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