A Description of COVID-19-Directed Therapy in Children Admitted to US Intensive Care Units 2020
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.
Schuster, J. E., Halasa, N. B., Nakamura, M., Levy, E. R., Fitzgerald, J. C., Young, C. C., Newhams, M. M., Bourgeois, F., Staat, M. A., Hobbs, C. V., Dapul, H., Feldstein, L. R., Jackson, A. M., Mack, E. H., Walker, T. C., Maddux, A. B., Spinella, P. C., Loftis, L. L., Kong, M., Rowan, C. M., Bembea, M. M., McLaughlin, G. E., Hall, M. W., Babbitt, C. J., Maamari, M., Zinter, M. S., Cvijanovich, N. Z., Michelson, K. N., Gertz, S. J., Carroll, C. L., Thomas, N. J., & Giuliano, J. S. (2022). A Description of COVID-19-Directed Therapy in Children Admitted to US Intensive Care Units 2020. https://doi.org/10.1093/jpids/piab123