COVID-19 infection in children and adolescents

Abstract

The COVID-19 pandemic has predominantly affected the adult population. The disease is less well-defined in children (≤18 years). This review summarises the current understanding of the epidemiology, clinical manifestations, and management of COVID-19 in children and adolescents. The prevalence of COVID-19 is significantly lower in children than adults, but paediatric disease is likely underdiagnosed as a result of the high numbers of asymptomatic or mild cases. Children are vulnerable to family cluster outbreaks, but are unlikely to be index cases within a household. Vertical transmission or breast milk transmission are yet to be proven. Between 10 and 90% of paediatric COVID-19 cases are asymptomatic. Symptomatic cases typically present with mild symptoms, including cough, fever and sore throat. Intensive care admission and mortality are rare. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 is a rare, but severe, newly emerging phenotype. At present, there is no specific treatment for COVID-19 in adults or children; management is usually supportive. For severe or critical disease, including paediatric multisystem inflammatory syndrome temporally associated with COVID-19, the decision to start antiviral or immunomodulatory therapy should be on a case-by-case basis; in the UK, this should be done within a clinical trial. Further research is needed into both the disease course and treatment of paediatric COVID-19.

COVID-19 Pneumonia in Children: From Etiology to Management

“…There is little reliable evidence for the utility of drugs in treating COVID-19 pneumonia in pediatric populations, and any available data to date are based on observations in adult populations. For this reason, pharmacological therapy discouraged in milder COVID-19 forms, while recommended for more severe forms; such decisions should invariably be made on a case-by-case basis (13,19,51,55,60).…”

“…-Antibiotics: Their use is discouraged unless there are signs of bacterial co-infection. The usefulness of macrolides, especially azithromycin, for their anti-inflammatory properties is also questionable (19,52,60,66). -Corticosteroids: Their routine use is discouraged; however, they should be considered in cases of PARDS, secondary haemophagocytic lymphoistiocytosis, septic shock, or concomitant asthma.…”

“…-Corticosteroids: Their routine use is discouraged; however, they should be considered in cases of PARDS, secondary haemophagocytic lymphoistiocytosis, septic shock, or concomitant asthma. In these cases, the administration of methylpredisolone at a dose of 1-2 mg/kg/day for a maximum of 4-5 days is recommended (19,52,60). -Gamma globulins: Their effectiveness is not clear.…”

“…They can be attempted in particularly severe forms of COVID-19 and in those with symptoms similar to Kawasaki disease at the dose of 2 g/kg/day for one day, 1 g/kg/day for two days or 400 mg/kg/day for five days (67,68). -Tocilizumab: This human anti-IL-6 monoclonal antibody appeared to be effective in the treatment in adults with extensive and bilateral lung involvement (60). However, recently its effectiveness has been greatly diminished to the extent that it appears not effective for preventing intubation or death in moderately ill hospitalized patients with COVID-19 (69).…”

“…However, recently its effectiveness has been greatly diminished to the extent that it appears not effective for preventing intubation or death in moderately ill hospitalized patients with COVID-19 (69). For this reason, it should be used cautiously in children: 12 mg/kg in children weighing <30 kg, 8 mg/kg (max: 800 mg) in children >30 kg, to repeat once after 12 h if no improvement (60,70).…”