View the latest communications for KidWell Network.
Monoclonal Antibody Treatment for High Risk Patients with COVID-19
August 27, 2021
As of August 27, 2021, two anti-SARS-CoV2 monoclonal antibody products have Emergency Use Authorization (EAUs) from the Food and Drug Administration (FDA). Please see memo from Nemours Infections Diseases Division or visit the FDA website for more information. Download PDF
Prior Authorizations for RSV that Require Virology
August 12, 2021
There has been concern expressed from community providers about the increase in RSV in the community. Many practices would like to submit early prior authorizations that require virology. We have partnered with the AAP, Nemours and Sobi (our Synagis supplier) to develop the request template approval letter. We have additional details on the AAP's guidance on use of Palivizumab prophylaxis. Read More (PDF)
MIS-C Pathway Update
August 9, 2021
The multisystem inflammatory syndrome (MIS-C) workgroup has taken into consideration feedback from providers and ongoing patient presentations to update the clinical pathway.
Diagnostic changes include:
- Procalcitonin, LDH, ferritin, fibrinogen, and D-dimer have been removed. These labs are all non-specific and have not been found to be helpful in the general evaluation of MIS-C. If a patient’s clinical presentation warrants these labs, you may order them at your discretion.
- Troponin and BNP will remain in the diagnostic evaluation to help discern between other diagnoses and to pick-up subtle cardiac involvement.
- Follow-up cardiac MRI timing has been changed to 3-6 months after diagnosis.
Treatment changes include:
- All disease severities (including mild) should be treated with methylprednisolone.
- Mild disease patients should be treated with low-dose aspirin.
- Anakinra is preferred over a second dose of IVIG. Consult rheumatology for dosing guidance.
- Remdesivir has been removed as a therapy.
Binax NOW Antigen Testing Deemed Not Sensitive Enough
July 26, 2021
Recent discussion between Nemours Infectious Disease specialists and DCHN clinical leadership has called into question the sensitivity of Binax antigen testing. Data regarding the antigen testing suggest that sensitivity is not good enough to recommend continuing this method of testing given widespread availability and improved turnaround time for PCR testing. An articlethe US DHHS and CDC demonstrates a study in adults which showed sensitivity of 36% in asymptomatic patients and 64% in symptomatic patients. The Nemours ID and Lab Teams both felt strongly that Nemours primary care practices should move away from antigen testing for all respiratory viruses (which is why we also do not use these for flu or RSV either). This is especially important given the current low pre-test probability of COVID-19 in our population. The preferred option is any PCR test, including point-of-care options like cepheid or ID NOW, or send out options to Quest and LabCorp. The turnaround time for send out is quick at this time, and in the fall you can send out for Covid-19/flu/RSV PCR when appropriate. So we will be discontinuing use of the antigen testing at Nemours practices and encouraging the same at the community practices. Download PDF
Post COVID-19 Vaccine Myocarditis
July 14, 2021
As of July 10, 2021, Nemours cardiology has reported that the hospital has seen 11 cases of post-vaccine myocarditis in only 2 months. This includes some with sustained ventricular tachycardia and high levels of troponin, requiring treatment by cardiology. They believe this is now more common than MIS-C, and everyone should be aware to ask about recent COVID-19 vaccination during evaluation. Specific questions can be referred to Dr. Thacker, pediatric cardiologist at firstname.lastname@example.org. Information about the presentation, work-sup, admission criteria and treatment Read More (PDF)