Abstract
Sufficient high-quality data are unavailable to describe the management approach and guideline of COVID-19 disease in pediatric and adolescent population which may be due to mild presentation in most of cases and less severe complications than older ages.
 World Health Organization was concerned with the establishment of an approved guideline to manage the increasing number of COVID-19 patients worldwide aiming to prevent or lessen COVID-19 global burden.
 The clinical features have a wide spectrum starting from uncomplicated mild illness, mild-moderate pneumonia, severe pneumonia, acute respiratory distress syndrome, sepsis, septic shock, and multisystem inflammatory syndrome in children.
 Many important definitions were developed to identify the COVID-19 case status including confirmed, suspected, and probable case.
 Many laboratory tests may be beneficially done but reverse transcriptase – polymerase chain reaction (RT-PCR) for SARS-CoV-2 RNA is diagnostic.
 Patient isolation and adequate intake of fluid and calories, antipyretics (preferably paracetamol), antibiotics (in secondary bacterial infections), and bed rest are the mainstay of approved supportive treatment. While oxygen supplementation may be added in moderate to severe cases; anticoagulation prophylaxis (enoxaparin) is strongly advised in children with certain situations where hypercoagulability state is identified, and therapy should be evaluated based on risk factors.
 New approaches, drugs, and therapies are currently under research to manage COVID-19 pediatric and adolescent patients including antivirals (lopinavir/ritonavir, and favipiravir), remdesivir, tocilizumab, dexamethasone, convalescent plasma, and specific treatment of multisystem inflammatory syndrome in children (immunoglobulin, steroids, tocilizumab, anakinra, and aspirin).
 The practical approach was summarized in a flow chart scheme to assist health care professionals to manage COVID-19 in children and adolescents within a rapid look though details are given in the text.
Highlights
Since the appearance of first cases of the recent pandemic of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) in China, the world has been changed
In the presence of co-morbidities and in some patients, the disease may progress to acute respiratory distress syndrome (ARDS), septicemia, septic shock, and even multisystem inflammatory syndrome in children (MIS-C) which has some similarity with Kawasaki disease
(3) Most of pediatric and adolescent patients show a milder form of COVID-19 infection and they are usually asymptomatic which may be a negative point related to the increased burden of community transmission where children usually have a close contact with other adults including geriatric population whom have a severe course of COVID-19 in most instances
Summary
Since the appearance of first cases of the recent pandemic of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) in China (which was called later as COVID19), the world has been changed. A patient with acute pulmonary disease (high temperature and at least one sign/symptom of a pulmonary illness, e.g., cough, and dyspnea), AND have been in contact with a confirmed or probable COVID-19 case (see definitions ahead) in the recent 2 weeks before the beginning of signs/symptoms. A patient with severe unexplained acute pulmonary disease (high temperature and at least one sign/symptom of a pulmonary illness, e.g., cough, and dyspnea), AND in need of hospital admission. Food and Drug Administration (FDA) has declared an emergency use (EUA) of convalescent plasma recently on August 23, 2020 for severe (including dyspnea, respiratory rate ≥ 30 per minute, oxygen saturation ≤ 93%, lung involvement more than 50% within 1-2 days, and partial pressure of arterial oxygen to fraction of inspired oxygen ratio less than 300) or lifethreatening (including septic shock, respiratory failure, and multiple organ dysfunction) COVID-19. Doses are given in pulses as 10-30 mg/kg daily for 1-3 days, 2 mg/kg daily in divided doses until the condition becomes stable, and followed by a taper
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