From the Guidelines
COVID-19 in a 6-month-old typically presents with mild symptoms that can be managed at home with supportive care. According to the American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19 1, the vast majority of children with COVID-19 have mild symptoms. However, it is essential to monitor the infant's symptoms closely and seek medical attention immediately if they develop difficulty breathing, persistent high fever, decreased wet diapers, extreme fussiness, or inability to eat.
Some key considerations for managing COVID-19 in a 6-month-old include:
- Keeping the infant comfortable, well-hydrated, and monitoring their symptoms closely
- Giving infant acetaminophen (Tylenol) for fever or discomfort at a dose of 10-15 mg per kg of body weight every 4-6 hours as needed, but never giving aspirin or ibuprofen to infants under 6 months
- Ensuring the baby gets plenty of rest and continues feeding normally, whether breast milk or formula
- Contacting the pediatrician immediately if the baby develops any concerning symptoms, such as difficulty breathing or persistent high fever
It is also crucial to prevent transmission to others by keeping the baby isolated from other household members when possible, and caregivers should wear masks and wash hands frequently 1. Most infants recover from COVID-19 within 1-2 weeks as their immune systems, though immature, are generally effective at fighting the virus.
From the FDA Drug Label
Clinical Trials in Pediatric Subjects Study GS-US-540-5823 was a Phase 2/3, single-arm, open-label clinical trial in hospitalized subjects from birth to <18 years of age and weighing at least 1.5 kg with mild, moderate, and severe COVID-19 treated with weight-based VEKLURY (n=58) for up to 10 days Cohorts 5–7: Subjects <14 days old, GA >37 weeks, and weighing ≥2.5 kg at birth (n=1); and subjects <56 days old, GA ≤37 weeks, and weighing ≥1.5 kg at birth (n=1): Received 2. 5 mg/kg on Day 1 and 1. 25 mg/kg once daily on subsequent days. Cohort 5: Subjects 14 to <28 days old, gestational age (GA) >37 weeks, and weighing ≥2.5 kg (n=3): Received 5 mg/kg on Day 1 and 2.5 mg/kg once daily on subsequent days.
Remdesivir use in 6-month-old with COVID-19:
- The dosage for a 6-month-old patient is not explicitly stated in the provided text, but based on the information given, a patient of this age would likely fall into one of the cohorts with a dosage of 5 mg/kg on Day 1 and 2.5 mg/kg once daily on subsequent days, or 2.5 mg/kg on Day 1 and 1.25 mg/kg once daily on subsequent days, depending on their exact age and weight.
- Adverse reactions observed in pediatric subjects were consistent with those observed in adults, with the most common adverse reaction being ALT increased.
- Laboratory abnormalities (Grades 3–4) occurring in at least 3% of subjects with COVID-19 receiving VEKLURY in Trial 5823 included hemoglobin decreased, eGFR decreased, creatinine increased, and others.
- The FDA drug label does provide some information on the use of remdesivir in pediatric patients, including those as young as birth 2.
From the Research
Covid 19 in 6 Month Old Infants
- Covid 19 is typically a mild viral illness in young healthy infants with no major complications observed in the majority of cases 3
- Hospitalization may not be necessary for well-appearing infants with Covid 19, as long as their clinical and laboratory evaluations do not raise any concerns 3
- Pediatric patients generally have a milder clinical presentation of Covid 19 but can also experience more severe symptoms and post-Covid phenomena 3
Treatment and Management
- Remdesivir can be regarded as a potential therapeutic agent against Covid 19, with clinical effectiveness in shortening time to clinical recovery and hospital stay 4
- Remdesivir has been shown to improve survival and disease progression in a variety of patient populations with Covid 19 across a spectrum of disease severity and SARS-CoV-2 variant periods 5
- Remdesivir is currently the only recommended antiviral for use in hospitalized patients with Covid 19, with or without a supplemental oxygen requirement 5
Risk Stratification and Prevention
- There are identifiable clinical characteristics that enable risk stratification for patients at risk for severe Covid 19, which can be used to guide treatment and prevention 6
- Understanding the risk factors for severe illness and the evidence for safety, efficacy, and effectiveness of therapies for Covid 19 in children is necessary to optimize therapy 6