Guidelines for the prevention and management of children and adolescents with COVID-19

Enmei Liu; Rosalind Louise Smyth; Qinyuan Li; Amir Qaseem; Ivan D. Florez; Joseph L. Mathew; Yasser Sami Amer; Janne Estill; Quan Lu; Zhou Fu; Xiaoxia Lu; Edwin Shih Yen Chan; Jürgen Schwarze; Gary Wing Kin Wong; Toshio Fukuoka; Hyeong Sik Ahn; Myeong Soo Lee; Detty Nurdiati; Bin Cao; Wenwei Tu; Yuan Qian; Shunying Zhao; Xiaoyan Dong; Xiaoping Luo; Zhimin Chen; Guobao Li; Xiaobo Zhang; Xiaodong Zhao; Hongmei Xu; Feng Xu; Yuan Shi; Ruiqiu Zhao; Yao Zhao; Junqiang Lei; Xianlan Zheng; Mengshu Wang; Shu Yang; Xixi Feng; Liqun Wu; Zhihui He; Shihui Liu; Qi Wang; Yang Song; Zhengxiu Luo; Qi Zhou; Gordon Guyatt; Yaolong Chen; Qiu Li

doi:10.1007/s00431-022-04615-4

Guidelines for the prevention and management of children and adolescents with COVID-19

Enmei Liu, Rosalind Louise Smyth, Qinyuan Li, Amir Qaseem, Ivan D. Florez, Joseph L. Mathew, Yasser Sami Amer, Janne Estill, Quan Lu, Zhou Fu, Xiaoxia Lu, Edwin Shih Yen Chan, Jürgen Schwarze, Gary Wing Kin Wong, Toshio Fukuoka, Hyeong Sik Ahn, Myeong Soo Lee, Detty Nurdiati, Bin Cao, Wenwei TuYuan Qian, Shunying Zhao, Xiaoyan Dong, Xiaoping Luo, Zhimin Chen, Guobao Li, Xiaobo Zhang, Xiaodong Zhao, Hongmei Xu, Feng Xu, Yuan Shi, Ruiqiu Zhao, Yao Zhao, Junqiang Lei, Xianlan Zheng, Mengshu Wang, Shu Yang, Xixi Feng, Liqun Wu, Zhihui He, Shihui Liu, Qi Wang, Yang Song, Zhengxiu Luo, Qi Zhou, Gordon Guyatt, Yaolong Chen, Qiu Li

Department of Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. Conclusion: This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged.What is Known:• Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated.• We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence.What is New:• The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.

Original language	English
Pages (from-to)	4019-4037
Number of pages	19
Journal	European Journal of Pediatrics
Volume	181
Issue number	12
DOIs	https://doi.org/10.1007/s00431-022-04615-4
Publication status	Published - 2022 Dec

Keywords

Children
COVID-19
Guidelines
Management
Prevention
SARS-CoV-2

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s00431-022-04615-4

Cite this

Liu, E., Smyth, R. L., Li, Q., Qaseem, A., Florez, I. D., Mathew, J. L., Amer, Y. S., Estill, J., Lu, Q., Fu, Z., Lu, X., Chan, E. S. Y., Schwarze, J., Wong, G. W. K., Fukuoka, T., Ahn, H. S., Lee, M. S., Nurdiati, D., Cao, B., ... Li, Q. (2022). Guidelines for the prevention and management of children and adolescents with COVID-19. European Journal of Pediatrics, 181(12), 4019-4037. https://doi.org/10.1007/s00431-022-04615-4

Liu, E, Smyth, RL, Li, Q, Qaseem, A, Florez, ID, Mathew, JL, Amer, YS, Estill, J, Lu, Q, Fu, Z, Lu, X, Chan, ESY, Schwarze, J, Wong, GWK, Fukuoka, T, Ahn, HS, Lee, MS, Nurdiati, D, Cao, B, Tu, W, Qian, Y, Zhao, S, Dong, X, Luo, X, Chen, Z, Li, G, Zhang, X, Zhao, X, Xu, H, Xu, F, Shi, Y, Zhao, R, Zhao, Y, Lei, J, Zheng, X, Wang, M, Yang, S, Feng, X, Wu, L, He, Z, Liu, S, Wang, Q, Song, Y, Luo, Z, Zhou, Q, Guyatt, G, Chen, Y & Li, Q 2022, 'Guidelines for the prevention and management of children and adolescents with COVID-19', European Journal of Pediatrics, vol. 181, no. 12, pp. 4019-4037. https://doi.org/10.1007/s00431-022-04615-4

@article{5167a49b556b4d4e9b768290d4664181,

title = "Guidelines for the prevention and management of children and adolescents with COVID-19",

abstract = "Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. Conclusion: This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged.What is Known:• Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated.• We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence.What is New:• The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.",

keywords = "Children, COVID-19, Guidelines, Management, Prevention, SARS-CoV-2",

author = "Enmei Liu and Smyth, {Rosalind Louise} and Qinyuan Li and Amir Qaseem and Florez, {Ivan D.} and Mathew, {Joseph L.} and Amer, {Yasser Sami} and Janne Estill and Quan Lu and Zhou Fu and Xiaoxia Lu and Chan, {Edwin Shih Yen} and J{\"u}rgen Schwarze and Wong, {Gary Wing Kin} and Toshio Fukuoka and Ahn, {Hyeong Sik} and Lee, {Myeong Soo} and Detty Nurdiati and Bin Cao and Wenwei Tu and Yuan Qian and Shunying Zhao and Xiaoyan Dong and Xiaoping Luo and Zhimin Chen and Guobao Li and Xiaobo Zhang and Xiaodong Zhao and Hongmei Xu and Feng Xu and Yuan Shi and Ruiqiu Zhao and Yao Zhao and Junqiang Lei and Xianlan Zheng and Mengshu Wang and Shu Yang and Xixi Feng and Liqun Wu and Zhihui He and Shihui Liu and Qi Wang and Yang Song and Zhengxiu Luo and Qi Zhou and Gordon Guyatt and Yaolong Chen and Qiu Li",

note = "Funding Information: This work was supported by grants from the National Clinical Research Center for Child Health and Disorders (Children's Hospital of Chongqing Medical University, Chongqing, China) (grant number NCRCCHD-2020-EP-01), the Fundamental Research Funds for the Central Universities (grant number lzujbky-2021-ey13), and Chongqing “Bayu Scholar” program. The sponsors did not have any influence in the content of the guideline. Funding Information: We thank Dr Yu-Lung Lau and Dr Anthony Que for external review the guideline. We thank the members of evidence synthesis and evaluation group involved in the conduction of the systematic reviews (Weiguo Li, Yuyi Tang, Qianling Shi, Zijun Wang, Xingmei Wang, Ruobing Lei, Siya Zhao, Hui Liu, Xiao Liu, Meng Lv, Xufei Luo, Jiao Liu, Xiangyang Dang, Yantong Zhou, Lidan Gan, Zhili Wang, Liangqin Yi, Shuai Peng). We thank the patient representatives (Maryam Yasser Sami Amer, Jianping Peng, Lei Shi) for giving comments to the initial guideline and voting for consensus. We thank Professor Rafael Gonz{\'a}lez Cort{\'e}s, Professor Saurabh Mehta, Professor Shariful Islam, and Gilead Sciences Inc for providing us their unpublished data. We thank Dr Sayada Zartasha Kazmi for helping the panelists fill out the questionnaire and check emails. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2022",

month = dec,

doi = "10.1007/s00431-022-04615-4",

language = "English",

volume = "181",

pages = "4019--4037",

journal = "Acta Paediatrica Hungarica",

issn = "0340-6199",

publisher = "Springer Verlag",

number = "12",

}

TY - JOUR

T1 - Guidelines for the prevention and management of children and adolescents with COVID-19

AU - Liu, Enmei

AU - Smyth, Rosalind Louise

AU - Li, Qinyuan

AU - Qaseem, Amir

AU - Florez, Ivan D.

AU - Mathew, Joseph L.

AU - Amer, Yasser Sami

AU - Estill, Janne

AU - Lu, Quan

AU - Fu, Zhou

AU - Lu, Xiaoxia

AU - Chan, Edwin Shih Yen

AU - Schwarze, Jürgen

AU - Wong, Gary Wing Kin

AU - Fukuoka, Toshio

AU - Ahn, Hyeong Sik

AU - Lee, Myeong Soo

AU - Nurdiati, Detty

AU - Cao, Bin

AU - Tu, Wenwei

AU - Qian, Yuan

AU - Zhao, Shunying

AU - Dong, Xiaoyan

AU - Luo, Xiaoping

AU - Chen, Zhimin

AU - Li, Guobao

AU - Zhang, Xiaobo

AU - Zhao, Xiaodong

AU - Xu, Hongmei

AU - Xu, Feng

AU - Shi, Yuan

AU - Zhao, Ruiqiu

AU - Zhao, Yao

AU - Lei, Junqiang

AU - Zheng, Xianlan

AU - Wang, Mengshu

AU - Yang, Shu

AU - Feng, Xixi

AU - Wu, Liqun

AU - He, Zhihui

AU - Liu, Shihui

AU - Wang, Qi

AU - Song, Yang

AU - Luo, Zhengxiu

AU - Zhou, Qi

AU - Guyatt, Gordon

AU - Chen, Yaolong

AU - Li, Qiu

N1 - Funding Information: This work was supported by grants from the National Clinical Research Center for Child Health and Disorders (Children's Hospital of Chongqing Medical University, Chongqing, China) (grant number NCRCCHD-2020-EP-01), the Fundamental Research Funds for the Central Universities (grant number lzujbky-2021-ey13), and Chongqing “Bayu Scholar” program. The sponsors did not have any influence in the content of the guideline. Funding Information: We thank Dr Yu-Lung Lau and Dr Anthony Que for external review the guideline. We thank the members of evidence synthesis and evaluation group involved in the conduction of the systematic reviews (Weiguo Li, Yuyi Tang, Qianling Shi, Zijun Wang, Xingmei Wang, Ruobing Lei, Siya Zhao, Hui Liu, Xiao Liu, Meng Lv, Xufei Luo, Jiao Liu, Xiangyang Dang, Yantong Zhou, Lidan Gan, Zhili Wang, Liangqin Yi, Shuai Peng). We thank the patient representatives (Maryam Yasser Sami Amer, Jianping Peng, Lei Shi) for giving comments to the initial guideline and voting for consensus. We thank Professor Rafael González Cortés, Professor Saurabh Mehta, Professor Shariful Islam, and Gilead Sciences Inc for providing us their unpublished data. We thank Dr Sayada Zartasha Kazmi for helping the panelists fill out the questionnaire and check emails. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2022/12

Y1 - 2022/12

N2 - Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. Conclusion: This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged.What is Known:• Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated.• We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence.What is New:• The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.

AB - Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. Conclusion: This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged.What is Known:• Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated.• We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence.What is New:• The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.

KW - Children

KW - COVID-19

KW - Guidelines

KW - Management

KW - Prevention

KW - SARS-CoV-2

UR - http://www.scopus.com/inward/record.url?scp=85138085787&partnerID=8YFLogxK

U2 - 10.1007/s00431-022-04615-4

DO - 10.1007/s00431-022-04615-4

M3 - Article

C2 - 36109390

AN - SCOPUS:85138085787

VL - 181

SP - 4019

EP - 4037

JO - Acta Paediatrica Hungarica

JF - Acta Paediatrica Hungarica

SN - 0340-6199

IS - 12

ER -

Guidelines for the prevention and management of children and adolescents with COVID-19

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this