BSPGHAN Updated Shielding Guidance and Advice on Returning to School for Children with Gastrointestinal, Liver and Nutritional problems

BSPGHAN Updated Shielding Guidance and Advice on Returning to School for Children with Gastrointestinal, Liver and Nutritional problems

Dear members,  

Please find:

1. BSPGHAN Updated shielding guidance and advice on returning to school for children with gastrointestinal, liver and nutritional problems and

2. BSPGHAN IBD Working Group – Coronavirus (SARS-CoV-2) and COVID-19 in children with IBD- Position Statement: Guidance for Returning to School 


Best wishes Sue Protheroe 

BSPGHAN President 

28th May 2020 

BSPGHAN Updated Shielding Guidance and Advice on Returning to School for Children with Gastrointestinal, Liver and Nutritional problems

President Update 17th May 2020:
1. BSPGHAN Award
2. Return to school -RCPCHadvice
3. ESPGHAN Parental advice
4. JAG accreditation and endoscopy recovery

BSPGHAN award
I am delighted to announce that Kwang Yang Lee has been awarded a BSPGHAN award for innovation in recognition of his significant achievements. You will be aware that Kwang Yang has redeveloped the BSPGHAN web site to offer a professional appearance, high quality illustrations and ease of navigation, giving the site the refreshment that was due. The award was also given for appreciation of the Covid Information Hub, helping members stay informed during the pandemic and for organising the regular BSPGHAN endorsed Zoom teaching for trainees. I am sure you will wish to congratulate him on this award. Please also get in touch if you can offer remote teaching e-mail webmaster@bspghan.org.uk
Thank you.

 

Principles to help paediatricians talk to children and families about returning to school.  https://www.rcpch.ac.uk/resources/covid-19-talking-children-families-about-returning-school-guiding-principles
BSPGHAN has been working in partnership with the RCPCH on Speciality specific advice to help describe those patients who may be extremely vulnerable. This advice is being coordinated with all stakeholders including NHS, Gov.uk and charitable partners.

 

ESPGHAN COVID-19 parental advice guide.

This short guide provides information and guidance for parents on gut, liver and nutritional conditions in children during the COVID-19 pandemic. Please find the parental advice guide by clicking here.

http://www.espghan.org/education/covid-19-advice-guide/

JAG accreditation: Supplementary environment guidance following the COVID-19 pandemic
This guidance provides a framework to assist endoscopy services to adapt their environment following the COVID-19 pandemic. It can be used by all endoscopy services in the UK and will be referred to during accreditation assessments. Restoration of services will vary significantly and so this guidance provides practical points for consideration locally and BSPGHAN Endoscopy Working Group is working on paediatric specific support for recovery of endoscopy services

I hope this bulletin finds you and your families in continuing good health. Looking after your mental wellbeing has never been so important.  Please don’t hesitate to get in touch if you need support during these challenging times and we can signpost you resources to support you.
Best wishes
Sue Protheroe, e-mail President@bspghan.org.uk
BSPGHAN President May 17th 2020

 

President Update 10th May 2020 Presidents update – BSPGHAN consensus statements on paediatric endoscopy recovery and EoE; Responses from Survey; • Thanks from BSPGHAN to charitable partners • Advocacy for trainees •Articles of interest

BSPGHAN is working to support recovery and restoration plans.

We are revising the list of conditions for children who should be shielded in line with what we know about the risks associated with COVID-19. This work, with the RCPCH, should provide the basis for advice on who should continue to shield once schools return. It emphasises the need for identification to be led by paediatricians/MDTs for those instances beyond a small core list of severe conditions.   

Content of todays bulletin

NEW BSPGHAN consensus statements on endoscopy recovery and management of EoE (attached and will be added to Covid Information Hub)
Survey feedback (attached)
Thanks from BSPGHAN to charitable partners
Advocacy for traineesArticles of interest
NEW Check out the BSPGHAN Covid Information Hub https://bspghan.org.uk/news/covid-information-and-guidance-information

BSPGHAN consensus statement on Paediatric endoscopy recovery and restoration during the Covid-19 pandemic May 10th 2020

  1. BSPGHAN endorses the British Society of Gastroenterology (BSG) position paper with some paediatric-specific amendments.

https://www.bsg.org.uk/covid-19-advice/bsg-guidance-on-recommencing-gi-endoscopy-in-the-deceleration-early-recovery-phases-of-the-covid-19-pandemic/

  1. The risks of transmission of SARS-CoV-2 to staff (especially those handling and cleaning the scopes) as a consequence of undertaking endoscopy are still unknown. Paediatric endoscopy takes place in a high-risk area; an anaesthetic is given by general anaesthetic (GA) or by total intravenous anaesthetic (TIVA) with laryngeal mask (LMA) which are both aerosol-generating procedures. We advise that upper and lower GI endoscopy under GA or TIVA be undertaken with level 2 PPE (FFP3 masks or respirators) until risk of transmission from faeces becomes clear. The BSG guidance acknowledges that there are other circumstances to be considered when deciding on PPE and states “It is important that consideration is given to other elements of endoscopy as well as the procedure itself. These might include but not be restricted to: use of nitrous oxide, oxygen gas (Entonox), use of nasal oxygen, administration of throat spray or enemas”
  2. Careful consideration needs to be given to the risk of exposing children and their families to a high-risk environment vs. the benefit of performing diagnostic endoscopy. The risk for staff also needs to be evaluated particularly in light of the evidence of increased risk amongst BAME colleagues. Chief Executive of NHSE, Sir Simon Stevens suggests that: “regarding people from BAME backgrounds … we recommend employers should risk assess staff at potentially greater risk and make more appropriate arrangements accordingly. Organisations should continue to assess staff who may be at increased risk including older colleagues, pregnant women, and those with underlying health conditions and make adjustments including working remotely or in a lower risk area”.
  3. BSPGHAN supports units trying to re-establish diagnostic endoscopy for suspected new IBD presentations where possible and to continue emergency endoscopy provision.
  4. Centres should adhere to the same COVID-19 screening protocols developed by their co-located adult colleagues in gastroenterology and/or the pathways developed for paediatric surgical patients undergoing urgent and elective procedures.
  5. Where possible paediatric endoscopy pathway should be in COVID-19-free areas of the hospital
  6. Please refer to Gov.uk guidance on PPE (Appendix 1)

BSPGHAN Eosinophilic Esophagitis (EoE) Working Group
Position Statement: Management of paediatric EoE during the Coronavirus outbreak.  28th April 2020

Survey Feedback: Thank you very much for your responses; the majority within the first few hours. It’s  a helpful snapshot of views while planning recovery, restoration of paused services and supporting families as the lock down eases.

Heartfelt thanks to charitable partners
BSPGHAN sent sincere thanks from all our members to the teams at CCUK, CICRA, and CLDF for their work in championing the needs of families.  They are facing a serious funding crisis at a time when we are relying on them more than ever. They work tirelessly in partnership with us to provide invaluable support and tailored family information that we have struggled to offer. They also make a massive contribution to the working life of professionals, by taking on communication strategies and campaigns. We offered a small token of financial support to thank them and show how much we appreciate their work.

Advocacy for trainees:  https://www.rcpch.ac.uk/news-events/news/advocacy-trainees-over-covid-19-pandemic

Articles of interest :
1.Challenges in chronic paediatric disease during the COVID-19 pandemic: diagnosis and management of inflammatory bowel disease in children.  https://adc.bmj.com/content/early/2020/05/07/archdischild-2020-319482 
2.COVID-19 and the gastrointestinal tract: emerging clinical data

a) 10.1% of a cohort with coronavirus–infected pneumonia presented with diarrhoea and nausea, preceding fever and respiratory symptoms by 1–2 days
b) Endoscopy – SARS-CoV-2 was detected in the oesophagus, stomach, duodenum and rectum of the two most severe patients and also in the duodenum. The implication is uncertain but raise the issue of gastrointestinal involvement and potential faeco-oral transmission,
c) Uneventful course in patients with IBD during SARS-CoV 2020 in Northern Italy – awaiting data from Espghan Porto and SECURE-IBD database.
d)The clinical importance of continued presence of RNA in the stool is uncertain and further work is required to determine risk
e) Risk of surgery during incubation period in some does start to ask the question as to whether testing prior to surgery should become routine
https://fg.bmj.com/content/early/2020/04/27/flgastro-2020-101507

3.Gastrointestinal endoscopy during COVID-19: when less is more  https://fg.bmj.com/content/early/2020/04/15/flgastro-2020-101492

Please check out the BSPGHAN website for the new Covid Information.  https://bspghan.org.uk/news/covid-information-and-guidance-information

Thanks to Carla and our webmaster Kwang Yang Lee for their amazing work.
Best wishes to you all; please stay well and in continuing good health. 

Sue Protheroe 
BSPGHAN President May 10th 2020e-mail: President@bspghan.org.uk

Consultants in Paediatric Hepatology

Closing Date: 04/06/2020

Employer: Leeds Children’s Hospital

We are looking for individuals to fill two replacement posts within the Paediatric Hepatology Department at the Leeds Children’s Hospital. One post will be available from September and the other from 1st December 2020, depending on availability of appointee. 

The Paediatric Hepatology Department in Leeds is a National Specialist Service for the assessment, diagnosis, treatment and follow-up of children who have a wide range of acute and chronic liver disease, portal hypertension, or intrahepatic lesions. 

For more information, see: https://www.jobs.nhs.uk/xi/vacancy/916041319 .

President Update 3rd May 2020

President Update 3rd May 2020

I hope this email finds you in continuing good health. 

We are taking stock while coming through a “peak ” of hospitalisations and set to enter the second phase in the NHS’s response to Covid-19
On April 29th we heard from the NHS CE and CEO about:-

  • ​Increased Covid-19 testing capacity – a pilot followed by roll out of regular testing to asymptomatic staff, guided by PHE and clinical advice.  
  • NHS to step up non-Covid19 urgent services as soon as possible with attention to infection prevention and control and start of some routine non-urgent elective care. 
  • Provisional plans to factor-in the availability of associated medicines, PPE, blood, consumables, equipment and other needed supplies.
  • Expanded winter flu vaccination campaign alongside a school immunisation ‘catch up programme’.

Now more than ever a safety and learning culture is vital. BSPGHAN has been working with the RCPCH, PHE and  NHS E this week to:- 
1. identify which patients should be recommended to still  “shield” (or stay at home with stringent social distancing) once lockdown restrictions are lifted and 
2. understand more about the impact of delayed presentations to healthcare or delayed delivery of care within our speciality
3. consider recovery and restoration plans of our routine activity for children and young people.

I would like to hear from members about these issues and what your current concerns are.  I will email out a survey monkey very soon. It should only take a few minutes to complete and I would be very grateful if you would return it straight away if possible and by Tuesday May 6th at the latest please. Thank you.

NICE Covid-19 rapid guideline: children and young people who are immunocompromised- published May 1st 2020 NICE guideline [NG174] https://www.nice.org.uk/guidance/NG174
This guideline is designed to be used alongside our professional guidance.  It aims to maximise the safety of children, protect staff from infection and enable services to make best use of resources during the pandemic. It can be updated as necessary. 

Children with a systemic inflammatory response – be aware and notify https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf
Most children are asymptomatic or exhibit mild symptoms from COVID-19 infection. However in the last two months a small number of children have been identified who develop a significant systemic inflammatory response which may be associated with COVID-19.

COVID-19 and the gastrointestinal tract: emerging clinical data https://fg.bmj.com/content/early/2020/04/27/flgastro-2020-101507
– prevalence of virus in the stool is important, impacting on endoscopy provision. 
​- clinical importance of continued presence of RNA in the stool is uncertain.
– the likelihood of faeco-oral transmission is low. 
– data on outcomes of adult patients undergoing surgeries during the incubation period of COVID-19 infection​ –  should  testing prior to surgery become routine?

Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study. https://gut.bmj.com/content/early/2020/04/30/gutjnl-2020-321411
– Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. 
– Preventing acute IBD flares in patients with IBD is important.

BSG Guiding principles on restoration of endoscopy services.   https://mailchi.mp/fb3ebe293ed0/welcome-to-the-august-edition-of-the-bsg-e-newsletter-12317385?e=12419cdbd5
– Consensus opinion and review of the available evidence.
– Some data is not yet available; some data is inconclusive: in this guidance, therefore, the safety and wellbeing of patients and staff is taken as paramount​. 

The pressure will remain in these uncertain times. Look after each other and be aware that enhanced and active support from your NHS employer is there to ensure your wellbeing and safety.

Please take a few minutes to report back in the anonymised survey. It asks about your concerns about your personal wellbeing and that of your patients as well as your answers to the questions above (1). THANK YOU. 

Best wishes
Sue
BSPGHAN President May 3rd 2020  e-mail President@bspghan.org.uk

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