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11. Paediatric care and access
At a clinical attack rate of 50%, some 5.9 million children under 16 years old will be affected by pandemic influenza; approximately 750,000 of these will be under 5 years old. The two age groups in which the severity of the illness was greatest in the most recent pandemic were those under the age of five and those over the age of 50. 53
The current UK pandemic influenza provisional clinical management guidelines 54 clearly set out paediatric physiological variables for monitoring clinical progress. It also suggests points at which access to primary, secondary and critical care services is indicated for influenza-like illness during a pandemic. However, the current clinical guidelines take no account of the potential impact the pandemic will have on the provision of primary and secondary healthcare services. A clinical algorithm to guide the prescription of antiviral medication to paediatric and adult patients with influenza in the community is being developed for use with the National Flu Line Service. This is designed to decrease the burden on the primary healthcare services.
The provision of paediatric critical care has been centralised within regions. This model of service requires the transport of children from less specialised institutions by specialist retrieval teams. Given the existing number of beds, it is likely that the demand for paediatric critical care will outstrip capacity. General hospitals may be able to provide some high-dependency and critical care services, working closely with their general-trained anaesthetic colleagues. Local arrangements for providing this service to children should be explored before a pandemic occurs and should form part of local surge plans. In these circumstances, regional paediatric intensivists should provide clinical support and advice at a distance, as resources allow.
In the pre-pandemic period, links between general hospitals and paediatric intensive care units should be strengthened, training needs should be identified and training packages should be developed and provided. Information and training packages will be available via the Paediatric Intensive Care Society website ( www.ukpics.org) and the Children's Acute Transport Service website ( www.cats.nhs.uk).
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