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Table 1 COVID-19 management and treatment in children, according to disease severity

From: Treatment of children with COVID-19: position paper of the Italian Society of Pediatric Infectious Disease

Clinical picture Supportive care Antiviral treatment
Asymptomatic infection None None
Mild case:
fever and/or asthenia with upper respiratory signs
None
In case of fever > 38 °C: paracetamol
None
Moderate case:
fever and/or asthenia and/or respiratory signs/symptoms, such as cough, mild distress with polypnea and/or difficulty in feeding, signs of dehydration
• Airway suction in case of obstruction
• Oxygen therapy using nasal cannulas or facial mask with Venturi system (if oxygen saturation in air < 95%)
• Intravenous access, adequate fluid and caloric intake based on hydration status
• Give paracetamol in case of fever > 38 °C
• Monitor vital signs (Bedside-PEWS )[18] every 8 h (or before in case of changes in the clinical picture)
None
Severe illness:
- SpO2 < 92% on finger pulse oximeter taken at rest
- Labored breathing (moaning, nasal flattering, sternal, clavicular and internal recesses
ribs), cyanosis, intermittent apnea
- Tachypnea, in apyrexia and absence of crying (respiratory rate > 60 breaths/minute < 3 months; > 50 breaths /minute 3–12 months; > 40 breaths /minute 1–5 years; > 30 breaths/ minute > 5 years)
- Systemic signs of worsening: lethargy, inability to feed/drink, convulsions
- Suspected sepsis
- Shock or other organ failure requiring care
• Airway suction in case of obstruction
• Oxygen therapy using nasal cannulas or facial mask with Venturi system or High Flow Nasal Cannula or Non-Invasive ventilation (target oxygen saturation > 95%), refer to WHO Interim guidance
• Intravenous access, adequate fluid and caloric intake based on hydration status. Monitor urinary output.
• Give paracetamol in case of fever > 38 °C
• Monitor vital signs (Bedside-PEWS )[18] every 8 h (or before in case of changes in the clinical picture)
• Avoid empiric antibiotic treatment if no evidence of bacterial infection (consult an infectious disease specialist or refer to hospital guidelines)
• Consider immunomodulation: methylprednisolone or interleukin inhibitors if available (Anakinra or Tocilizumab)
• Consider venous thromboembolism prevention: low molecular-weight heparin
Remdesivir
if not available
Hydroxychloroquine OR Lopinavir/ritonavir
Critical illness
ARDS
Sepsis-associated organ dysfunction
Septic shock
Coma
• Airway suction in case of obstruction
• Oxygen therapy using nasal cannulas or facial mask with Venturi system or High Flow Nasal Cannula or Non-Invasive Ventilation (target oxygen saturation > 95%). In case of mechanical ventilation refer to WHO Interim guidance
• Intravenous access, adequate fluid and caloric intake based on hydration status. Monitor urinary output.
• Give paracetamol in case of fever > 38 °C
• Monitor vital signs (Bedside-PEWS )[18] every 8 h (or before in case of changes in the clinical picture)
• Avoid empiric antibiotic treatment if no evidence of bacterial infection (consult an infectious disease specialist or refer to hospital guidelines)
• Add immunomodulation: methylprednisolone or interleukin inhibitors if available (Anakinra or Tocilizumab)
• Add venous thromboembolism prevention: low molecular-weight heparin
Remdesivir
if not available
Hydroxychloroquine OR Lopinavir/ritonavir