Clinical care of children and adolescents with COVID‐19: recommendations from the National COVID‐19 Clinical Evidence Taskforce

Abstract

Introduction The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID‐19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS‐TS). Recognising the distinct needs of this population, the National COVID‐19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID‐19 and COVID‐19 complications. Living guidelines mean that these evidence‐based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. Main recommendations To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID‐19 and for the management of PIMS‐TS. Changes in management as a result of the guidelines The Taskforce currently recommends corticosteroids as first line treatment for acute COVID‐19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non‐invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS‐TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS‐TS. The latest updates and full recommendations are available at http://www.covid19evidence.net.au.

Clinical care of children and adolescents with COVID ‐19: recommendations from the National COVID ‐19 Clinical Evidence Taskforce

“…in reply : We read with interest the letter by Crighton and colleagues 1 addressing our recently published recommendations 2 and highlighting the need for anticoagulation guidance in children and adolescents with coronavirus disease 2019 (COVID‐19)‐related illness. The National COVID‐19 Clinical Evidence Taskforce (NC19CET) follows a living guideline model and continually reviews emerging evidence as well as addressing new topics and clinical questions from panel members, organisations and the general public.…”

“…An additional layer of complexity is the evolving nature of the COVID‐19 pandemic, with new variants, treatments and vaccination options raising additional issues regarding the applicability of earlier findings 2 to guide current decisions. As highlighted in the letter, we monitor with particular interest emerging observational studies in our local context.…”

Characteristics and conflicting recommendations of clinical practice guidelines for COVID-19 management in children: A scoping review

“…1 ). These CPGs were developed by the American College of Rheumatology (ACR) [ 18 ], Spanish Pediatric Association (AEP) [ 19 ], National Institutes of Health (NIH) [ 20 ], Swiss Society of Intensive Care Medicine and the Pediatric Infectious Diseases Group of Switzerland (SSICM and PIGS) [ 21 ], and the Australian National Health and Medical Research Council (NHMRC) [ 22 ].

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Pediatric lower respiratory tract infection: Considerations for the anesthesiologist

“…Intravenous corticosteroids, immunoglobulin, aspirin, thromboprophylaxis, and anti‐viral medication should be considered in pediatric inflammatory multisystem syndrome (PIMS‐TS). PIMS‐TS should be managed within a multidisciplinary team 17‐19 …”