ABSTRACT
Ground. The sudden outbreak of the covid-19 pandemic resulted in a need to start coordinated research projects on the disease. The creation of the COPEDI-CAT group (July 2020;more than 170 professionals) to study pediatric covid-19 in Catalonia represents a good example of this effort. Objective. To disseminate the results of the COPEDI-CAT group to show the feasibility of a quality muftidisciplinary research strategy with wide participation of primary care (PC). Method. Review of the scientific production of the COPEDI-CAT group generated by a muftidisciplinary team. The group reviewed ongoing studies and collected data, proposed new projects, implemented interventions recommended by expert professionals (local, national, and international), and created a space for debate and monitoring of the pandemic. Results. The main questions about the symptoms, transmissibility, severity, and main complications of covid-19 in pediatrics (multisystem inflammatory syndrome and long covid-19) have been addressed. This research has generated papers at national and international conferences, high-impact scientific publications, recommended clinical guidelines for the management of long covid-19, clinical prediction models, research grants (Prandi and Marató TV3 scholarship) and the participation in the «Escoles Sen-tinella» project. Conclusions. The covid-19 pandemic has represented a unique opportunity to carry out quality multidisciplinary research in pediatrics at PC. COPEDI-CAT can be a model for future research on diseases that affect children and adolescents in our country.
ABSTRACT
Long COVID in pediatrics is a rare but real entity. It mainly affects adolescents who after infection with the SARS-CoV-2 virus present a complex group of symptoms for more than 8 weeks. The most common symptom is both physical and mental fatigue, which can significantly affect the quality of life, limiting school and social activity. Dyspnea, chest pain, or autonomic nervous system disorders with tachycardia or orthostatic hypotension are also frequently described. It is important to diagnose these cases early by the Primary Care pediatrician and offer support (believe what they explain, accompany them), identify symptoms and signs of severity, rule out other diseases, review referral criteria and assess whether they require symptomatic treatment and rehabilitation. The purpose of this guide is to make an adaptation for the pediatric population of Long COVID management guidelines published in adults. © 2021, Ediciones Ergon SA. All rights reserved.
ABSTRACT
The SARS-CoV-2 pandemic has given us many reflections and an uncertain future. But it has also been an opportunity to open to new challenges in paediatric research. In Catalonia, a multidisciplinary research group (COPEDI-CAT) formed by hospital and primary care paediatricians and physicists from the Computational Biology and Complex Systems Unit (BIOCOM-SC) of the Polytechnic University of Catalonia was set up to answer some of the unknowns about SARS-CoV-2 infection in the paediatric age group. In a first study, at the beginning of the pandemic, we demonstrated that children and adolescents were not the driving force behind the spread of the virus: 70% of the positive cases were transmitted by a cohabiting adult and only 7.7% were index cases within the family nucleus. In another study on the transmission of the virus in school bubble groups, we found that 75% of the positive cases did not infect any of their peers. We also found that most of the children and adolescents were asymptomatic or had mild COVID-19 and were progressing favourably. Hospitalisations and complications are described but are very rare. In the fifth wave, the SARS-CoV-2 delta variant has affected significantly more children (20%) than in previous waves. Thanks to the effort and investment made, research has borne fruit and we now have effective and safe vaccines. Vaccines have put us in a much more optimistic scenario, but with all the scientific information available and with the predominant delta variant, it is inevitable to ask whether vaccination in children under 12 years of age could be of benefit to them and to the general population. At the moment, we have no results on efficacy, safety and immunity in this age group and, of course, no authorisation from international health organisations such as the WHO, EMA and FDA. For now, we should insist on the responsibility of adults to be fully vaccinated before making decisions on vaccination strategies for the very young. It seems reasonable to delay and be cautious with vaccination in the population below 12 years of age. © 2021, Spanish Association of Primary Care Pediatrics. All rights reserved.
ABSTRACT
Background: This study aimed to identify the different syndromes presented in hospitalized children with SARS-CoV-2, to analyze if the clinical features and biomarkers confer different risk depending on the syndromes, and to create a predictive model to anticipate the probability of the need for critical care Methods: We conducted a multicenter, prospective study of children aged 0 to 18 years old with SARS-CoV-2 infection in 52 Spanish hospitals. The primary outcome was the need for critical care: defined as the combined outcome of admission into a PICU, and/or need for respiratory support beyond nasal prongs. To understand the probability of needing critical care according to the diagnostic group and for each risk factor, a Bayesian multivariable model was applied. To build a predictive model of critical care, a naïve Bayes algorithm was implemented in a web app. Results: 292 children were hospitalized from March 12th, 2020 to July 1st, 2020;Of them, 214 (73.3%) were considered to have relevant COVID-19 (r-COVID-19). Among patients with r-COVID-19, 24.2% needed critical care. Out of 214 patients, 22.4% were admitted into a pediatric intensive care unit, 41.6% required respiratory support, and 38.8% presented complications (mostly cardiological). Four patients (1.8%) died, all of them had severe comorbidities. We identified 11 primaries diagnoses and grouped them into 4 large syndromes of decreasing severity: MIS-C (17.3%), bronchopulmonary (51.4%), gastrointestinal (11.6%), and mild syndrome with complications (19.6%). In the predictive model, the predictors with higher relative importance were high C-reactive protein, anemia, lymphopenia, platelets <220 000/mm3, type of syndrome, high creatinine, and days of fever. The different risk factors increase the risk differently depending on the patient's syndrome: the more severe the syndrome, the more risk the factor confers. We developed an online risk prediction tool to quantify the risk of critical disease (https://rserver.h12o. es/pediatria/EPICOAPP/, username: user, password:0000) Conclusion: We described the spectrum of r-COVID-19 in hospitalized children, consisting of 4 large syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, and a mild syndrome with complications. The risk factors increase the risk differently depending on the syndrome. A Bayesian model was implemented in an online app to anticipate the individual risk of critical care.