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Romani L, Roversi M, Bernardi S, Venturini E, Garazzino S, Donà D, Krzysztofiak A, Montagnani C, Funiciello E, Calò Carducci FI, Marabotto C, Castagnola E, Salvini F, Lancella L, Lo Vecchio A, Galli L, Castelli Gattinara G. Use of Remdesivir in children with COVID-19: report of an Italian multicenter study. Ital J Pediatr 2024; 50:32. [PMID: 38413992 PMCID: PMC10900665 DOI: 10.1186/s13052-024-01606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND COVID-19 is generally milder in children than in adults, however severe infection has been described in some patients. Few data are available on use of Remdesivir (RDV) in children, as most clinical trials focused on adult patients. We report a multicenter study conducted in 10 Italian Hospitals to investigate the safety of RDV in children affected by COVID-19. METHODS We collected the clinical data of children with COVID-19 treated with RDV between March 2020 and February 2022 in 10 Italian hospitals. Clinical data were compared according to a duration of RDV therapy more or less than 5 days. Linear regression model was used to determine the association of significant variables from the bivariate analysis to the duration of RDV therapy. RESULTS A total of 50 patients were included, with a median age of 12.8 years. Many patients had at least one comorbidity (78%), mostly obesity. Symptoms were fever (88%), cough (74%) and dyspnea (68%). Most patients were diagnosed with pneumonia of either viral and/or bacterial etiology. Blood test showed leukopenia in 66% and increased C-reactive protein (CRP) levels in 63% of cases. Thirty-six patients received RDV for 5 days, nine patients up to 10 days. Most children who received RDV longer were admitted to the PICU (67%). Treatment with RDV was well tolerated with rare side effects: bradycardia was recorded in 6% of cases, solved in less than 24 h after discontinuation. A mild elevation of transaminases was observed in 26% of cases, however for the 8%, it was still detected before the RDV administration. Therefore, in these cases, we could not establish if it was caused by COVID-19, RDV o both. Patients who received RDV for more than 5 days waited longer for its administration after pneumonia diagnosis. The presence of comorbidities and the duration of O2 administration significantly correlated with the duration of RDV therapy at the linear regression analysis. CONCLUSION Our experience indicates that RDV against SARS-CoV-2 is safe and well-tolerated in pediatric populations at high risk of developing severe COVID-19. Our data suggest that delaying RDV therapy after diagnosis of pneumonia may be associated with a longer duration of antiviral therapy, especially in patients with comorbidities.
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Affiliation(s)
- Lorenza Romani
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Roversi
- PhD Course "Immunology, Molecular Medicine and Applied Biotechnology", University of Rome Tor Vergata, Rome, Italy
| | - Stefania Bernardi
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | | | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elisa Funiciello
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Caterina Marabotto
- Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elio Castagnola
- Hematology and Oncology, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Filippo Salvini
- Pediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Lancella
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
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Indolfi C, Klain A, Dinardo G, D’Addio E, Ferrara S, Decimo F, Ciprandi G, Tosca MA, Miraglia del Giudice M. COVID-19 Pediatric Follow-Up: Respiratory Long COVID-Associated Comorbidities and Lung Ultrasound Alterations in a Cohort of Italian Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:166. [PMID: 38397278 PMCID: PMC10887372 DOI: 10.3390/children11020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
In children, the factors that influence COVID-19 disease and its medium- and long-term effects are little known. Our investigation sought to evaluate the presence of comorbidity factors associated with respiratory long COVID manifestations in children and to study ultrasound abnormalities following SARS-CoV-2 infection. Children, who arrived at the 'Respiratory Diseases of Pediatric Interest Unit' at the Department of Woman, Child, and General and Specialized Surgery of the University of Campania 'Luigi Vanvitelli', were selected during the timeframe from September 2021 to October 2022. The children were diagnosed with a SARS-CoV-2 infection that occurred at least one month before the visit. All patients followed a COVID-19 follow-up protocol, developed by the Italian Society of Pediatric Respiratory Diseases (SIMRI), which included: collection of data regarding SARS-CoV-2 illness and history of known respiratory and allergic diseases; physical examination; BMI assessment; baseline spirometry and after bronchodilation test; six-minute walking test; and lung ultrasound (LUS). In a cohort of 104 participants with respiratory long COVID symptoms (64.7% male, average age 8.92 years), 46.1% had fever with other symptoms, and 1% required hospitalization. BMI analysis showed 58.4% of the cohort was overweight. The LUS was positive in 27.0% of cases. A significant BMI association was observed with COVID-19 symptoms and LUS score (p-value < 0.05). No associations were found with asthma or atopy.
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Affiliation(s)
- Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Elisabetta D’Addio
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Serena Ferrara
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Giorgio Ciprandi
- Department of Medicine, Allergy Clinic, Casa di Cura Villa Montallegro, 16145 Genoa, Italy;
| | - Maria Angela Tosca
- Pediatric Allergy Center, Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Michele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
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Kozak K, Pavlyshyn H, Kamyshnyi O, Shevchuk O, Korda M, Vari SG. The Relationship between COVID-19 Severity in Children and Immunoregulatory Gene Polymorphism. Viruses 2023; 15:2093. [PMID: 37896870 PMCID: PMC10612096 DOI: 10.3390/v15102093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Coronavirus disease (COVID-19) and its outcomes remain one of the most challenging problems today. COVID-19 in children could be asymptomatic, but can result in a fatal outcome; therefore, predictions of the disease severity are important. The goal was to investigate the human genetic factors that could be associated with COVID-19 severity in children. Single-nucleotide polymorphisms of the following genes were studied: ACE2 (rs2074192), IFNAR2 (rs2236757), TYK2 (rs2304256), OAS1 (rs10774671), OAS3 (rs10735079), CD40 (rs4813003), FCGR2A (rs1801274) and CASP3 (rs113420705). In the case-control study were 30 children with mild or moderate course of the disease; 30 with severe COVID-19 symptoms and multisystem inflammatory syndrome in children (MIS-C) and 15 who were healthy, and who did not have SARS-CoV-2 (PCR negative, Ig G negative). The study revealed that ACE2 rs2074192 (allele T), IFNAR2 rs2236757 (allele A), OAS1 rs10774671 (allele A), CD40 rs4813003 (allele C), CASP3 rs113420705 (allele C) and male sex contribute to severe COVID-19 course and MIS-C in 85.6% of cases. The World Health Organization reported that new SARS-CoV-2 variants may cause previously unseen symptoms in children. Although the study has limitations due to cohort size, the findings can help provide a better understanding of SARS-CoV-2 infection and proactive pediatric patient management.
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Affiliation(s)
- Kateryna Kozak
- Department of Pediatrics No. 2, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine;
| | - Halyna Pavlyshyn
- Department of Pediatrics No. 2, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine;
| | - Oleksandr Kamyshnyi
- Department of Microbiology, Virology, and Immunology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine;
| | - Oksana Shevchuk
- Department of Pharmacology and Clinical Pharmacology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine;
| | - Mykhaylo Korda
- Department of Medical Biochemistry, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine;
| | - Sandor G. Vari
- International Research and Innovation in Medicine Program, Cedars–Sinai Medical Center, Los Angeles, CA 90048, USA;
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Bozzola E, Caffarelli C, Santamaria F, Corsello G. The year 2021 in COVID-19 pandemic in children. Ital J Pediatr 2022; 48:161. [PMID: 36064605 PMCID: PMC9444079 DOI: 10.1186/s13052-022-01360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/30/2022] [Indexed: 01/08/2023] Open
Abstract
In this article, the developments in the field of COVID-19 pandemic published in the Italian Journal of Pediatrics in 2021 are reflected. We describe progresses in SARS-CoV-2 transmission route, clinical presentation, diagnosis, treatment, and access to health care facilities in children. They led to substantial changes in the clinical approach.
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Affiliation(s)
- Elena Bozzola
- Department of Pediatric, IRCCS Bambino Gesù Children's Hospital, Pediatric Diseases Unit, Rome, Italy.
| | - Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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Colomba C, Guccione C, Rubino R, Scalisi M, Condemi A, Bagarello S, Giordano S, Cascio A. Third Case of Visceral Leishmaniasis in COVID-19: Mini Review Article. Pathogens 2022; 11:pathogens11080913. [PMID: 36015034 PMCID: PMC9412552 DOI: 10.3390/pathogens11080913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/29/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In the currently ongoing coronavirus pandemic, coinfections with unrelated life-threatening febrile conditions may pose a particular challenge to clinicians. Leishmaniasis is a zoonosis that may present general symptoms, including fever, malaise, and arthralgia, rendering it indistinguishable from COVID-19. Methods: In this paper, we aim to draw attention to this issue and analyze the clinical characteristics of the coinfection SARS-CoV-2/Leishmania through a systematic review of the literature. We were motivated by the observation of the first case of visceral leishmaniasis and COVID-19 in a paediatric patient. Conclusion: Our case is a reminder for healthcare providers to consider the diagnosis of visceral leishmaniasis in patients presenting with febrile syndrome in endemic regions during the COVID-19 pandemic.
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Affiliation(s)
- Claudia Colomba
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Cristoforo Guccione
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Raffaella Rubino
- Infectious and Tropical Diseases Unit, AOU Policlinico “P-Giaccone”, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-0916554015
| | - Michela Scalisi
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Anna Condemi
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Sara Bagarello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Salvatore Giordano
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Infectious and Tropical Diseases Unit, AOU Policlinico “P-Giaccone”, 90127 Palermo, Italy
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Di Chiara C, Mengato D, De Pieri M, Longo G, Benetti E, Venturini F, Giaquinto C, Donà D. Early Use of Sotrovimab in Children: A Case Report of an 11-Year-Old Kidney Transplant Recipient Infected with SARS-CoV-2. CHILDREN (BASEL, SWITZERLAND) 2022; 9:451. [PMID: 35455495 PMCID: PMC9028505 DOI: 10.3390/children9040451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The use of virus-neutralizing monoclonal antibodies has been approved in fragile populations, including kidney transplant recipients, who are at risk of developing severe COVID-19. Sotrovimab is the only currently available anti-SARS-CoV-2 neutralizing monoclonal antibody with activity against the new Omicron variant of concern. While sotrovimab has been approved in adolescents and adults, studies regarding its efficacy and safety in children aged less than 12 years old and weighing less than 40 kg are still lacking. Here, we report a first case of a child, who was treated early with sotrovimab after a kidney transplant. CASE REPORT At the end of January 2022, a 11-year-old male child underwent a deceased-donor kidney transplant and became infected with SARS-CoV-2 during the first day after surgery. Due to the increased risk of developing severe COVID-19, based on the predominance of Omicron and the patient's renal function, the child was treated with sotrovimab. The clinical course was successful and no adverse reactions were reported. CONCLUSIONS For the first time, we report the well-tolerated use of sotrovimab in children under 12 years old. As the pandemic affects children across the globe, urgent data on sotrovimab dosing in children with a higher risk of developing severe COVID-19 are needed.
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Affiliation(s)
- Costanza Di Chiara
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University of Padua, 35128 Padua, Italy; (M.D.P.); (C.G.); (D.D.)
| | - Daniele Mengato
- Hospital Pharmacy Department, University Hospital of Padova, 35121 Padua, Italy; (D.M.); (F.V.)
| | - Marica De Pieri
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University of Padua, 35128 Padua, Italy; (M.D.P.); (C.G.); (D.D.)
| | - Germana Longo
- Department for Women’s and Children’s Health, Division of Pediatric Nefrology Unit, University of Padua, 35128 Padua, Italy; (G.L.); (E.B.)
| | - Elisa Benetti
- Department for Women’s and Children’s Health, Division of Pediatric Nefrology Unit, University of Padua, 35128 Padua, Italy; (G.L.); (E.B.)
| | - Francesca Venturini
- Hospital Pharmacy Department, University Hospital of Padova, 35121 Padua, Italy; (D.M.); (F.V.)
| | - Carlo Giaquinto
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University of Padua, 35128 Padua, Italy; (M.D.P.); (C.G.); (D.D.)
| | - Daniele Donà
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University of Padua, 35128 Padua, Italy; (M.D.P.); (C.G.); (D.D.)
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Romani L, Calò Carducci FI, Chiurchiù S, Cursi L, De Luca M, Di Giuseppe M, Krzysztofiak A, Lancella L, Palma P, Vallesi L, Corsetti T, Campana A, Nicastri E, Rossi P, Bernardi S. Safety of Monoclonal Antibodies in Children Affected by SARS-CoV-2 Infection. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030369. [PMID: 35327741 PMCID: PMC8947030 DOI: 10.3390/children9030369] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
Monoclonal antibody therapies for COVID-19 have been frequently used in adults, whereas there are little data regarding the safety or efficacy of monoclonal antibody treatments in pediatric patients affected by COVID-19. We report our experience in the administration of mAb as a treatment for SARS-CoV-2 infection in children aged from 24 days to 18 years old.
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Affiliation(s)
- Lorenza Romani
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
- Correspondence:
| | - Francesca Ippolita Calò Carducci
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Sara Chiurchiù
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Laura Cursi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Maia De Luca
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Martina Di Giuseppe
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Andrzej Krzysztofiak
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Laura Lancella
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Paolo Palma
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Chair of Pediatrics, Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Leonardo Vallesi
- Hospital Pharmacy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.V.); (T.C.)
| | - Tiziana Corsetti
- Hospital Pharmacy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.V.); (T.C.)
| | - Andrea Campana
- Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, 00149 Rome, Italy;
| | - Paolo Rossi
- Chair of Pediatrics, Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Stefania Bernardi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
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Zurita-Cruz J, Fonseca-Tenorio J, Villasís-Keever M, López-Alarcón M, Parra-Ortega I, López-Martínez B, Miranda-Novales G. Efficacy and safety of vitamin D supplementation in hospitalized COVID-19 pediatric patients: A randomized controlled trial. Front Pediatr 2022; 10:943529. [PMID: 35958172 PMCID: PMC9357919 DOI: 10.3389/fped.2022.943529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Some studies suggested that adequate levels of vitamin D (VD) decrease the risk of severe COVID-19. Information about the effectiveness of VD supplementation in children is scarce. OBJECTIVE To assess the efficacy and safety of VD supplementation compared to the standard of care in hospitalized children with COVID-19. PATIENTS AND METHODS An open-label randomized controlled single-blind clinical trial was carried out. We included patients from 1 month to 17 years, with moderate COVID-19, who required hospitalization and supplemental oxygen. They were randomized into two groups: the VD group, which received doses of 1,000 (children < 1 year) or 2,000 IU/day (from 1 to 17 years) and the group without VD (control). The outcome variables were the progression of oxygen requirement, the development of complications, and death. STATISTICAL ANALYSIS For comparison between groups, we used the chi-squared test or Fisher's exact test and the Mann-Whitney U test. Absolute risk reduction (ARR) and the number needed to treat (NNT) were calculated. p ≤ 0.05 was considered statistically significant. RESULTS From 24 March 2020 to 31 March 2021, 87 patients were eligible to participate in the trial; 45 patients were randomized: 20 to the VD group and 25 to the control group. There was no difference in general characteristics at baseline, including serum VD levels (median 13.8 ng/ml in the VD group and 11.4 ng/ml in the control group). OUTCOMES 2/20 (10%) in the VD group vs. 9/25 (36%) in the control group progressed to a superior ventilation modality (p = 0.10); one patient in the VD group died (5%) compared to 6 (24%) patients in the control group (p = 0.23). ARR was 26% (95% CI 8.8 to 60.2%) and NNT was 3 (2 to 11) for progression and ARR was 19% (95% CI -3.9 to 42.8%) and NNT was 6 (2 to 26) for death. None of the patients receiving VD had adverse effects. The trial was stopped for ethical reasons; since after receiving the results of the basal VD values, none of the patients had normal levels. CONCLUSION In this trial, VD supplementation in pediatric patients seems to decrease the risk of COVID-19 progression and death. More studies are needed to confirm these findings. CLINICAL TRIAL REGISTRATION This protocol was registered on ClinicalTrials.gov with the registration number NCT04502667.
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Affiliation(s)
- Jessie Zurita-Cruz
- Faculty of Medicine, National Autonomous University of Mexico, Pediatric Hospital Federico Gómez, Mexico City, Mexico
| | - Jeffry Fonseca-Tenorio
- Infectious Diseases Department, Pediatric Hospital National Medical Center, XXI Century, Mexican Institute of Social Security, Mexico City, Mexico
| | - Miguel Villasís-Keever
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center XXI Century, Mexican Institute of Social Security, Mexico City, Mexico
| | - Mardia López-Alarcón
- Medical Nutrition Research Unit, Pediatric Hospital National Medical Center, XXI Century, Mexican Institute of Social Security, Mexico City, Mexico
| | - Israel Parra-Ortega
- Clinical Laboratory Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Briceida López-Martínez
- Auxiliary Diagnostic Services, Hospital Infantil de México Federico Gómez, Ministry of Health, Mexico City, Mexico
| | - Guadalupe Miranda-Novales
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center XXI Century, Mexican Institute of Social Security, Mexico City, Mexico
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