The EPICO-SEHOP platform gathers data from children with SARS-CoV-2 in Spain, allowing comparison between children with cancer or allogeneic hematopoietic stem cell transplantation (alloHSCT) and those without. The infection is milder in the cancer/alloHSCT group than in children without comorbidities (7.1% vs. 15%), except in children with recent alloHSCT (less than 300 days), of which 35.7% experienced severe COVID-19. These data have been shared with the SEHOP members to support treatment and isolation policies akin to those for children without cancer, except for those with recent alloHSCT or additional comorbidities. This highlights the collaborative registries potential in managing pandemic emergencies.

Background: Despite advancements in vaccination and the transition from pandemic to endemic, SARS-CoV-2 continues to pose a medical challenge, particularly among children. In this context, imaging diagnostics, such as chest x-rays, are crucial to the initial treatment of patients. This study aims to characterize the radiological findings in pediatric patients with confirmed SARS-CoV-2 infection in Colombia between April 2020 and November 2021, as well as their potential association with intensive care admission. Methods: In Colombia, a multicenter cohort comprised patients aged 29 days to 17 years with confirmed SARS-CoV-2 infection and chest X-ray administered within 72 hours of hospitalization. In two separate groups, four radiologists evaluated the images. A fifth radiologist reviewed all the X-rays; and subsequently, these readings were used to calculate the kappa coefficient and to resolve discrepancies among the other radiologists. The results were compared to admission to intensive care. Results: Analysis was conducted on 392 patients with a mean age of 2 years, the majority of whom (42%) were infants. Sixty-eight percent of the radiographs had normal results. Peribronchial thickening and interstitial opacity were the most common aberrant findings (59%), followed by alveolar opacity (12%). 88 percent of findings were bilateral. The most common association between peribronchial thickening and intensive care admission was ventilatory failure. Interobserver agreement was low for peribronchial thickening (kappa = 0.1), but higher for consolidations and alveolar opacities (kappa = 0.4 and 0.5, respectively). Conclusion: In pediatric patients with SARS-CoV-2, radiological findings are nonspecific and interobserver agreement is minimal. Although consolidation and alveolar opacities demonstrated greater concordance, they were not associated with clinical differences; therefore, chest radiography is not considered useful for determining the severity of COVID-19 in children.

Background: SARS-CoV-2 infection has been extensively documented since the onset of the pandemic, particularly in the adult population. However, there is a lack of evidence describing the phenotypic manifestations of the disease in the pediatric population. We aimed to characterize the clinical phenotypes of SARS-CoV-2 infection in hospitalized children. Methods: The EPICO study is a multicenter cohort conducted between April 2020- November 2021, involving 55 institutions in Spain and 13 institutions in Colombia. Hospitalized children aged 29 days to 17 years with confirmed SARS-CoV-2 infection were included to determine the disease´s evolution, severity factors, and outcomes. Cluster analysis was conducted to characterize clinical phenotypes. Results: A total of 2318 patients from Colombian and Spanish institutions were included. The population was 55% male, with infants being the largest group (36%). Five distinct phenotype clusters emerged, differing significantly in clinical and epidemiological characteristics. Cluster 1 (26.57%) consisted of infants without comorbidities, with low PICU admission and mortality rates. Cluster 2 (18.5%) had respiratory comorbidities, high co-detection, and mortality rates. Cluster 3 (11.51%) showed fever, gastrointestinal symptoms, and high PICU admission. Cluster 4 (32.09%) had mild unspecific symptoms and low mortality. Cluster 5 (11.3%) included adolescents without comorbidities, with low co-detection and hospitalization rates. Comparable findings were observed in both countries. Conclusion: Our study successfully identified distinct patterns of clinical and epidemiological characteristics associated with SARS-CoV-2 infection in hospitalized pediatric patients. These findings may help shape future guidelines and improve risk stratification in children.

Pneumonia is a frequent manifestation of COVID-19 in hospitalized children. Methods The study involved 80 hospitals in the SARS-CoV-2 Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from 2012 to 2019. Results In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP included. Main clinical features of SARS-CoV-2-associated CAP were cough 117/151(77%), fever 115/151(76%) and dyspnea 63/151(46%); 22/151(15%) patients were admitted to a pediatric intensive care unit (PICU), and 5/151(3%) patients died. Lymphopenia was found in 63/147(43%) patients. Chest X-ray revealed condensation (64/151[42%]) and other infiltrates (87/151[58%]). Compared with CAP from other viral pathogens, COVID-19 patients were older (8 vs.1 year; odds ratio [OR] 1.42 [95% confidence interval, CI 1.23;1.42]), with lower CRP levels (23 vs.48 mg/L; OR 1 [95%CI 0.99;1]), less wheezing (17 vs.53%; OR 0.18 [95%CI 0.11;0.31]) and greater need of mechanical ventilation, MV (7 vs.0.7%, OR 10.8 [95%CI 1.3;85). Patients with non-SARS-CoV-2-associated CAP had a greater need for oxygen therapy (77 vs.44%, OR 0.24 [95%CI 0.14;0.40]). There were no differences in the use of CPAP or HVF or PICU admission between groups. Conclusion SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap, and differentiating the etiology may be difficult. The overall prognosis is good.

Objetives. To perform a description of the etiology of hospitalized children with community-acquired pneumonia (CAP) in Spain and analyze predictors related to etiology. Hypothesis. The different etiological groups of pediatric CAP are associated to different clinical, radiographic and analytical data. Design. Observational, multi-center, prospective study. Patient selection. Patients from 1 month to 17 years admitted because of CAP from April 2012 to May 2019. Methods. An extensive microbiological workup was done. Clinical, radiographic and analytical parameters were analyzed in order to differentiate viral, atypical bacteria (AB) and typical bacteria (TyB) pneumonia. Results. 495 children were enrolled. At least one likely causative pathogen was identified in 262 (52.9%). Pathogenic viruses in 155/262 (59.2%), AB in 84/262 (32.1%) and TyB in 40/262 (15.3%). Consolidation was found in 89/138 (64.5%) CAP attributed to virus only, in 74/84 (88.1%) of CAP attributed to AB and 40/40 (100%) of CAP attributed to TyB. Para-pneumonic pleural effusion (PPE) was found in 112/495 (22.6%) patients, 61/112 (54.5%) with a likely causative pathogen: virus 12/61 (19.7%), AB 23/61 (37.7%) and TyB 26/61 (42.6%). Viral etiology was significantly more frequent in younger patients and those with lower oxygen saturation, wheezing, no-consolidation and higher lymphocyte counts. Patients with AB were significantly more likely to have more days of fever at admission and a higher rate of use of antibiotics before admission. Conclusions. Viruses and AB are the main cause of pediatric CAP in Spain. Wheezing, younger age and no-consolidation on the X-ray support viral etiology. Viruses and AB can also cause PPE. The use of antibiotic in pediatric CAP can be restricted.