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

Author:

Schuster Jennifer E1,Halasa Natasha B2,Nakamura Mari34,Levy Emily R5,Fitzgerald Julie C6,Young Cameron C7,Newhams Margaret M7,Bourgeois Florence8,Staat Mary A9,Hobbs Charlotte V10,Dapul Heda11,Feldstein Leora R12ORCID,Jackson Ashley M12,Mack Elizabeth H13,Walker Tracie C14,Maddux Aline B15,Spinella Philip C16,Loftis Laura L17,Kong Michele18,Rowan Courtney M19,Bembea Melania M20,McLaughlin Gwenn E21,Hall Mark W22,Babbitt Christopher J23,Maamari Mia24,Zinter Matt S25,Cvijanovich Natalie Z26,Michelson Kelly N27,Gertz Shira J28,Carroll Christopher L29,Thomas Neal J30,Giuliano John S31,Singh Aalok R32,Hymes Saul R33,Schwarz Adam J34,McGuire John K35,Nofziger Ryan A36,Flori Heidi R37,Clouser Katharine N38,Wellnitz Kari39,Cullimore Melissa L40,Hume Janet R41,Patel Manish12,Randolph Adrienne G742,

Affiliation:

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

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.

Funder

United States Centers for Disease Control and Prevention

National Institutes of Health

Burroughs Welcome Fund Innovation in Regulatory Science Award

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,General Medicine,Pediatrics, Perinatology and Child Health

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