What are the supportive care guidelines for pediatric patients with Coronavirus Disease (COVID-19)?

From the Guidelines

For pediatric patients with COVID-19, supportive care is crucial to manage symptoms and prevent complications. The primary goal is to ensure adequate hydration, nutrition, and oxygenation.

Recommendations for Supportive Care

• Encouraging oral hydration with fluids like water or electrolyte-rich beverages 1, 2.
• Providing nutritional support through a balanced diet or supplements if necessary.
• Monitoring oxygen saturation and providing supplemental oxygen if levels fall below 94% on room air.
• Managing fever and pain with acetaminophen (10-15 mg/kg/dose every 4-6 hours as needed, not to exceed 75 mg/kg/day) or ibuprofen (5-10 mg/kg/dose every 6-8 hours as needed, not to exceed 40 mg/kg/day) 3, 4.
• Practicing good respiratory hygiene, including coughing into a tissue or elbow and frequent hand washing.

Hospitalization and Antiviral Therapy

For children requiring hospitalization, close monitoring of vital signs, oxygen therapy as needed, and consideration of antiviral therapy such as remdesivir (5 mg/kg on the first day, followed by 2.5 mg/kg once daily for up to 9 additional days) may be necessary under the guidance of a pediatric healthcare provider 5, 6.

Individualized Care

It's essential to note that the management of COVID-19 in pediatric patients should be individualized based on the severity of symptoms, age, and underlying health conditions, and always under the supervision of a qualified healthcare professional 1, 2.

Cardiac Life Support

In cases of cardiac arrest, pediatric basic life support algorithms should be followed, with modifications for suspected or confirmed COVID-19, including the use of personal protective equipment (PPE) and high-efficiency particulate air (HEPA) filters 1, 2.

Immunomodulatory Treatment

For pediatric patients with hyperinflammation and severe symptoms, immunomodulatory treatment such as anakinra or tocilizumab may be considered, although the evidence is still limited and the decision should be made on a case-by-case basis 3, 4.

From the FDA Drug Label

The recommended total treatment duration for hospitalized patients requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) is 10 days The recommended treatment duration for hospitalized patients not requiring invasive mechanical ventilation and/or ECMO is 5 days. If a patient does not demonstrate clinical improvement, treatment may be extended for up to 5 additional days for a total treatment duration of up to 10 days Perform hepatic laboratory testing in all patients before starting VEKLURY and while receiving VEKLURY as clinically appropriate Determine prothrombin time in all patients before starting VEKLURY and monitor while receiving VEKLURY as clinically appropriate

The supportive care guidelines for pediatric patients with Coronavirus Disease (COVID-19) include:

• Monitoring: Perform hepatic laboratory testing and determine prothrombin time before starting and during treatment with remdesivir as clinically appropriate 7
• Treatment duration: The recommended total treatment duration for hospitalized patients requiring invasive mechanical ventilation and/or ECMO is 10 days, and for hospitalized patients not requiring invasive mechanical ventilation and/or ECMO is 5 days, with the option to extend treatment for up to 5 additional days if clinical improvement is not demonstrated 7
• Dosing: The recommended dosage for pediatric patients weighing 1.5 kg to less than 40 kg is presented in Table 1 of the drug label, with loading and maintenance doses administered via intravenous infusion 7

From the Research

Supportive Care Guidelines for Pediatric Patients with COVID-19

The mainstay of management for pediatric patients with COVID-19 remains supportive care, with the goal of relieving symptoms and preventing complications 8, 9, 10, 11, 12.

• Supportive care is recommended for all patients, regardless of disease severity 9, 12.
• For patients with mild disease, supportive care alone is often sufficient 9, 12.
• For patients with severe or critical disease, additional interventions such as antiviral therapy, immunomodulatory agents, and respiratory support may be necessary 8, 9, 11.
• Prevention through vaccination is highly recommended, with several vaccines being evaluated in children and adolescents 10, 12.

Management of Severe Disease

For pediatric patients with severe or critical COVID-19, the following interventions may be considered:

• Antiviral therapy, such as remdesivir or Paxlovid 8, 9.
• Immunomodulatory agents, such as dexamethasone or tocilizumab 8, 9.
• Respiratory support, such as oxygen therapy or mechanical ventilation 11.
• Anticoagulation therapy for patients with markedly elevated D-dimer levels or superimposed clinical risk factors for hospital-associated venous thromboembolism 8.

Prevention and Complications

Prevention through vaccination is crucial in reducing the risk of COVID-19 in pediatric patients 10, 12.

• Vaccination is recommended for all pediatric patients, with several vaccines being evaluated in children and adolescents 10, 12.
• Clinicians should be aware of potential complications, such as multisystem inflammatory syndrome in children (MIS-C) and long COVID 8, 11.
• Surveillance and preventive approaches are essential in controlling the spread and mortality of COVID-19 in pediatric patients 10.