LETTER TO THE EDITOR
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2021 - Universidad Ricardo PalmaDOI 10.25176/RFMH.v21i1.3595
CLINICAL PRESENTATIONS ASSOCIATED WITH SARS-COV-2 IN A COVID PEDIATRIC INTENSIVE CARE UNIT OF A NATIONAL HOSPITAL IN LIMA
PRESENTACIONES CLÍNICAS ASOCIADAS AL SARS-COV-2 EN UNA UNIDAD DE CUIDADOS INTENSIVOS PEDIÁTRICOS COVID DE UN HOSPITAL NACIONAL DE LIMA
Edgar Coila-Paricahua1, Ricardo Rodriguez-Portilla1, Liliana Cieza-Yamunaqué1, Pedro Baique-Sánchez1, Claudia Guerra-Ríos1
1Médico Pediatra Intensivista, Hospital Nacional Edgardo Rebagliati Martins, Lima-Perú
Coronavirus disease 2019 (COVID-19) affects more adults than children(1). Then the multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) was described, with an incidence peak of around 4 weeks after the peak of contagion Therefore, it is postulated that this is a postinfectious entity, which is characterized by affecting multiple organs and systems(2,3). In response to this new necessity, the Pediatric Intensive Care Unit (PICU) in Hospital Nacional Edgardo Rebagliati Martins provided a separate two-bed room for the care of children with SARS-CoV-2 infection to reduce the risk of nosocomial infections. In order to describe the clinical presentations associated with SARS-CoV-2 infection, it was conducted a retrospective evaluation of the electronic medical records of patients admitted to the COVID PICU from April to October 2020. Data were collected, such as serologic and molecular test for SARS-CoV-2, age, sex, nutritional status, admission priority(4), length of stay in PICU, some comorbidity, and death. A three-group classification was carried out based on the clinical diagnosis and test results for SARS-CoV-2. COVID-19 group (acute respiratory distress syndrome (ARDS), record of contact with COVID-19 cases and testing for SARS-CoV-2); MIS-C group, according to WHO criteria(5); and Non-COVID-19/Non-MIS-C group, patients admitted for a condition unrelated to SARS-CoV-2, but on suspicion of the disease, they had to go to the separate area. This last group has been divided into two subgroups: SARS-CoV-2(+) with at least one positive SARS-CoV-2 test, and SARS-CoV-2(-) subgroup.
The first patient was seen on April 20th and the last patient was released on October 23rd, 2020. Thirty-six patients were seen (Table 1), three patients (8.3%) had COVID-19, with acute respiratory affectation and two of them contracted the disease during their hospital stay in a non-COVID area. Thirteen patients (36.1%) had MIS-C, with hemodynamic impairment, and as reported in other studies, all had negative molecular test and positive serologic test, mainly IgG. One of the patients with a final diagnosis of MIS-C, who was the first seen, was admitted with a diagnosis of COVID-19 at the end of April, when the definition of MIS-C had not been disseminated, so the diagnosis was made after reviewing the clinical record. In Non-COVID-19/Non-MIS-C group (55.5%), in the SARS-CoV-2(+) subgroup (38.9%), the main problem of care was not related to the SARS-CoV-2 infection, but they were admitted to the COVID PICU to take precautionary measures against the possibility of spreading the infection. They were admitted as patients with suspected COVID-9 or suspected MIS-C that were finally ruled out; and in the SARS-CoV-2(-) subgroup (19. 4%), all were admitted for respiratory failure and suspected COVID-19, however, infection was ruled out and other causes were found to explain the respiratory problem, mostly related to comorbidity.
In our experience, we have mainly attended patients with suspicion and/or record of SARS-CoV-2 or MIS-C infection. Acute SARS-CoV-2 infectious disease, which can spread up to 10 days after symptom onset when mild or moderate, or up to 10-20 days when severe(6), has been uncommon considering the magnitude of care in the adult population and could accelerate the normalization of care for other non-infectious diseases in the pediatric population affected by the pandemic.
Table 1. Epidemiological and laboratory characteristics of children based on clinical presentations associated with SARS-CoV-2 in a COVID Pediatric Intensive Care Unit.
|
|
COVID-19† n (%) |
MIS-C †† n (%) |
Non COVID-19/Non MIS-C |
Total n (%) |
||
|
SARS-CoV-2(+) n (%) |
SARS-CoV-2(-) n (%) |
|||||
|
Cases |
3(8,3) |
13(36,1) |
13(36,1) |
7(19,4) |
36(100) |
|
|
Age * |
0,7 [0,4-12,3] |
8 [7–10,5] |
9.7 [4,3–11,4] |
1,5 [0,3–9,3] |
8,2 [3–10,7] |
|
|
Sex |
F |
1(33,3) |
6(46,2) |
5(38,5) |
5(71,4) |
17(47,2) |
|
M |
2(66,7) |
7(53,8) |
8(61,5) |
2(28,6) |
19(52,8) |
|
|
Nutritional status |
Emaciated |
1(33,3) |
1(7,7) |
0(0) |
0(0) |
2(5,6) |
|
Normal |
2(66,7) |
4(30,8) |
7(53,8) |
4(57,1) |
17(47,2) |
|
|
Overweight |
0(0) |
3(23,1) |
0(0) |
2(28,6) |
5(13,9) |
|
|
Obesity |
0(0) |
2(15,4) |
2(15,4) |
0(0) |
4(11,1) |
|
|
Admission priority |
I |
0(0) |
13(100) |
10(76,9) |
2(28,6) |
25(69,4) |
|
II |
1(33,3) |
0(0) |
2(15,4) |
1(14,3) |
4(11,1) |
|
|
III |
1(33,3) |
0(0) |
1(7,7) |
4(57,1) |
6(16,7) |
|
|
IV |
1(33,3) |
0(0) |
0(0) |
0(0) |
1(2,8) |
|
|
Length of stay in PICU* |
4 [3–18] |
6 [5–6] |
5 [2–8] |
6 [3–15] |
5 [3-8] |
|
|
Serologic test |
IgM(-)/IgG(-) |
2(66,7) |
0(0) |
2(15,4) |
7(100) |
11(30,6) |
|
IgM(-)/IgG(+) |
0(0) |
9(69,2) |
7(53,8) |
0(0) |
16(44,4) |
|
|
IgM(+)/IgG(-) |
1(33,3) |
1(7,7) |
1(7,7) |
0(0) |
3(8,3) |
|
|
IgM(+)/IgG(+) |
0(0) |
3(23,1) |
3(23.1) |
0(0) |
6(16,7) |
|
|
Molecular test |
Negativo |
1(33,3) |
13(100) |
8(61,5) |
7(100) |
29(80,6) |
|
Positivo |
2(66,7) |
0(0) |
3(23,1) |
0(0) |
5(13,9) |
|
|
Mechanical ventilation |
3(100) |
10(76,9) |
8(61,5) |
7(100) |
28(77,8) |
|
|
With comorbidity |
3(100) |
0(0) |
4(30,8) |
5(71,4) |
12(33,3) |
|
|
Dead |
2(667) |
1(7,7) |
1(7,7) |
1(14,3) |
5(13,9) |
|
Authorship contributions: All authors conceived and designed the article, collected, analyzed and interpreted the data, drafted the article and approved the final version.
Funding sources: Self-funded.
Conflicts of Interests: The authors declare that there is no conflict of interest regarding the publication of this article.
Received: 25 November 2020
Accepted: 15 July 2020
Correspondence: Juan Coila Paricahua
Address: Av. Boulevard de Surco 322 Dpto. 101, San Borja, Lima-Perú.
Telephone number: 996300108
E-mail: edcopa@gmail.com
REFERENCES
