Guidelines for the prevention and management of children and adolescents with COVID-19

Abstract

Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. Conclusion : This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged. What is Known: • Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated. • We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence. What is New: • The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-022-04615-4.

Recent findings on drug hypersensitivity in children

“…These patients require close monitoring, but most of them improve quickly after treatment (37). Considering the risk/benefit ratio, an international guideline published in 2022 suggested vaccination against COVID-19 for children/adolescents aged between 3 and 17 years, monitoring possible side effects after vaccination (38). One of the most common situations involving vaccine allergies is the evaluation of children with suspected food allergy (e.g., egg, milk, gelatin) (34).…”

Efficacy of N‑Acetylcysteine in Children with Moderate COVID-19: A Placebo-Controlled Randomized Clinical Trial

“…2024; 15(2): e139612. drugs such as remdesivir, systemic corticosteroids, and intravenous immunoglobulin have been utilized in hospitalized children, and several clinical trials have yielded diverse outcomes (11). Since the 1960s, Nacetylcysteine (NAC) has been used for its mucolytic effect in patients with chronic bronchitis, cystic fibrosis, and bronchiectasis (12), as well as for acute liver failure and acetaminophen overdose (13,14).…”

Evaluation of the safety profile and therapeutic efficacy of remdesivir in children with SARS-CoV-2 infection – a single-center, retrospective, cohort study

“…To date, only a few clinical practice guidelines have been developed for children with COVID-19. This is partly due to the very limited number of pediatric clinical trials of drugs used to treat COVID-19 [ 3 , 12 ]. Remdesivir was not only the first drug approved for the treatment of COVID-19 but also the first and most widely used drug in children.…”