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Allocating Resources Across the Life Span During COVID-19—Integrating Neonates and Children Into Crisis Standards of Care Protocols

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Pandemics rarely affect all age groups equally. Historically, pandemic influenzas have disproportionately impacted children. Coronavirus disease 2019 (COVID-19) primarily threatens adult populations. Yet in many hospitals, critical care resources are shared between adult and pediatric patients. Most ventilators can be used to treat both adults and children. Other resources—including medications, physical space, and staff—can be shared too.

Most protocols for resource allocation in the setting of scarce critical care resources urge hospitals to enact policies that apply to all patients in need of critical care resources—for example, a patient with a congestive heart failure exacerbation should compete for the same resources as a patient with respiratory failure related to COVID-19. According to this framework, critically ill neonates and children, regardless of COVID-19 status, must be accounted for in hospital resource allocation protocols.

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Article Information

Corresponding Author: Monica E. Lemmon, MD, Department of Pediatrics, Duke University School of Medicine, DUMC 3936, Durham, NC 27710 (monica.lemmon@duke.edu).

Published Online: December 14, 2020. doi:10.1001/jamapediatrics.2020.5215

Conflict of Interest Disclosures: Dr Lemmon reported receiving salary support from the National Institute of Neurological Disorders and Stroke and compensation for medicolegal work. Dr Truog reported receiving compensation as a consultant on data safety monitoring boards for Sanofi and Covance. No other disclosures were reported.

Additional Contributions: We thank David A. Turner, MD (Duke University), for his thoughtful review and input on this manuscript. He received no financial compensation for his contribution.

References
1.
White  DB , Lo  B .  A framework for rationing ventilators and critical care beds during the COVID-19 pandemic.   JAMA. 2020;323(18):1773-1774. doi:10.1001/jama.2020.5046 PubMedGoogle ScholarCrossref
2.
Matics  TJ , Sanchez-Pinto  LN .  Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children.   JAMA Pediatr. 2017;171(10):e172352. doi:10.1001/jamapediatrics.2017.2352 PubMedGoogle Scholar
3.
Wynn  JL , Polin  RA .  A neonatal sequential organ failure assessment score predicts mortality to late-onset sepsis in preterm very low birth weight infants.   Pediatr Res. 2020;88(1):85-90. doi:10.1038/s41390-019-0517-2PubMedGoogle ScholarCrossref
4.
Schlapbach  LJ , Straney  L , Bellomo  R , MacLaren  G , Pilcher  D .  Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit.   Intensive Care Med. 2018;44(2):179-188. doi:10.1007/s00134-017-5021-8 PubMedGoogle ScholarCrossref
5.
Richardson  DK , Corcoran  JD , Escobar  GJ , Lee  SK .  SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores.   J Pediatr. 2001;138(1):92-100. doi:10.1067/mpd.2001.109608 PubMedGoogle ScholarCrossref
6.
Stoll  BJ , Hansen  NI , Bell  EF ,  et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.  Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network.   Pediatrics. 2010;126(3):443-456. doi:10.1542/peds.2009-2959 PubMedGoogle ScholarCrossref
7.
Lemmon  ME , Ubel  PA , Janvier  A .  Estimating neurologic prognosis in children: high stakes, poor data.   JAMA Neurol. 2019;76(8):879-880. doi:10.1001/jamaneurol.2019.1157 PubMedGoogle ScholarCrossref
8.
White  DB . A model hospital policy for allocating scarce critical care resources. University of Pittsburgh School of Medicine. Published April 15, 2020. Accessed May 22, 2020. https://ccm.pitt.edu/?q=content/model-hospital-policy-allocating-scarce-critical-care-resources-available-online-now
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