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

doi:10.1093/jpids/piab123

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. RowanMelania 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

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

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.

Original language	English (US)
Pages (from-to)	191-198
Number of pages	8
Journal	Journal of the Pediatric Infectious Diseases Society
Volume	11
Issue number	5
DOIs	https://doi.org/10.1093/jpids/piab123
State	Published - May 1 2022

Keywords

COVID-19
intensive care unit
pediatric
remdesivir
treatment

ASJC Scopus subject areas

General Medicine

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10.1093/jpids/piab123

Cite this

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., ... Randolph, A. G. (2022). A Description of COVID-19-Directed Therapy in Children Admitted to US Intensive Care Units 2020. Journal of the Pediatric Infectious Diseases Society, 11(5), 191-198. https://doi.org/10.1093/jpids/piab123

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 2022, 'A Description of COVID-19-Directed Therapy in Children Admitted to US Intensive Care Units 2020', Journal of the Pediatric Infectious Diseases Society, vol. 11, no. 5, pp. 191-198. https://doi.org/10.1093/jpids/piab123

@article{81c592a9fe3d4f5d97761b4d09d86e37,

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

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",

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

note = "Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2022",

month = may,

day = "1",

doi = "10.1093/jpids/piab123",

language = "English (US)",

volume = "11",

pages = "191--198",

journal = "Journal of the Pediatric Infectious Diseases Society",

issn = "2048-7193",

publisher = "Oxford University Press",

number = "5",

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TY - JOUR

T1 - A Description of COVID-19-Directed Therapy in Children Admitted to US Intensive Care Units 2020

AU - Schuster, Jennifer E.

AU - Halasa, Natasha B.

AU - Nakamura, Mari

AU - Levy, Emily R.

AU - Fitzgerald, Julie C.

AU - Young, Cameron C.

AU - Newhams, Margaret M.

AU - Bourgeois, Florence

AU - Staat, Mary A.

AU - Hobbs, Charlotte V.

AU - Dapul, Heda

AU - Feldstein, Leora R.

AU - Jackson, Ashley M.

AU - Mack, Elizabeth H.

AU - Walker, Tracie C.

AU - Maddux, Aline B.

AU - Spinella, Philip C.

AU - Loftis, Laura L.

AU - Kong, Michele

AU - Rowan, Courtney M.

AU - Bembea, Melania M.

AU - Mclaughlin, Gwenn E.

AU - Hall, Mark W.

AU - Babbitt, Christopher J.

AU - Maamari, Mia

AU - Zinter, Matt S.

AU - Cvijanovich, Natalie Z.

AU - Michelson, Kelly N.

AU - Gertz, Shira J.

AU - Carroll, Christopher L.

AU - Thomas, Neal J.

AU - Giuliano, John S.

AU - Singh, Aalok R.

AU - Hymes, Saul R.

AU - Schwarz, Adam J.

AU - Mcguire, John K.

AU - Nofziger, Ryan A.

AU - Flori, Heidi R.

AU - Clouser, Katharine N.

AU - Wellnitz, Kari

AU - Cullimore, Melissa L.

AU - Hume, Janet R.

AU - Patel, Manish

AU - Randolph, Adrienne G.

PY - 2022/5/1

Y1 - 2022/5/1

N2 - 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.

AB - 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.

KW - COVID-19

KW - intensive care unit

KW - pediatric

KW - remdesivir

KW - treatment

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DO - 10.1093/jpids/piab123

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JO - Journal of the Pediatric Infectious Diseases Society

JF - Journal of the Pediatric Infectious Diseases Society

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

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