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.

Introduction: Radiotherapy is an underutilized resource in pediatric palliative care; however, it is useful in relieving various symptoms at the end of life. Patients and methods: A retrospective study of 30 pediatric patients who received radiotherapy for palliative reasons is shown. The objective was to review whether radiotherapy was beneficial. Results: Radiotherapy was useful in relieving symptoms, showing an overall response in 87% of cases and with mild toxicities. The poorest responses were in gliomas with relief in 56% of cases showing toxicity in 89%. The need for anesthesia and irradiation at early ages were predisposing factors for the development of toxicities. Conclusions: The use of palliative radiotherapy is beneficial and should be included in the multidisciplinary management of the child in palliative care.

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.

Background: Controversy surrounds the routine use of urine culture (UC) in febrile neutropenic children. We aimed to evaluate the need for routine urine studies in febrile neutropenic children with cancer. Procedure: We conducted a prospective study of pediatric cancer patients with urinary continence who presented to the emergency department with febrile neutropenia between 2019 and 2021. Epidemiologic data and clinical and laboratory findings were collected. Urinary tract infection (UTI) was defined as urinary signs/symptoms and positive UC with or without pyuria. Study data were analyzed using descriptive statistics. The diagnostic performance of urinalysis was calculated using positive UC as the gold standard. Results: Positive UC was found in seven of the 205 children included (3.4%; 95% CI 1.4-6-9%), 2 presenting urinary symptoms. UTI prevalence was 1.0% (95% CI 0.1-3.5). A 23.8% prevalence of positive UC was found in patients with urinary symptoms and/or history of urinary tract disease (95% CI 8.2-47.2%) as compared to 1.1% of those without symptoms or history (95% CI 0.1-3.9%) (p<0.001). The sensitivity, specificity, negative predictive value, and area under the curve for urinalysis was 16.7% (95% CI 3.0-56.4), 98.4% (95% CI 95.3-99.4), 97.3% (95% CI 93.9-98.9), and 0.65 (95% CI 0.51-0.79), respectively. Conclusions: UTI is an infrequent cause of infection in these patients. Urinalysis is indicated only in febrile neutropenic children with urinary signs/symptoms and in asymptomatic patients with a history of urinary tract disease. When urine is collected, UC should be requested regardless of the result of the urinalysis.

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.