Article in Japanese

Severe pediatric COVID-19 pneumonia treated with high-flow nasal cannula and intravenous remdesivir

Fumika YURUGI^1）, Takuma OHNISHI^1）, Satoshi SATO^1）, Kuntaro DEGUCHI^1）, Haruka TAKEI^1）, Yoji UEJIMA^1）, Takehiro NIITSU^2）, Eisuke SUGANUMA^1）

Most pediatric patients with coronavirus disease 2019 (COVID-19) caused by severe respiratory syndrome coronavirus-2 (SARS-CoV-2) in Japan exhibit a mild clinical course. We encountered a case with severe COVID-19 pneumonia treated with high-flow nasal cannula (HFNC) and intravenous remdesivir. A previously healthy 14-year-old female was diagnosed with COVID-19 due to fever, cough, and fatigue using polymerase chain reaction. She was admitted to the community hospital after her respiratory symptoms worsened on day 4 of her illness. On admission, nasal cannula oxygen and intravenous dexamethasone were administered. On day 7, her respiratory condition worsened and she was transferred to our pediatric intensive care unit (PICU) for further treatment. After admission to the PICU, intravenous remdesivir and oxygen support using a HFNC were initiated along with intravenous dexamethasone (6.6 mg/dose). The next day, her respiratory condition improved, and HFNC was tapered off. On day 10, oxygen support was removed. HFNC therapy has been reported to curtail worsening symptoms and it avoids intubation in COVID-19 patients. Remdesivir is an antiviral medication that is expected to decrease both recovery time and estimated mortality. In our case, HFNC therapy and intravenous remdesivir, along with intravenous dexamethasone, successfully prevented deterioration of respiratory status without any serious adverse events. Since there are only a few serious pediatric COVID-19 patients in Japan, more clinical experience in treating pediatric patients with acute SARS-CoV-2 infection is needed.

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1） Division of Infectious Diseases, Immunology and Allergy, Saitama Children’s Medical Center

2） Division of Critical Care Medicine, Saitama Children’s Medical Center

Key words	COVID-19, high-flow nasal cannula, remdesivir
Received	June 13, 2022
Accepted	February 22, 2023

35 (1)：17─23,2023