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Master of Public Health

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

AUTHORS

Schuster JE , Halasa NB , Nakamura M , Levy ER , Fitzgerald JC , Young CC , Newhams MM , Bourgeois F , Staat MA , Hobbs CV , Dapul H , Feldstein LR , Jackson AM , Mack EH , Walker TC , Maddux AB , Spinella PC , Loftis LL , Kong M , Rowan CM , Bembea MM , McLaughlin GE , Hall MW , Babbitt CJ , Maamari M , Zinter MS , Cvijanovich NZ , Michelson KN , Gertz SJ , Carroll CL , Thomas NJ , Giuliano JS , Singh AR , Hymes SR , Schwarz AJ , McGuire JK , Nofziger RA , Flori HR , Clouser KN , Wellnitz K , Cullimore ML , Hume JR , Patel M , Randolph AG , , . Journal of the Pediatric Infectious Diseases Society. 2022 1 12; ().

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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