Guidelines endorsed by RCPCH - Intensive care medicine

The College reviews high quality guidelines and standards produced and published by other organisations against the RCPCH Standards for Endorsement. We believe the following publications will be of interest to paediatricians working in intensive care medicine.

On this page:

Endorsed guidelines

Antibiotics for Early Onset of Neonatal Infection (NICE NCC-WCH)

This clinical guideline offers evidence-based advice on the use of antibiotics to prevent and treat early-onset neonatal infection (infection with onset within 72 hours of birth). It includes a review of the risk factors for infection, clinical indicators of possible infections and investigation before starting antibiotics. The guideline covers recommendations about choice of antibiotics, duration of course and therapeutic monitoring.  
 
This guideline is particularly relevant to healthcare professionals who work within the acute and primary healthcare sectors who have direct contact with postnatal women and their babies, those responsible for commissioning and planning healthcare services, public health and trust managers and women who have recently given birth, their partners, families and other carers.
 
RCPCH Notes:
 
This national clinical guidance is very welcomed. The guideline presents recommendations for practice within the limit of current evidence. Much of the guideline is consistent with current practice and many elements of good practice are highlighted. However, There is a lack of evidence for some of the recommendations which have therefore been reached by consensus expert opinion.
 
Date of Publication: August 2012
Date of Endorsement: August 2012 (badged September 2014)
 
Full Guideline (PDF, 172KB, 39 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE QS)

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

This quality standard covers the diagnosis and management of children and young people (younger than 16 years) with bacterial meningitis or meningococcal septicaemia.

Date of Publication: June 2012
Date of Endorsement: July 2012

Full quality standard (PDF, 257KB, 50 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE CG)

The guideline covers the diagnosis and management of bacterial meningitis and meningococcal septicaemia in children and young people under 16 years in primary and secondary care.

The guideline is accompanied by a quick reference guide, parent/carer version, audit tools and algorithms.

RCPCH notes:

Please note that since publication of the guideline:

  • NICE have updated the quick reference guide to reflect the action required when meningococcal meningitis is confirmed in children older than 3 months. Please see the NICE website for further information.
     
  • Recommendation 1.4.45 has been amended from:

    'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 0.25mg/m2 four times daily) should be used only when directed by a paediatric intensivist.'

    To:

    'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 25mg/m2) four times daily) should be used only when directed by a paediatric intensivist.'

Date of Publication: June 2010
Date of Endorsement: June 2010

Full guideline (PDF, 5.90MB, 275 Pages)
NICE guideline (Revised) (PDF, 294KB, 45 Pages)
Press release (PDF, 47KB, 6 Pages)
 

Children Presenting with Acute Breathing Difficulties (PAERG)

The guideline aims to provide clinicians with recommendations for the management of children presenting with acute breathing difficulties based on the available evidence. It also aims to promote consistency of care of patients with similar clinical problems and to guide the decision-making process of junior doctors seeing the majority of patients in the first instance.

RCPCH notes: This guideline is due for review by the Paediatric Accident and Emergency Research Group.

Date of Publication: January 2002
Date of Endorsement: December 2002

Full guideline (PDF, 943KB, 112 Pages)
 

Fractures (complex): assessment and management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected complex facture. 
 
Two of the five guidelines in the NICE Trauma Suite relate to fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.
 
This guideline covers assessing and managing pelvic fractures, open fractures and severe ankle fractures (known as pilon fractures and intra-articular distal tibia fractures) in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. It aims to reduce deaths and long-term health problems by improving the quality of emergency and urgent care.
 
The key clinical issues that are covered are as follows:
  • Initial triage by pre-hospital care provider
  • Initial assessment and management by pre-hospital care provider
  • Acute stage clinical assessment
  • Acute stage imaging assessment
  • Timing of referral and criteria for acceptance
  • Initial management and treatment plan
  • Ongoing management
  • Skills to be present within the multidisciplinary team
  • Documentation of clinical assessments and management for people with complex fracture
  • Information and support needs of patients and their families and carers where appropriate.
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,191KB, 278 Pages) 
NICE Clinical Guideline (PDF, 117KB, 18 Pages)
 

Fractures (non-complex): assessment and management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected non-complex facture. 
 
Two of the five guidelines in the NICE trauma suite relate to fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.
 
This guideline covers assessing and managing non-complex fractures that can be treated in the emergency department or orthopaedic clinic. It aims to improve practice so that people with fractures receive the care that they need without unnecessary tests and treatments.
 
The key clinical issues that are covered are as follows:
  • Assessment tools for initial triage
  • Acute-stage imaging assessment
  • Initial management and treatment plan
  • Ongoing management
  • Follow-up clinics
  • Skills to be present within the multidisciplinary team
  • Documentation of clinical assessments and management for people with fractures
  • Information and support needs of patients and their families and carers when appropriate.
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,577KB, 295 Pages) 
NICE Clinical Guideline (PDF, 111KB, 16 Pages)
 

Intravenous fluid therapy in children and young people in hospital (NICE QS)

This quality standard covers the management of intravenous (IV) fluids in term neonates (babies born at term or born prematurely with a corrected age of term or more), children and young people under 16 years. 
 
It covers IV fluids used for a range of conditions and in different hospital settings. It does not cover term neonates, children and young people with condition-specific IV fluid needs, because they are under the care of specialists due to their specific needs.
 
The quality standard is expected to contribute to improvements in the following outcomes: 
patient safety incidents resulting from errors in IV fluid therapy. 
length of hospital stay. 
children’s and young peoples’ experience of inpatient services. 
mortality resulting from errors in IV fluid therapy. 
 
Date of Publication: September 2016
Endorsed on: October 2016
 
Full Quality Standard (PDF, 162KB, 34 Pages)
 

Intravenous fluid therapy in children and young people in hospital (NICE CG)

Correct fluid and electrolyte balance is essential to maintain normal physiological function in humans. Normally, children are able to maintain their fluid requirements through drinking. However, many children admitted to hospital may be too ill to drink and may require intravenous (IV) fluid therapy to maintain correct fluid and electrolyte balance. 
 
Children may need IV fluids to account for losses of red blood cells, plasma, water or electrolytes, beyond the usual losses in urine, stools and sweat. These losses can occur via the loss of blood, plasma and other fluids resulting from burns, diarrhoea, vomiting or leakage of fluid from the circulation into the interstitial space. In these situations, the aim is to replace any depleted fluids and restore associated electrolyte imbalances. 
 
This clinical guideline contains recommendations about general principles for managing intravenous (IV) fluids in children and young people under 16 years, and aims to help prescribers understand the:
  • indications for IV fluid therapy
  • reasons for the choice of the various fluids available
  • prevention and treatment of sodium imbalance
  • principles of assessing fluid balance
  • training and education needs of those prescribing IV fluids.
Date of Publication: December 2015
Endorsed on: February 2016
 
NICE clinical guideline (PDF, 142KB, 33 Pages) 
NICE full clinical guideline (PDF, 1,421KB, 33 Pages)
 

Major trauma: assessment and initial management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected major traumatic injury. 
 
This guideline covers the rapid identification and early management of major trauma in pre-hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by improving the quality of their immediate care. It does not cover care for people with burns.
 
The key clinical areas covered are as follows:
  • Airway management
  • Pre-hospital management of chest trauma
  • Hospital management of chest trauma
  • Management of haemorrhage
  • Management of shock
  • Heat loss
  • Pain management
  • Documentation and transfer of information
  • Information and support
  • Skills to be present in the multidisciplinary team. 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,829KB, 330 Pages) 
NICE Clinical Guideline (PDF, 127KB, 21 Pages)
 

Major trauma: service delivery (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a major traumatic injury or a suspected major traumatic injury. 
 
This guideline covers the organisation and provision of major trauma services in pre-hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by providing a systematic approach to the delivery of major trauma care. It does not cover services for people with burns.
 
The key service areas are:
  • Access to services
  • Appropriate destination
  • Continuity of care
  • Documentation and transfer of information
  • Audit
  • Provision of information
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 2,361KB, 203 Pages) 
NICE Clinical Guideline (PDF, 147KB, 20 Pages)
 

Management of Invasive Meningococcal Disease in Children and Young People (SIGN)

This guideline covers best practice in the recognition and management of meningococcal disease in children and young people up to 16 years of age.

The guideline is accompanied by a quick reference guide and information for parents and carers and includes key audit criteria,

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The recommendation that "parenteral antibiotics (either benzylpenicillin or cefotaximine) should be administered in children as soon as IMD is suspected and not delayed pending investigations" is a Grade D recommendation and based upon expert opinion. Evidence from a systematic review by Hahne et al suggested that the use of parenteral antibiotics is inconsistent and that results are inconclusive. SIGN have amended the guideline to include this reference; however, the grading has not been altered as the recommendation is in line with advice from the Health Protection Agency.

Date of Publication: May 2008
Date of Endorsement: April 2009

Full guideline (PDF, 572KB, 53 Pages)
Quick reference guide (PDF, 181KB, 2 Pages)
Key messages (PDF, 537KB, 25 Pages) 
 

Management of the Child with a Decreased Conscious Level (PAERG)

The scope of the guideline includes children aged 0-18 years who have a decreased conscious level and are being reviewed in a hospital setting. Decreased conscious level is defined as a modified Glasgow coma score less than 14, or being unresponsive only to voice or being unresponsive on the AVPU scale.

The guideline does not apply to pre-term infants on a NICU or full term infants with a decreased conscious level from birth onwards.

Also, the guideline does not apply to children with a previously diagnosed condition that is known to cause the decreased conscious level.

The guideline is accompanied by a quick reference algorithm, guide to implementation and audit criteria.

Date of Publication: November 2005
Date of Endorsement: October 2006

Full guideline (PDF, 594KB, 88 Pages)
Recommendations summary (PDF, 442KB, 59 Pages)
 

Organ Donation for Transplantation (NICE)

This guideline recognises the complexities that arise owing to the majority of potential adult and paediatric organ donors lacking the capacity to be directly involved in decision making at the time of their death. It covers strategies for improving donor identification and consent rates for deceased organ donation.

RCPCH notes:

The College asks members to note that:

  • There are few data on the validity of trigger tools in paediatric practice. NICE’s response to this comment is as follows: ‘The GDG made their decisions using the best available evidence, and where this was not available or lacking, the GDG based their recommendations on their clinical experience.’ It should be noted that NICE has deemed the best evidence from studies investigating conversion of patients displaying clinical triggers into organ donors is of very low quality.
  • Explicit reference to contraindications to donation from a paediatric perspective is not covered by the guideline.  This is because the GDG agreed that contraindications should not be included due to the rapid pace at which changes to contraindications occur particularly in paediatric patients.

Date of Publication: December 2011
Date of Endorsement: February 2012

Full guideline (PDF, 168KB, 28 Pages)
Appendices
 

Pressure ulcers: prevention and management of pressure ulcers (NICE)

Pressure ulcers are caused when an area of skin and the tissues below are damaged as a result of being placed under pressure sufficient to impair its blood supply. Typically they occur in a person confined to bed or a chair by an illness and as a result they are sometimes referred to as 'bedsores', or 'pressure sores'.
 
This guideline offers best practice advice on the care of people with pressure ulcers. 
 
Date of Publication: April 2014
Endorsed on: October 2015
 
Full Guideline (PDF, 233KB, 38 Pages) 
 

Pressure ulcers (NICE)

Pressure ulcers are caused when an area of skin and/or the tissues below are damaged as a result of being placed under sufficient pressure or distortion to impair its blood supply. Typically they occur in a person confined to a bed or a chair most of the time by an illness; as a result they are sometimes referred to as 'bedsores', or 'pressure sores'.
 
This quality standard covers the prevention, assessment and management of pressure ulcers in all settings, including hospitals, care homes with and without nursing and people’s own homes. It covers people of all ages: neonates, infants, children, young people and adults (including older people).
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • incidence of category 2 pressure ulcers
  • incidence of category 3 pressure ulcers
  • incidence of category 4 pressure ulcers
  • health-related quality of life
  • length of hospital stay
  • discharge destination 
Date of Publication: June 2015
Endorsed on: July 2015
 
Full quality standard (PDF, 228KB, 54 Pages)
 

Recognition and Assessment of Acute Pain in Children (RCN)

This guideline updates the Royal College of Nursing (RCN) guideline 'Assessment of Acute Pain in Children' (2001). The guideline covers the recognition of acute pain in children, as well as the assessment of acute pain using scales and other tools in children with and without cognitive impairment. It provides recommendations based upon the best available evidence.

The guideline is accompanied by a quick reference guide and poster, and includes implementation advice.

The RCPCH believes that the update of this guideline is extremely valuable. However, the College believes that it would be worthwhile to consider cross-cultural and ethnicity issues in a future update of the guideline.

Date of Publication: September 2009
Date of Endorsement: July 2009

Full guideline (PDF, 3.06MB, 74 Pages)
 

The diagnosis of death by neurological criteria (DNC) in infants less than two months old

This report provides recommendations on the diagnosis of death by neurological criteria (DNC) in infants from 37 weeks corrected gestation (post menstrual) to two months (post term) of age.

By request of the Academy of Medical Royal Colleges (AoMRC), the RCPCH has updated the report, Diagnosis of brain stem death in infants and children: a working party report by the British Paediatric Association, which was published in 1991 by the British Paediatric Association (currently RCPCH).

This report is aimed at UK paediatric and neonatal healthcare staff working with infants under two months of age. They are not applicable to pre term infants less than 37 weeks corrected gestation (post menstrual) age or infants older than two months post term. 

For infants older than two months the 2008 AoMRC ‘A Code of Practice for the Diagnosis and Confirmation of Death’ recommendations continue to apply.

Date of Publication: April 2015
Date of Endorsement: March 2015 

More about the diagnosis of death by neurological criteria (DNC) in infants less than two months
 

The management of children and young people with an acute decrease in conscious level (2015 Update) (RCPCH)

This guideline aims to give clinicians working acutely a framework to aid the timely and safe care of children and young people (aged four weeks to 18 years) presenting with a decreased conscious level of unknown cause.
 
The first guideline for 'The Management of Decreased Conscious Level' was published in 2005. Since, there have been changes in the demographics of the children and young people presenting to emergency settings with a decreased conscious level. 
 
Consistent with the previous guideline, this version emphasises the importance of managing this condition in a standard manner from first presentation to health services, to ensure the best outcome for patients and their families.
 
The continuing support of the National Reye's Syndrome Foundation UK (NRSF-UK) has allowed the work required to update the guideline.
 
Date of Publication: April 2015
Date of Endorsement: February 2015
 

Spinal injury: assessment and initial management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with suspected spinal column or spinal cord injury secondary to a traumatic event. 
 
This guideline covers the assessment and early management of spinal column and spinal cord injury in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. It covers traumatic injuries to the spine but does not cover spinal injury caused by a disease.It aims to reduce death and disability by improving the quality of emergency and urgent care.
 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,363KB, 247 Pages) 
NICE Clinical Guideline (PDF, 120KB, 22 Pages)
 

Transition from children’s to adults' services for young people using health or social care services (NICE)

Transition occurs during the period when young people and their families are thinking about their hopes for the future. If people are likely to have care and support needs when they are 18, they need information and advice so that they can make the necessary plans. Despite this, there is evidence that the transition process is variable, with previous good practice guidance not always being implemented.
 
This clinical guideline focuses on young people passing through transition to adult services with health and/or social care needs. 
 
It covers the period before, during and after a young person moves from children's to adults' services, and aims to help young people and their carers have a better experience of transition by improving the way it’s planned and carried out.
 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 1,710KB, 218 Pages)
NICE Clinical Guideline (PDF, 173KB, 31 Pages) 
 

Supported

Surgical Site Infections (NICE)

This guideline covers the prevention and treatment of surgical site infection in adults and children undergoing surgical incisions through the skin, including minimal invasive surgery.
 
The guideline is accompanied by a costing report, slide set, quick reference guide, parent/carer version and audit support and includes audit criteria.
 
Date of publication: October 2008
Date affirmed: September 2009
 
Full guideline (PDF, 5.9 MB, 168 Pages)
NICE guideline(PDF, 213 KB, 28 Pages)
 
RCPCH Comments:
The RCPCH welcomes the publication of this guideline but asks Members to note the following:
  • The guideline presents recommendations relating to the prevention and treatment of surgical site infection, however the Guideline Development Group did not include paediatric representation