present the relevant strategies of this particular paediatric outpatient department when responding to the epidemic. Conclusion: Concurrently, we hope that this article can act as a reference in the fight against SARS-CoV-2 infection. Further modifications will be made in the future with the increase in clinical experience and changes in the disease. This article is protected by copyright. All rights reserved. 15 July 2020, more than 13 000 000 people around the world have been diagnosed with SARS-CoV-2 infection. Children are susceptible to acute infectious diseases. Thus far, more than 2000 children have become infected in china; the youngest child was a 36-hour-old newborn. Moreover, children show milder cases and a better prognosis than adults. 4 Although detailed analysis from the epicentre of the Italian COVID-19 outbreak describes increase in cases of rare Kawasaki-like disease in young children, but this syndrome is rare and experts stress that children remain minimally affected by SARS-CoV-2 infection overall. 5 The were 2346 fever cases, 12 suspected children cases and 39 suspected adults cases. All the suspected patients were safely sent to the designated hospital for further diagnosis and treatment, and none of the staff in the pediatric outpatient department was infected. The current review summarizes the management plan of pediatric outpatient department in our hospital. The purpose of this paper is to discuss how to prevent and control SARS-CoV-2 infection in paediatric outpatient services from the aspects of protection, diagnosis, psychological adjustment, etc. At the same time, we also hope that this article can act as a reference in the fight against SARS-CoV-2 infection. 1. Establish a management team, implement pre-inspection and triage procedures, allocate a fever outpatient area, and prepare personnel properly through training and other preliminary work. (1) Fever, dry cough, and fatigue; a small number of newborns show low fever or normal body temperature; (2) Imaging examination is consistent with the expected characteristics; (3) In the early stage of the disease, the total number of white blood cells is normal or decreases or the number of lymphocytes decreases. (4) Inability to explain the current clinical manifestations with regard to other diseases. 11 Suspected case (with one of the following): (1) Positive in history of epidemiology, and consistent with any two clinical manifestations; (2) Consistent with any three clinical manifestations without clear history of epidemiology. Confirmed cases (with one of the following): (1) A positive nasopharyngeal swab or blood nucleic acid test; (2) A virus gene sequence from respiratory secretion or blood samples that is highly homologous with SARS-CoV-2. (3) Serum-specific antibody immunoglobulin G level changed from negative to positive or in the recovery period was four times or more greater than in the acute period. (4) Severe pneumonia (in accordance with any of the following). (a) In the quiet state with a normal temperature, the respiratory rate is ≥60 times/min (<2 months old) or ≥50 times/min (2-12 months old) or ≥40 times/min (1-5 years old) or ≥30 times/min (>5 year old); (b) Oxygen saturation is ≤92%; (c) There is hypoxia, moaning, nasal wing agitation, three concave chest signs or apnoea or cyanosis; (d) There is loss of consciousness, convulsion, drowsiness, coma, or altered awareness; (e) There are refusals to feed, feeding difficulties, dehydration. The paediatric outpatient department, as the first defence in protecting children's health, has a great responsibility. Medical staff fighting the epidemic suffer from a high-pressure, fast-paced, high-risk environment and have great responsibility. In addition to their daily work, such as diagnosis, treatment and screening, medical staffs also experience psychological pressure from children's parents and from the epidemic, which indicates that they must not only overcome physical fatigue but also the negative effects of psychological pressure. Thus, it is very important to pay attention to their mental status.13 Therefore, in the fight against the epidemic, relevant strategies for the mental health of medical personnel should also be prepared 14 : (1) Strengthen humanistic care and establish a special mental health team to conduct psychological counselling; The members of the special mental health team are mainly composed of psychiatrists in our hospital. A simple psychological self-assessment form is filled in daily by the medical staff of pediatric outpatient department. If the medical personnel with psychological problems are found, the mental health team members shall provide one-onone psychological guidance. (2) In cooperation with the psychology department of the hospital, invite professional psychologists to provide relevant lectures; Psychological lectures are held once a week, mainly including how to conduct self psychological counseling, how to deal with the panic caused by the epidemic, how to pacify the family members of children with emotional tension, etc. (3) Share positive news to prevent staff from becoming frightened; (4) Investigate the medical staffs' family status in case they have any difficulties and try helping them address their concerns. The epidemic developed extremely quickly and is very serious. Cases of infection in children are also increasing, and most cases are 4 | WU AND LI asymptomatic. A reasonable and effective prevention and control strategy is very important for disease prevention. We formulated this strategy based on previous experience and the existing diagnosis and treatment guidelines to respond to the epidemic. As the first line of defence for children with SARS-CoV-2 infection, the pediatric clinic can effectively prevent and avoid infection to allow children to grow up healthily by actively doing the important work of protection, diagnosis, transportation and psychological adjustment. For the children with positive epidemiological history, we recommend nucleic acid test whether they have symptoms or not. In addition, there will be further modifications with the increase in clinical experience and with changes in the disease. This study was supported by Natural Science Foundation of Chongqing (no. 2019ZDXM017). European Centre for Disease Prevention and Control. Cluster of pneumonia cases caused by a novel coronavirus A novel coronavirus from patients with pneumonia in China World Health Organization. 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Novel coronavirus pneumonia diagnosis and treatment plan (trial version seventh Human coronavirus in hospitalized children with respiratory tract infections: a 9-year populationbased study from Norway Evidence of a novel human coronavirus that is associated with respiratory tract disease in infants and young children Characteristics and outcomes of coronavirus infection in children: the role of viral factors and an immunocompromised state Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement Coronavirus-related nosocomial viral respiratory infections in a neonatal and paediatric intensive care unit: a prospective study Multiple risk factors of depression and anxiety in medical staffs: a cross-sectional study at the outbreak of SARS-CoV-2 in China A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units Management plan of a paediatric outpatient department during the SARS-CoV-2 epidemic The authors declare that there are no conflict of interests. XW wrote the manuscript. XL reviewed the manuscript. http://orcid.org/0000-0002-8382-6005