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Table 3c. Therapeutic Management of Hospitalized Children With COVID-19

Last Updated: December 28, 2022

Table 3c. Therapeutic Management of Hospitalized Children With COVID-19
Disease SeverityPanel's Recommendations
Hospitalized for COVID-19 For children aged ≥12 years admitted for COVID-19, use prophylactic anticoagulation unless contraindicated (BIII).
Does Not Require Supplemental OxygenFor children admitted for COVID-19 who are at the highest risk of progression to severe COVID-19,a consider using remdesivirb for children aged 12–17 years (CIII). There is insufficient evidence for using remdesivir in children aged 28 days to <12 years.
For children admitted for reasons other than COVID-19 who have mild to moderate COVID-19 and are at the highest risk of progression,a refer to Therapeutic Management of Nonhospitalized Children With COVID-19.
Requires Conventional OxygencUse 1 of the following options:
  • Remdesivirb (BIII)
  • Dexamethasone plus remdesivirb for children with increasing oxygen needs, particularly adolescents (BIII)
Requires Oxygen Through High-Flow Device or NIVdUse 1 of the following options:
  • Dexamethasone (BIII)
  • Dexamethasone plus remdesivirb (BIII)
For children who do not have rapid (e.g., within 24 hours) improvement in oxygenation after initiation of dexamethasone, baricitinibe or tocilizumab can be considered for children aged 12–17 years (BIII) and for children aged 2–11 years (CIII).
Requires MV or ECMOfDexamethasonef (AIII)
For children who do not have rapid (e.g., within 24 hours) improvement in oxygenation after initiation of dexamethasone, baricitinibe or tocilizumab may be considered for children aged 12–17 years (BIII) and for children aged 2–11 years (CIII).
Each recommendation in the Guidelines receives 2 ratings that reflect the strength of the recommendation and the quality of the evidence that supports it. See Guidelines Development for more information.

a For example, for children who are severely immunocompromised regardless of COVID-19 vaccination status and those who are unvaccinated and have additional risk factors for progression (see Therapeutic Management of Nonhospitalized Children With COVID-19).

b The clinical benefit of remdesivir is greatest if it is initiated within 10 days of symptom onset. Remdesivir should be given for 5 days or until hospital discharge, whichever comes first.

c Conventional oxygen refers to oxygen supplementation that is not high-flow oxygen, NIV, MV, or ECMO.

d Patients who are receiving NIV or MV at baseline and require a substantial increase in baseline support should be treated per the recommendations for patients requiring new NIV or MV.

e Tofacitinib is an alternative if baricitinib is not available (BIII).

f For children who started receiving remdesivir before admission to the ICU, the remdesivir should be continued to complete the treatment course.

 

Key: ECMO = extracorporeal membrane oxygenation; ICU = intensive care unit; MV = mechanical ventilation; NIV = noninvasive ventilation