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

Last Updated: August 8, 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).
Rating of Recommendations: A = Strong; B = Moderate; C = Weak
Rating of Evidence: I = One or more randomized trials without major limitations; IIa = Other randomized trials or subgroup analyses of randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion