NYMC Faculty Publications

A Description of COVID-19-Directed Therapy in Children Admitted to US Intensive Care Units 2020

Jennifer E. Schuster, Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.
Natasha B. Halasa, Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Mari Nakamura, Division of Pediatric Infectious Diseases, Department of Pediatrics and Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, Massachusetts, USA.
Emily R. Levy, Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Julie C. Fitzgerald, Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Cameron C. Young, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Margaret M. Newhams, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Florence Bourgeois, Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Mary A. Staat, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Charlotte V. Hobbs, Division of Disease, Departments of Pediatrics and Microbiology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Heda Dapul, Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, New York, USA.
Leora R. Feldstein, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Ashley M. Jackson, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Elizabeth H. Mack, Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Tracie C. Walker, Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Aline B. Maddux, Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
Philip C. Spinella, Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA.
Laura L. Loftis, Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA.
Michele Kong, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Courtney M. Rowan, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.
Melania M. Bembea, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Gwenn E. McLaughlin, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.
Mark W. Hall, Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
Christopher J. Babbitt, Division of Pediatric Critical Care, Department of Pediatrics, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, USA.
Mia Maamari, Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Health Medical Center, Dallas, Texas, USA.
Matt S. Zinter, Department of Pediatrics, Division of Critical Care, University of California San Francisco, San Francisco, California, USA.
Natalie Z. Cvijanovich, Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.
Kelly N. Michelson, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Shira J. Gertz, Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
Christopher L. Carroll, Division of Critical Care, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
Neal J. Thomas, Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
John S. Giuliano

Author Type(s)

Faculty

DOI

10.1093/jpids/piab123

Journal Title

Journal of the Pediatric Infectious Diseases Society

First Page

191

Last Page

198

Document Type

Article

Publication Date

5-30-2022

Department

Pediatrics

Abstract

BACKGROUND: It is unclear how acute coronavirus disease 2019 (COVID-19)-directed therapies are used in children with life-threatening COVID-19 in US hospitals. We described characteristics of children hospitalized in the intensive care unit or step-down unit (ICU/SDU) who received COVID-19-directed therapies and the specific therapies administered. METHODS: Between March 15, 2020 and December 27, 2020, children <18 years of age in the ICU/SDU with acute COVID-19 at 48 pediatric hospitals in the United States were identified. Demographics, laboratory values, and clinical course were compared in children who did and did not receive COVID-19-directed therapies. Trends in COVID-19-directed therapies over time were evaluated. RESULTS: Of 424 children in the ICU/SDU, 235 (55%) received COVID-19-directed therapies. Children who received COVID-19-directed therapies were older than those who did not receive COVID-19-directed therapies (13.3 [5.6-16.2] vs 9.8 [0.65-15.9] years), more had underlying medical conditions (188 [80%] vs 104 [55%]; difference = 25% [95% CI: 16% to 34%]), more received respiratory support (206 [88%] vs 71 [38%]; difference = 50% [95% CI: 34% to 56%]), and more died (8 [3.4%] vs 0). Of the 235 children receiving COVID-19-directed therapies, 172 (73%) received systemic steroids and 150 (64%) received remdesivir, with rising remdesivir use over the study period (14% in March/April to 57% November/December). CONCLUSION: Despite the lack of pediatric data evaluating treatments for COVID-19 in critically ill children, more than half of children requiring intensive or high acuity care received COVID-19-directed therapies.

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