Clinical and Therapeutic Approach to Hospitalized COVID-19 Patients: A Pediatric Cohort in Portugal

Authors

  • Bárbara Martins Saraiva Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa. https://orcid.org/0000-0003-2771-9464
  • Ana Margarida Garcia Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.
  • Tiago Milheiro Silva Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.
  • Catarina Gouveia Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.
  • Maria João Brito Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.

DOI:

https://doi.org/10.20344/amp.15360

Keywords:

Antiviral Agents/therapeutic use, Child, COVID-19, Portugal, SARS-CoV-2

Abstract

Introduction: Coronavirus disease 2019, or COVID-19, in children is usually a mild disease, but severe illness has been reported. Currently, the therapy benefits of antiviral experimental drugs are still uncertain. The main aim of this study is to describe the experience of a level III hospital regarding therapeutic management of hospitalized children with COVID-19 and to characterize clinical features and evolution.
Material and Methods: This is a descriptive study of patients with COVID-19 in a level III pediatric hospital in Portugal between March and June 2020. Experimental drugs were administered according to the best scientific evidence at the time as ‘off-label use’.
Results: Among 200 children with SARS-CoV-2 infection, 37 were admitted due to COVID-19. Median age was one year (23 days - 18 years), 43% had comorbidities and 20/37 (54%) received antiviral therapy. Hydroxychloroquine was administered in 13 patients, in monotherapy or combined with lopinavir/ritonavir or azithromycin. Lopinavir/ritonavir was administered in eight patients and three children were treated with remdesivir. The patients who were treated had pneumonia (14), multisystem inflammatory syndrome in children (2), sepsis (2), myocarditis (1), acute respiratory distress syndrome (1), and mild illness with comorbidities (3). Other therapies included methylprednisolone and immunoglobulin (3), enoxaparin (2), antibiotics (16), oxygen (7), corticosteroids, and other inhaled therapy (16).
Discussion: Several treatment approaches have been proposed for severe COVID-19, even though none of them had been proven effective or approved for small children. Currently, remdesivir is approved for children aged above 12 years-old. Although 54% of our patients were treated with antivirals, it is important to understand that the favorable clinical evolution could be related with the natural course of the disease.
Conclusion: A significant proportion of our population presented severe and critical disease, was hospitalized and received treatment according to the most recent data, although most patients had mild disease. COVID-19 treatment in children is a clinical challenge and clinical trials are urgently needed.

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Author Biographies

Bárbara Martins Saraiva, Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.


Bárbara Martins Saraiva, Medical Doctor, graduated in Faculty of Medicine, University of Lisbon. Resident in the first year of Paediatrics, in Hospital Dona Estefânia, Centro Hospitalar Lisboa Central

Paediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon Portugal

Ana Margarida Garcia, Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.


Senior Assistant Medical Doctor in Paediatrics

Paediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon Portugal

Tiago Milheiro Silva, Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.


Senior Assistant Medical Doctor in Paediatrics

Paediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon Portugal

Catarina Gouveia, Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.


Senior Assistant Medical Doctor in Paediatrics

Paediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon Portugal

Maria João Brito, Pediatric Infectious Diseases Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.


Senior Assistant Medical Doctor in Paediatrics

Chief of the department of Paediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon Portugal

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Published

2021-03-31

How to Cite

1.
Saraiva BM, Garcia AM, Silva TM, Gouveia C, Brito MJ. Clinical and Therapeutic Approach to Hospitalized COVID-19 Patients: A Pediatric Cohort in Portugal. Acta Med Port [Internet]. 2021 Mar. 31 [cited 2023 Feb. 9];34(4):283-90. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/15360

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Original