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Research papers
Medwave 2021;21(1):e8107 doi: 10.5867/medwave.2021.01.8107
Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru
Jesús Domínguez Rojas, Matilde Estupiñan Vigil, Raquel Garcés-Ghilardi, Giancarlo Alvarado-Gamarra, Olguita del Águila, Adanida Flor Lope Tenorio, Carmen Cecilia Ayón Dejo, Kenny Chonlon Murillo, Sebastián Boluarte Baca, Angie Stapleton Herbozo, Ricardo Seminario Aliaga, Giuliana Reyes Florian, Diana Dávila Riega, Sarah Fernández Suárez, Álvaro Coronado Muñoz
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Key Words: COVID-19, coronavirus, pediatric multisystem inflammatory disease, COVID-19 related, pediatrics

Abstract

Introduction
Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones.

Objectives
To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020.

Methods
A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19.

Results
We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008).

Conclusions
We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19.


 

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Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

Introducción
La infección por coronavirus 2019 (SARS-CoV-2) en niños se presentó en Perú desde marzo del 2020. Desde entonces fue necesario internar pacientes pediátricos en el Hospital Nacional Edgardo Rebagliati Martins, en el área de hospitalización adaptada para dicho propósito. Al inicio, la demanda de hospitalización era baja y se fue incrementando progresivamente. Coincidiendo con los reportes internacionales, la mayoría presentó cuadros leves o moderados, pero también hubo casos graves e incluso mortales.

Objetivos
Describir las características y el desenlace clínico de los pacientes pediátricos con COVID-19 hospitalizados en un hospital de referencia en Lima, Perú, entre marzo y agosto de 2020.

Métodos
Se realizó un estudio transversal descriptivo e inferencial. La población incluyó a todos los pacientes que se hospitalizaron en el Departamento de Pediatría Clínica, con diagnósticos clínicos y quirúrgicos asociados a COVID-19.

Resultados
Incluimos 100 pacientes, con edad promedio de 83,4 ± 54 meses, con predominio de varones (55%). Los pacientes hospitalizados fueron agrupados en cinco categorías: insuficiencia respiratoria (17%), síndrome inflamatorio multisistémico (31%), presentación neurológica (19%), abdomen agudo (20%) y pacientes con problemas oncológicos (13%). La mayoría de los pacientes (74%) tenían comorbilidades. Respecto a los síntomas de presentación, el dolor intestinal predominó en el grupo de apendicitis (90%, p < 0,001), la fiebre estuvo presente en la mayoría de los pacientes con falla respiratoria (64,7%), el síndrome inflamatorio multisistémico se registró en 90,3%, la sintomatología neurológica en 15,8%, el abdomen agudo 50% y oncológicos en 61,5% de los pacientes. Los síntomas de Kawasaki estuvieron presentes en 38,7% de los pacientes con síndrome inflamatorio multisistémico. La mortalidad fue de 4%. En 29,4% de problemas respiratorios y en 22,6% de síndrome inflamatorio multisistémico, se requirió de admisión en cuidados intensivos, lo que fue más frecuente que las otras presentaciones (p = 0,008).

Conclusiones
Se concluye que la población pediátrica vulnerable es aquella con comorbilidades preexistentes. La división de pacientes en nuestro estudio fue definida por la presentación, diagnóstico y complicaciones predominantemente con problemas respiratorios, y en pacientes oncológicos con COVID-19.

Authors: Jesús Domínguez Rojas[1,2], Matilde Estupiñan Vigil[1,2], Raquel Garcés-Ghilardi[1,2], Giancarlo Alvarado-Gamarra[1,2], Olguita del Águila[1,3], Adanida Flor Lope Tenorio[1,4], Carmen Cecilia Ayón Dejo[1,5], Kenny Chonlon Murillo[1,2], Sebastián Boluarte Baca[1,6], Angie Stapleton Herbozo[1,4], Ricardo Seminario Aliaga[1,2], Giuliana Reyes Florian[1,4], Diana Dávila Riega[1,2], Sarah Fernández Suárez[1,2], Álvaro Coronado Muñoz[7]

Affiliation:
[1] Departamento de Pediatría, Hospital Edgardo Rebagliati Martins, Lima, Perú
[2] Facultad de Medicina, Universidad Nacional Federico Villarreal, Lima, Perú
[3] Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
[4] Facultad de Medicina, Universidad Ricardo Palma, Lima, Perú
[5] Facultad de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
[6] Facultad de Medicina, Universidad San Martin de Porres, Lima, Perú
[7] Departamento de Pediatría, Centro de Ciencias de la Salud de la Universidad de Texas en Houston, Estados Unidos

E-mail: jesusdominguez24@gmail.com

Author address:
[1] Fray Angélico 238 Departamento 103
San Borja, Lima, Perú

Citation: Domínguez Rojas J, Estupiñan Vigil M, Garcés-Ghilardi R, Alvarado-Gamarra G, del Águila O, Lope Tenorio AF, et al. Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru. Medwave 2021;21(1):e8107 doi: 10.5867/medwave.2021.01.8107

Submission date: 6/10/2020

Acceptance date: 21/12/2020

Publication date: 20/1/2021

Origin: Not commissioned

Type of review: Externally peer-reviewed by three reviewers, double-blind

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  1. World Health Organization. Coronavirus disease (COVID-19) Weekly Epidemiological Update. Geneva: WHO; 2020. [On line]. | Link |
  2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239-1242. | CrossRef | PubMed |
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  4. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020 Jun;145(6):e20200702. | CrossRef | PubMed |
  5. Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City. J Pediatr. 2020 Aug;223:14-19.e2. | CrossRef | PubMed |
  6. Williams N, Radia T, Harman K, Agrawal P, Cook J, Gupta A. COVID-19 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review of critically unwell children and the association with underlying comorbidities. Eur J Pediatr. 2020 Sep 10:1–9. | CrossRef | PubMed |
  7. González-Dambrauskas S, Vásquez-Hoyos P, Camporesi A, Díaz-Rubio F, Piñeres-Olave BE, Fernández-Sarmiento J, et al. Pediatric Critical Care and COVID-19. Pediatrics. 2020 Sep;146(3):e20201766. | CrossRef | PubMed |
  8. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771–8. | CrossRef |
  9. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020 May 23;395(10237):1607-1608. | CrossRef | PubMed |
  10. Thabet F, Chehab M, Bafaqih H, Al Mohaimeed S. Middle East respiratory syndrome coronavirus in children. Saudi Med J. 2015 Apr;36(4):484-6. | CrossRef | PubMed |
  11. Capone CA, Subramony A, Sweberg T, Schneider J, Shah S, Rubin L, et al. Characteristics, Cardiac Involvement, and Outcomes of Multisystem Inflammatory Syndrome of Childhood Associated with severe acute respiratory syndrome coronavirus 2 Infection. J Pediatr. 2020;224:141–5. | CrossRef |
  12. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020 Sep 1;174(9):868-873. | CrossRef | PubMed |
  13. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;20(6):689–96. | CrossRef |
World Health Organization. Coronavirus disease (COVID-19) Weekly Epidemiological Update. Geneva: WHO; 2020. [On line]. | Link |

Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239-1242. | CrossRef | PubMed |

Ministerio de Salud de Perú, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades. Situación actual COVID 19 PERU-2020. 2020. [On line]. | Link |

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020 Jun;145(6):e20200702. | CrossRef | PubMed |

Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City. J Pediatr. 2020 Aug;223:14-19.e2. | CrossRef | PubMed |

Williams N, Radia T, Harman K, Agrawal P, Cook J, Gupta A. COVID-19 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review of critically unwell children and the association with underlying comorbidities. Eur J Pediatr. 2020 Sep 10:1–9. | CrossRef | PubMed |

González-Dambrauskas S, Vásquez-Hoyos P, Camporesi A, Díaz-Rubio F, Piñeres-Olave BE, Fernández-Sarmiento J, et al. Pediatric Critical Care and COVID-19. Pediatrics. 2020 Sep;146(3):e20201766. | CrossRef | PubMed |

Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771–8. | CrossRef |

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020 May 23;395(10237):1607-1608. | CrossRef | PubMed |

Thabet F, Chehab M, Bafaqih H, Al Mohaimeed S. Middle East respiratory syndrome coronavirus in children. Saudi Med J. 2015 Apr;36(4):484-6. | CrossRef | PubMed |

Capone CA, Subramony A, Sweberg T, Schneider J, Shah S, Rubin L, et al. Characteristics, Cardiac Involvement, and Outcomes of Multisystem Inflammatory Syndrome of Childhood Associated with severe acute respiratory syndrome coronavirus 2 Infection. J Pediatr. 2020;224:141–5. | CrossRef |

Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020 Sep 1;174(9):868-873. | CrossRef | PubMed |

Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;20(6):689–96. | CrossRef |