By Elizabethe Holland Durando/Washington University School of Medicine
Indi Trehan, MD, Washington University emergency medicine and infectious diseases physician at St. Louis Children’s Hospital, was first author of guidelines for treating children with Ebola virus that were published Jan. 8 in The Journal of Pediatrics. Dr. Trehan and his co-authors believe the protocol will provide a basis for treating children during future outbreaks. They suggest an aggressive approach that includes giving children fluids intravenously, treating other possible infections, feeding them highly fortified food, and greatly increasing the amount of bedside care they receive.
“We know Ebola is going to come back,” says Dr. Trehan. “But the next time an Ebola treatment unit 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.”
Dr. Trehan and his co-authors treated Ebola patients during the winter of 2015 at what was then the busiest Ebola treatment unit (ETU) in Port Loko, Sierra Leone. The 106-bed ETU was run by the Sierra Leone Ministry of Health in collaboration with Partners in Health, a Boston-based nonprofit organization that works to strengthen health systems in poverty-stricken areas.
The team examined emerging literature and case reports regarding the ongoing outbreak, adapted World Health Organization and Doctors Without Borders guidelines from previous viral hemorrhagic fever outbreaks, compared notes with colleagues throughout Sierra Leone, and pulled from their own clinical experiences to shape a protocol they felt would be effective and feasible. When resources and manpower allowed, the team applied as much of the protocol as they could, including:
- Two IVs per patient to administer fluids before the patients’ veins could collapse.
- Boosting young patients’ electrolytes, targeting other possible infections with antibiotics and antimalarial medication, and providing medicine to reduce vomiting and diarrhea.
- Increasing the use of ready-to-use therapeutic foods.
- Ensuring the unit was manned 24 hours a day.
Further recommendations include future ETUs having pressure bags that allow for IV fluids to be administered faster and ultrasound machines to help obtain access to veins and determine whether patients are hydrated.