200: Successful Use of Convalescent Plasma for Severe COVID-19 Infection in Two Adolescent Patients

INTRODUCTION: Convalescent plasma has been used in adults to facilitate viral clearance and hasten recovery in patients with COVID-19 infection We describe the first use of convalescent plasma in two pediatric patients with acute respiratory distress syndrome (ARDS) at our institution METHODS: Patient 1: A 14-year-old 108 4-kg female admitted with one week of fatigue, fever, cough, and shortness of breath On admission she required supplemental oxygen Dexamethasone, ceftriaxone, azithromycin and enoxaparin prophylaxis were started She subsequently developed ARDS, requiring transfer to the pediatric intensive care unit (PICU), where she was treated with heated high flow nasal cannula (HFNC) and prone positioning An arterial oxygen partial pressure (PaO2) to fractional inspired oxygenation (FiO2) ratio (P/F) of 170 qualified her for treatment with convalescent plasma per our expanded access IRB protocol On hospital day 2, she received 1 unit of convalescent plasma It was tolerated well and within 24 hours she was weaned from 24 liters/minute (L/min) with a FiO2 of 60% to 12 L/min, FiO2 50% By 48 hours the patient was weaned to 2 L of oxygen with a FiO2 of 21% The patient was weaned to room air and discharged home on hospital day 6 Patient 2: A 15-year-old 113 5-kg female with a history of panhypopituitarism secondary to craniopharyngioma, admitted to the PICU due to one week of intermittent fevers and respiratory distress She was hypoxic with a PaO2 of 87% on room air She was placed on 5 L/min via nasal cannula, but due to subsequent ARDS she required HFNC 30 L/min, 100% FiO2 Ceftriaxone, dexamethasone and enoxaparin prophylaxis were started On hospital day 2 her hypoxia progressed with oxygen saturations as low as 79% requiring 40 L/min, 100% of FiO2 She met criteria with a P/F ratio of 79 and was given 1 unit of convalescent plasma She was simultaneously started on remdesivir and prone positioning She remained on 40 L/min of HFNC, FiO2 100% until day 3 In addition, tocilizumab was given on days 3 and 4 By day 3, she was weaned to HFNC 30 L/min, FiO2 30% She was successfully transitioned to room air and discharged on day 10 RESULTS: Administration of convalescent plasma with COVID-19 infection and ARDS was safe and potentially effective in two pediatric patients