1.
COVID-19 treatment in children: A systematic review and meta-analysis
Panda PK, Sharawat IK, Natarajan V, Bhakat R, Panda P, Dawman L
Journal of family medicine and primary care. 2021;10(9):3292-3302
Abstract
BACKGROUND Exact information about the efficacy of various medications proposed by regulatory bodies in children with COVID-19 is limited due to the lack of controlled trials in the existing literature. METHODS Different electronic databases (MEDLINE, EMBASE, Web of Science, COCHRANE CENTRAL, LitCovid, medRxiv, and bioRxiv) were searched for articles describing the management of COVID-19 cases in children with 18 shortlisted medications. Prospective/retrospective studies/case series (with at least 20 cases) reporting COVID-19 in patients aged ≤14 years were searched to collect information regarding clinical details and severity of participants, medications used, and outcome. The pooled estimate of these parameters across studies was performed using a random-effect or fixed-effect meta-analysis depending on the degree of heterogeneity. RESULTS From a total of 5794 records, 97 studies/case series (8243 patients) fulfilled the eligibility criteria and were included in this systematic review. A total of 21% children received at least one medication specifically used for COVID-19. While antivirals were used in 15.3% of children, remedesivir was the most commonly used antiviral drug in 6.2% of included children without many reports of serious adverse effects. There was a more prevalent use of anti-inflammatory medications including corticosteroids (27.8%, P = 0.01). Total 91% of severe cases described in literature in children received some anti-inflammatory medications. Among them, corticosteroids (17%) and Intravenous immune globulin (IVIG) (17.5%) were the most predominant followed by interferon (4.2%), tocilizumab (1.5%), and anakinra (0.8%). The most predominant therapy among multisystem inflammatory syndrome in children (MIS-C) cases were IVIG (81%), followed by aspirin (67%), corticosteroids (64%), inotropes (62%), and anticoagulation (56%, mostly low molecular weight heparin, LMWH). Overall mortality was only 1.3%, but when we analyzed separately including only cases with moderate and severe disease, the mortality rate was 4.6%. CONCLUSION Among pharmacological modalities, anti-inflammatory agents like corticosteroids and antivirals like remdesivir have the most promising evidence for severe cases of pediatric COVID-19. Intravenous immunoglobulin and other anti-inflammatory/immunomodulatory agents like anakinra, aspirin, and anticoagulants have important therapeutic role in cases with MIS-C. Most of the mild cases recover with conservative treatment only.
2.
THE USE OF CONVALESCENT PLASMA FOR PEDIATRIC PATIENTS WITH SARS-COV-2: A SYSTEMATIC LITERATURE REVIEW
Zaffanello, Marco Piacentini Giorgio Nosetti Luana Franchini Massimo
Transfusion and Apheresis Science. 2020;:103043-103043
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19), a severe illness leading to pneumonia, multiorgan failure, and death With this study, we performed a systematic review of the literature and ongoing clinical trials on convalescent plasma therapy in pediatric patients with COVID-19 The electronic databases Medline PubMed, Scopus, and Web Of Science were searched Also, clinical trials registries were searched for potentially eligible studies A total of 90 records were retrieved after duplicate removal Eight studies were case reports of children treated with convalescent plasma therapy (14 children, age range, 9 weeks to 18 years);5 children had a chronic disease During the hospital stay, 5 received drugs (e g , remdesivir) in addition to convalescent plasma therapy No convalescent plasma therapy-related adverse events were reported in 5 studies and 3 made no mention of adverse events Seven studies concluded that convalescent plasma therapy is or could be a useful therapeutic option;one study made no claims Only 3 of the 13 retrieved trials underway were planned exclusively for children This is the first systematic review of the literature regarding convalescent plasma therapy for COVID-19 in children We found insufficient clinical information on the safety and efficacy of convalescent plasma therapy in children Nevertheless, the positive outcomes of the few case reports published to date suggest that convalescent plasma therapy may be of potential benefit Further research with well-designed and powered clinical trials is needed