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

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

Clinical picture Supportive care Antiviral treatment
Asymptomatic infection None None
Mild case:
fever and/or asthenia with upper respiratory signs, not requiring supplemental oxygen
• Paracetamol (10–15 mg/kg every 4–6 h) in case of fever > 38 °C
• Airway suction in case of obstruction
• Consider monoclonal antibodies only in the presence of risk factorsa
Moderate case:
respiratory signs/symptoms (such as cough, mild distress with polypnea) requiring supplemental oxygen with nasal cannulas or Venturi system +/−fever, difficulty in feeding, signs of dehydration
• Paracetamol in case of fever > 38 °C
• Airway suction in case of obstruction
• Oxygen therapy using nasal cannulas or facial mask with Venturi system (target oxygen saturation > 95%), refer to WHO Interim guidance
• Intravenous access, adequate fluid and caloric intake based on hydration status
• Monitor vital signs (Bedside-PEWS) [3] every 8 h (or before in case of changes in the clinical picture)
• Dexamethasone (0.1–0.2 mg/kg) or methylprednisolone (1–2 mg/kg day)
• Remdesivir (5 mg/kg/1st day than 2.5 mg/kg for 5 days)
• Dexamethasone/methylprednisolone plus Remdesivir
Severe illness:
respiratory signs/symptoms (tachypnea, labored breathing) requiring supplemental oxygen with high flow nasal cannulas or non-invasive ventilation +/− fever, systemic signs of worsening (lethargy, inability to feed/drink)
• Paracetamol in case of fever > 38 °C
• Airway suction in case of obstruction
• Oxygen therapy using high-flow nasal cannulas 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.
• Venous thromboembolism prevention: low molecular-weight heparin
• Avoid empiric antibiotic treatment if no evidence of bacterial infection (consult an infectious disease specialist or refer to hospital guidelines)
• Monitor vital signs (Bedside-PEWS) [3] every 8 h (or before in case of changes in the clinical picture)
• Dexamethasone/methylprednisolone
• Dexamethasone/methylprednisolone plus Remdesivir (available for this group of patients only within clinical trials)
Critical illness:
ARDS
Respiratory involvement requiring mechanical ventilation or extracorporeal membrane oxygenation
• Paracetamol in case of fever > 38 °C
• Airway suction in case of obstruction
• Oxygen therapy using mechanical ventilation (target oxygen saturation > 95%) or extracorporeal membrane oxygenation, refer to WHO Interim guidance
• Intravenous access, adequate fluid and caloric intake based on hydration status. Monitor urinary output.
• Venous thromboembolism prevention: low molecular-weight heparin
• Avoid empiric antibiotic treatment if no evidence of bacterial infection (consult an infectious disease specialist or refer to hospital guidelines)
• Monitor vital signs (Bedside-PEWS) [4] every 8 h (or before in case of changes in the clinical picture)
• Dexamethasone/methylprednisolone
  1. aeligibility criteria for emergency use of mAb in high-risk adolescents between 12 and 17 years of age are the presence of
  2. BMI >95th percentile for age and sex
  3. Sickle cell disease
  4. Congenital or acquired heart disease
  5. Neurodevelopmental disorders (cerebral palsy)
  6. Technological dependence (tracheostomy, gastrostomy, positive pressure ventilation (not related to Covid-19))
  7. Asthma, reactive airways or chronic respiratory disease requiring daily medical supervision