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.

Introduction Pediatric critical care patients with COVID-19 treated in Peru have higher mortality than those previously reported from other countries. Pediatric providers have reported a high number of patients without comorbidities presenting with hemorrhagic strokes associated with COVID-19. We present a study analyzing the factors associated with mortality in this setting. Methods Prospective case–control study that included patients <17 years old admitted to a pediatric critical care unit with a positive test confirming COVID-19. The primary outcome was mortality. Fisher’s exact test and the Mann–Whitney U test were used for the analysis. Results Forty-seven patients were admitted to critical care. The mortality of our study is 21.3%. The mortality of patients with neurological presentation was 45.5%, which was significantly higher than the mortality of acute COVID-19 (26.7%) and MIS-C (4.8%), p 0.18. Other risk factors for mortality in our cohort were strokes and comorbidities. Only one patient presenting with hemorrhagic stroke had an undiagnosed comorbidity. Conclusion Cerebrovascular events associated with COVID-19 in pediatric patients, including infants, must be recognized as one of the more severe presentations of this infection in pediatric patients. Impact Pediatric patients with COVID-19 can present with hemorrhagic and ischemic strokes on presentation. Neurological presentation in pediatric patients with COVID-19 has high mortality. Mortality of pediatric patients with COVID-19 is associated with comorbidities. Pediatric presentation and outcomes of COVID-19 in different regions can be novel to previously described.

Introduction: Pediatric critical care patients with COVID-19 treated in Peru have higher mortality than those previously reported from other countries. Pediatric providers have reported a high number of patients without comorbidities presenting with hemorrhagic strokes associated with COVID-19. We present a study analyzing the factors associated with mortality in this setting.Methods: Prospective case-control study that included patients < 17 years old admitted to a pediatric critical care unit with a positive test confirming COVID-19. The primary outcome was mortality, and secondary outcomes were laboratory results and length of stay. Fisher’s exact test and the Mann-Whitney U test were used for the analysis.Results: Forty-seven patients were admitted to critical care. The mortality of our study is 21.3%. The mortality of patients with neurological presentation was 45.5%, which was significantly higher than the mortality of acute COVID-19 (26.7%) and MIS-C (4.8%), p 0.18. Other risk factors for mortality in our cohort were strokes and comorbidities. Only one patient presenting with hemorrhagic stroke had an undiagnosed comorbidity.Conclusion: Cerebrovascular events associated with COVID-19 in pediatric patients, including infants, must be recognized as one of the more severe presentations of this infection in pediatric patients.

Resumen: El objetivo de este trabajo fue presentar una serie de casos de COVID-19 con manifestacionesextra pulmonares atípicas de la enfermedad. Los casos fueron evaluados por un equipo interdisciplinario de personal de la salud del Departamento de Pediatría del Hospital Edgardo Rebagliati Martins, de pacientes pediátricos con Covid-19, posteriormente los datos fueron tomados de la historia clínica de cada paciente. Se evaluaron tres casos, con desenlace satisfactorio. La pandemia por SARS-CoV-2 cada día cobra más vidas, por lo que se hace necesario la descripción de casos y su diversa variedad de presentación extrapulmonar, con el fin de identificar oportunamente a los infectados y tomar medidas tanto terapéuticascomo de prevención con el fin de evitar la propagación de la enfermedad y lograr su control.

El síndrome inflamatorio multisistémico pediátrico asociado a COVID-19 (SIM-C) es una entidad poco frecuente y heterogénea, potencialmente fatal. Existen pocos reportes de casos de esta enfer- medad y de sus fenotipos en Latinoamérica. Objetivo: Describir las características de los fenotipos clínicos en pacientes hospitalizados en Lima, Perú, con diagnóstico de SIM-C. Pacientes y Método: Estudio retrospectivo de pacientes < 14 años con diagnóstico de SIM-C en el Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú, abril 2020 - agosto 2021. Se registraron variables clínico- demográficas y microbiológicas. Según éstos, se clasificó a los pacientes con SIM-C en el fenotipo shock, enfermedad de Kawasaki (EK) sin shock, y el fenotipo fiebre e inflamación, analizando sus re- sultados clínicos. Resultados: Se incluyeron 58 pacientes, 32 (55,2%) presentaron el fenotipo shock, 15 (25,8%) el fenotipo EK sin shock, y 11 (19%) el fenotipo fiebre e inflamación. Del fenotipo shock, 17 presentaron EK. La edad media fue de 7 ± 3,5 años y el 67,2% eran varones. Las manifestaciones gastrointestinales y mucocutáneas predominaron en todos los fenotipos. La mortalidad fue de 3,5%. La frecuencia de aneurismas coronarios fue del 10,2%. La mayoría de los pacientes recibió trata- miento inmunomodulador y antiplaquetario. Los pacientes con fenotipo shock presentaron mayor disfunción hematológica, inflamatoria y cardiaca, con mayor frecuencia de insuficiencia respiratoria y ventilación mecánica invasiva. Conclusiones: En nuestra serie de casos, los pacientes con fenotipo shock fueron los más frecuentes y presentaron peores desenlaces clínicos. Se necesita una vigilancia activa de los fenotipos clínicos para un diagnóstico y manejo precoz con el fin de mejorar el pronós- tico en estos pacientes.