En julio de 2020 se constituyó el proyecto EPICO-AEP: “Estudio de las infecciones por el nuevo coronavirus (SARS-CoV-2) e influencia de los factores genéticos del huésped en población pediátrica”, un registro nacional multihospitalario de pacientes pediátricos afecta dos por COVID-19 durante la epidemia en España.
En el transcurrir de este año ya son 80 hospitales (de las 17 Comunidades Autónomas de España) los representados en EPICO-AEP y que han aportado su casuística a esta cohorte pediátrica con los siguientes criterios de inclusión:
- Pacientes menores de 18 años hospitalizados
- Clínica compatible con COVID-19 más infección confirmada por SARS-CoV-2 por PCR o test antigénico rápido PanBio o MIS-C según criterios de la OMS
- Consentimiento informado por parte de sus padres o tutores.
Y ya hemos publicado que gracias a este trabajo colaborativo, ya son varias las publicaciones científicas que se han publicado en relación a la infección SARS-CoV-2 en la edad pediátrica. Y hoy compartimos el último trabajo, publicado en Eur J Pediatr bajo el título de “Clinical spectrum of COVID‑19 and risk factors associated with severity in Spanish children”. Os dejamos el artículo debajo, así como el resumen del artículo:
“We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-infammatory syndrome (MIS-C) younger than 18 years old, attended during the frst year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild síndrome (including upper respiratory tract infection and fu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma fare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma fare.
Conclusion: Hospitalised children with COVID-19 usually present as one of fve major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of infammation biomarkers, asthma, moderate or severe live disease and cardiac disease.
What is Known: All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifable syndromes and the severity associated with them.
What is New: We have gathered the primary diagnoses into fve major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classifcation of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to defne the spectrum of the disease instead of just describing symptoms and signs.
Solo de la suma de un gran número de pacientes recogidos en un estudio multicéntrico como el presente es posible disponer de un tamaño muestral que nos devuelve resultados válidos desde el punto de vista de la investigación y relevantes en relación a su importancia clínica.
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