Managing acute COVID-19 in immunocompromised pediatric patients

ABSTRACT

Introduction

SARS-CoV-2 infection is a potentially life-threatening infection in immunocompromised pediatric patients, and its management has rapidly evolved during the pandemic. To control SARS-CoV-2 infection over time, the scenario changed for the better with the introduction of specific treatments such as antiviral drugs, vaccines, and monoclonal antibodies, together with drugs blocking the inflammatory cytokine cascade and improvements in supportive care.

Areas covered

This paper discusses the therapeutic strategies to apply for patients affected by COVID-19 in the pediatric population, with a focus on the immunocompromised patients.

Expert opinion

Treatment in pediatric patients retraces the therapies investigated and approved in adults and must be calibrated on the basis of the severity of the infection (anti-spike monoclonal antibody, antivirals, anti-inflammatory drugs, and immunomodulators). Transmission prevention policies and vaccination reduce the risk of infection, while early intervention in the immunocompromised patients at high-risk of progression to severe-critical COVID-19 may reduce the period of viral shedding and the need for hospitalization, intensive care admission, and death. In hemato-oncological patients, the delayed treatment of SARS-CoV-2 infection or COVID-19 disease represents a frequent complication and its impact on the patient outcome remains a matter of research for the next few years.

KEYWORDS:

• Anti-SARS-CoV-2 monoclonal antibodies
• children
• COVID-19
• remdesivir
• vaccination

Article highlights

• SARS-CoV-2 infection can be severe or life-threatening in immunocompromised pediatric patients.

• To date, no specific recommendations have been issued for these patients

• Prevention strategy (contact measurements and vaccines) remain essential to avoid infection and risk of severe course but also to prevent delaying in administering chemotherapy in oncohematological patients

• Available efficient treatments include anti-spike monoclonal antibodies, antivirals, antiinflammatory drugs, and immunomodulators.

• Treatment strategy should be tailored according to the phase of SARS-CoV2 infection and the clinical severity of COVID-19

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.