Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain.

BACKGROUND: Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. METHODS: A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. RESULTS: Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. CONCLUSIONS: MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

Trombosis venosa profunda secundaria a canalización de vena femoral en niños con cetoacidosis diabética / Deep venous thrombosis secondary to femoral vein catheterization in children with diabetic ketoacidosis

Los niños ingresados por cetoacidosis diabética (CAD) suelen manejarse con vías periféricas; sin embargo, algunos pacientes necesitan un catéter central para el manejo inicial. Es sabido que la CAD implica un estado de hipercoagulabilidad que supone un aumento del riesgo de trombosis asociada a catéter. Se presentan 2 casos de trombosis femoral asociada a canalización de vena femoral coincidiendo con cetoacidosis diabética en lactantes de 18 y 27 meses. En ambos la trombosis fue precoz (antes de 72 h tras la inserción) y se desarrolló a pesar de la rápida retirada de la vía central (menor de 48 h). Debido al alto riesgo de trombosis asociada a catéter en los pacientes diabéticos más pequeños (menores de 3 años), debe considerarse individualmente la necesidad de catéter central y evitarlo siempre que sea posible. En caso de canalización, debe valorarse la profilaxis con heparina de bajo peso molecular (AU)

Children admitted to hospital for diabetic ketoacidosis are frequently managed with peripheral venous lines. However, due to the severity of their illness, some patients need central lines for initial treatment. Diabetic ketoacidosis is known to produce hypercoagulability, increasing the risk of catheter-related deep venous thrombosis. We present two patients with diabetic ketoacidosis, aged 18 and 27 months, who developed deep venous thrombosis after placement of femoral central venous catheters. In both patients, the thrombosis occurred within 72 hours of catheter insertion, despite rapid removal of the central lines (less than 48 hours). Due to the high risk of catheter-related thrombosis in patients with diabetic ketoacidosis (especially in children aged less than 3 years old), the need for central venous lines should be evaluated in each patient and avoided as far as possible. Low molecular weight heparin prophylaxis should be considered if a venous central catheter is required (AU)