COVID-19 and Multisystem Inflammatory Syndrome in Latin American Children

  1. Omar Yassef Antúnez-Montes
  2. Maria Isabel Escamilla
  3. Augusto Flavio Figueroa-Uribe
  4. Erick Arteaga-Menchaca
  5. Manuel Lavariega-Saráchaga
  6. Perla Salcedo-Lozada
  7. Priscilla Melchior
  8. Rodrigo Beréa de Oliveira
  9. Juan Carlos Tirado Caballero
  10. Hernando Pinzon Redondo
  11. Laura Vanessa Montes Fontalvo
  12. Roger Hernandez
  13. Carolina Chavez
  14. Francisco Campos
  15. Fadia Uribe
  16. Olguita del Aguila
  17. Jorge Alberto Rios Aida
  18. Andrea Parra Buitrago
  19. Lina Maria Betancur Londoño
  20. León Felipe Mendoza Vega
  21. Carolina Almeida Hernández
  22. Michela Sali
  23. Julian Esteban Higuita Palacio
  24. Jessica Gomez-Vargas
  25. Adriana Yock-Corrales
  26. Danilo Buonsenso

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Abstract

To date, there are no comprehensive data on pediatric COVID-19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Latin American children, to appropriately plan and allocate resources to face the pandemic on a local and international level.

Methods:

Ambispective multicenter cohort study from 5 Latin American countries. Children 18 years of age or younger with microbiologically confirmed SARS-CoV-2 infection or fulfilling MIS-C definition were included.

Findings:

Four hundred nine children were included, with a median age of 3.0 years (interquartile range 0.6–9.0). Of these, 95 (23.2%) were diagnosed with MIS-C. One hundred ninety-one (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a pediatric intensive care unit. Ninety-two (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure and 29 (7%) on mechanical ventilation. Thirty-five (8.5%) patients required inotropic support. The following factors were associated with pediatric intensive care unit admission: preexisting medical condition ( P < 0.0001), immunodeficiency ( P = 0.01), lower respiratory tract infection ( P < 0.0001), gastrointestinal symptoms ( P = 0.006), radiologic changes suggestive of pneumonia and acute respiratory distress syndrome ( P < 0.0001) and low socioeconomic conditions ( P = 0.009).

Conclusions:

This study shows a generally more severe form of COVID-19 and a high number of MIS-C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hispanic children or in people of lower socioeconomic level. The findings highlight an urgent need for more data on COVID-19 in Latin America.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.29.20184242: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was reviewed and approved by the CoviDOMINGO core group and approved by the Ethic Committee of the coordinating center and by each participating center (Mexico: COMINVETICA-30072020-CEI0100120160207; Colombia: PE-CEI-FT-06; Perù: N° 42-IETSI-ESSALUD-2020; Costa Rica: CEC-HNN-243-2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were collected on Excel spreadsheets completed by each collaborator and sent to two study core group members via email (DB and OYAM), without including personal or identifiable data.
    Excel
    suggested: None
    Statistical analyses: Data were analyzed using SPSS (SPSS, Chicago, IL).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations to address. The main limitation of this study relates to the variables collected. As happened during a multinational European study, this one was performed during the Latin American peak with clinicians struggling in the front-line, usually with limited human resources to dedicate extra time for clinical research. For example, detailed blood tests were not collected. However, at this time of the pandemic enough laboratory data on pediatric COVID-19 have been published and we think that a first, large, multinational picture of SARS-CoV-2 infection in Latin American children was more important than smaller, more detailed studies. Also, the different centers may have used different decision rules to perform SARS-CoV-2 test in children. Another limitation concerns MIS-C cases. Since MIS-C is a clinical diagnosis with no confirmatory test, and that the CDC case definition is broad, some cases may have been misdiagnosed and, therefore, the real MIS-C cases being lower or higher. For example, some severe cases of acute COVID-19 may overlap with MIS-C. Also, some details about MIS-C were not included in our data collection, including the possible skin, renal and neurological involvement during MIS-C. Despite these limitations, this study provides the most comprehensive overview on COVID-19 in South American children to date. In conclusion, our study adds new data about the Latin American face of the pediatric SARS-CoV-2 pandemic, describing a generally ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1097/inf.0000000000002949
  3. Version published to 10.1101/2020.08.29.20184242v1 on medRxiv