Management of COVID-19 infection in children without MIS-C

AIDS: acquired immunodeficiency syndrome; CAR-T: chimeric antigen receptor T; COVID-19: coronavirus disease 2019; ECMO: extracorporeal membrane oxygenation; HFNC: high-flow nasal cannula; HIV: human immunodeficiency virus; IV: intravenous; MIS-C: multisystem inflammatory syndrome in children; NIV: noninvasive ventilation.

* Manifestations of clinical deterioration include severe respiratory distress, difficulty breathing, chest pain or pressure, blue lips or face, signs and/or symptoms of shock, and inability to drink or keep down any liquids.

• Active treatment for solid tumor or hematologic malignancies
• Hematologic malignancy that has been associated with poor response to COVID-19 vaccines, regardless of the patient's current treatment
• Receipt of a solid organ or islet transplant and receiving immunosuppressive therapy
• Received CAR T-cell therapy or a hematopoietic cell transplant and are within 2 years of transplantation or are receiving immunosuppressive therapy
• Moderate or severe primary immunodeficiency
• Untreated HIV infection or AIDS
• Receiving active treatment with high-dose corticosteroids (ie, ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, or immunosuppressive or immunomodulatory biologic agents (eg, B cell-depleting agents)

Δ Refer to related UpToDate content on the management of COVID-19 in children for a list of underlying conditions that increase risk of progression to severe disease.