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

Jennifer E Schuster; Natasha B Halasa; Mari Nakamura; Emily R Levy; Julie C Fitzgerald; Cameron C Young; Margaret M Newhams; Florence Bourgeois; Mary A Staat; Charlotte V Hobbs; Heda Dapul; Leora R Feldstein; Ashley M Jackson; Elizabeth H Mack; Tracie C Walker; Aline B Maddux; Philip C Spinella; Laura L Loftis; Michele Kong; Courtney M Rowan; Melania M Bembea; Gwenn E McLaughlin; Mark W Hall; Christopher J Babbitt; Mia Maamari; Matt S Zinter; Natalie Z Cvijanovich; Kelly N Michelson; Shira J Gertz; Christopher L Carroll; Neal J Thomas; John S Giuliano; Aalok R Singh; Saul R Hymes; Adam J Schwarz; John K McGuire; Ryan A Nofziger; Heidi R Flori; Katharine N Clouser; Kari Wellnitz; Melissa L Cullimore; Janet R Hume; Manish Patel; Adrienne G Randolph; Overcoming COVID-19 Investigators

doi:10.1093/jpids/piab123

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

J Pediatric Infect Dis Soc. 2022 May 30;11(5):191-198. doi: 10.1093/jpids/piab123.

Authors

Jennifer E Schuster¹, Natasha B Halasa², Mari Nakamura^{3

4}, Emily R Levy⁵, Julie C Fitzgerald⁶, Cameron C Young⁷, Margaret M Newhams⁷, Florence Bourgeois⁸, Mary A Staat⁹, Charlotte V Hobbs¹⁰, Heda Dapul¹¹, Leora R Feldstein¹², Ashley M Jackson¹², Elizabeth H Mack¹³, Tracie C Walker¹⁴, Aline B Maddux¹⁵, Philip C Spinella¹⁶, Laura L Loftis¹⁷, Michele Kong¹⁸, Courtney M Rowan¹⁹, Melania M Bembea²⁰, Gwenn E McLaughlin²¹, Mark W Hall²², Christopher J Babbitt²³, Mia Maamari²⁴, Matt S Zinter²⁵, Natalie Z Cvijanovich²⁶, Kelly N Michelson²⁷, Shira J Gertz²⁸, Christopher L Carroll²⁹, Neal J Thomas³⁰, John S Giuliano³¹, Aalok R Singh³², Saul R Hymes³³, Adam J Schwarz³⁴, John K McGuire³⁵, Ryan A Nofziger³⁶, Heidi R Flori³⁷, Katharine N Clouser³⁸, Kari Wellnitz³⁹, Melissa L Cullimore⁴⁰, Janet R Hume⁴¹, Manish Patel¹², Adrienne G Randolph^{7

42}; Overcoming COVID-19 Investigators

Affiliations

¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.
² Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Division of Pediatric Infectious Diseases, Department of Pediatrics and Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, Massachusetts, USA.
⁴ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
⁷ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
⁸ Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁰ Division of Disease, Departments of Pediatrics and Microbiology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
¹¹ 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.
¹² COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
¹³ Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁴ Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁵ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
¹⁶ Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA.
¹⁷ Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA.
¹⁸ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.
²⁰ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.
²² Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
²³ Division of Pediatric Critical Care, Department of Pediatrics, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, USA.
²⁴ Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Health Medical Center, Dallas, Texas, USA.
²⁵ Department of Pediatrics, Division of Critical Care, University of California San Francisco, San Francisco, California, USA.
²⁶ Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.
²⁷ Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
²⁸ Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
²⁹ Division of Critical Care, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
³⁰ Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
³¹ Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut, USA.
³² Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
³³ Division of Pediatric Infectious Diseases, Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, New York, USA.
³⁴ Division of Critical Care Medicine, CHOC Children's Hospital, Orange, California, USA.
³⁵ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital and the University of Washington, Seattle, Washington, USA.
³⁶ Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio, USA.
³⁷ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan, USA.
³⁸ Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.
³⁹ Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
⁴⁰ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA.
⁴¹ Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
⁴² Departments of Anesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.

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.

Keywords: COVID-19; intensive care unit; pediatric; remdesivir; treatment.

© The Author(s) 2022. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

MeSH terms

COVID-19 Drug Treatment*
Child
Critical Illness
Hospitalization
Hospitals, Pediatric
Humans
Intensive Care Units
United States

Abstract

MeSH terms

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