Abstract
The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
infection has milder presentation in children than adults, mostly
requiring only supportive therapy. The immunopathogenic course of
COVID-19 can be divided in two distinct but overlapping phases: the
first triggered by the virus itself and the second one by the host
immune response. Cytokine storm induces Acute Respiratory Distress
Syndrome (ARDS) in 20-30% of adults while less than 1% of children
develops severe pulmonary or systemic involvement as Multisystem
Inflammatory Syndrome in Children (MIS-C), requiring intensive care.
Less severe lung injury in children could be explained by qualitative
and quantitative differences in age-related immune response. Evidence on
the best therapeutic approach for COVID-19 lung disease in children is
lacking. Currently, the approach is mainly conservative and based on
supportive therapy. However, in hospitalized children with critical
illness and worsening lung function, antiviral therapy with remdesivir
and immunomodulant treatment with systemic steroids could be considered
the “therapeutic pillars”. In addition, optimal disease control of
allergic and asthmatic children and, in the near future, vaccinations
are expected to be important as preventive strategies to reduce the
COVID-19 burden.