Carolinas Hospital System issued the following announcement on February 14.
More than 11 million children have contracted COVID-19 during the course of the pandemic, making up over 18% of all COVID-19 cases, according to the American Academy of Pediatrics (AAP). That percentage has ticked yet higher during the Omicron surge.
The vast majority of children do not experience severe symptoms, but a small percentage will go on to develop severe, sometimes life-threatening, illness and require intensive care, according to Elizabeth Mack, M.D., division chief of Pediatric Critical Care Medicine at MUSC and a spokeswoman for the AAP.
“Thankfully most children’s bodies are resilient, and they won’t end up in the ICU,” she said. Although there are few severe COVID-19 cases in children, those who do end up needing intensive care are “somebody’s everything,” said Mack.
"People think that there are a lot of options, but there aren’t, whether it is because they are not studied, the data is not there or there are scarce resources.”
-- Dr. Elizabeth Mack, division chief, Pediatric Critical Care Medicine
For children with severe disease treated in the pediatric intensive care unit, the choice of treatment is limited. In the absence of therapies approved for pediatric use, doctors rely on treatments approved in adults for the sickest of children.
“People think that there are a lot of options, but there aren’t,” said Mack, “whether it is because they are not studied, the data is not there or there are scarce resources.”
To obtain insight into how therapies are being used in children, the Overcoming COVID-19 study team analyzed data from children receiving intensive care in its 43 participating pediatric hospitals. Mack led the MUSC site. The study’s findings are published in the Journal of the Pediatric Infectious Diseases Society.
The study found that more than half of the children with life-threatening COVID-19 received some type of COVID-19 directed therapies, the most common being steroids and remdesivir. Mack explained that these two therapies had significant positive data in adult clinical trials and were accessible when treating life-threatening COVID-19 cases in children. Also, the data showed that therapies were most commonly used in children between 13 and 17 years old and were used in 80% of children with at least one preexisting condition, such as obesity, diabetes or asthma. Those conditions put children at higher risk of developing severe disease.
Although various COVID-19 directed therapies have been approved for adults, they have not been as well studied in children. That’s because it’s much harder to recruit for pediatric clinical trials of any therapy, including those for COVID-19.
Dr. Elizabeth Mack, division chief of Pediatric Critical Care Medicine, in the ICU
As a result, even outside of a pandemic, doctors frequently have to treat children off-label, using drugs approved for adults but not for children.
“In pediatrics, treating off-label is our bread and butter,” said Mack. “About one third of the therapies that are used in children are off-label.”
Without such “off-label” use of drugs that have been shown to be effective in clinical trials in adults, critically ill children would have far fewer treatment options.
“Pediatricians have known for decades that prevention strategies, such as vaccines, are the best medicine.”
-- Dr. Elizabeth Mack
The Overcoming COVID-19 study has been crucial to understanding the impact of COVID-19 in children and evaluating prevention and treatment strategies. The study team collects data on the severity of illness in these children, their vitals, what kinds of tests they had done, how they were treated and how they responded. Since there are not as many clinical trials in children as in adults, this type of national collaborative effort provides a large population of patients to study and serves as “a nice surrogate in the absence of trials,” said Mack.
While this study provides valuable data on COVID-19 therapies in children, Mack emphasizes the importance of preventing COVID-19 in the first place.
“Pediatricians have known for decades that prevention strategies, such as vaccines, are the best medicine.”
Reference
Jennifer E Schuster, Natasha B Halasa, Mari Nakamura, et al; Overcoming COVID-19 Investigators, A description of COVID-19-directed therapy in children admitted to US intensive care units 2020, Journal of the Pediatric Infectious Diseases Society, 2022; https://doi.org/10.1093/jpids/piab123
About the Author
Maxwell Cook
Maxwell Cook is a Ph.D. student and science communications intern at MUSC's College of Graduate Studies. He is interested in neurodegenerative research and works in Dr. Gavin Wang's lab.
Keywords: COVID-19, Pediatrics, Research
Original source can be found here.
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