Dear Editor:

Coronavirus disease 2019 (COVID-19) affects more adults than children¹. Then the multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) was described, with an incidence peak of around 4 weeks after the peak of contagion Therefore, it is postulated that this is a postinfectious entity, which is characterized by affecting multiple organs and systems^2,3. In response to this new necessity, the Pediatric Intensive Care Unit (PICU) in Hospital Nacional Edgardo Rebagliati Martins provided a separate two-bed room for the care of children with SARS-CoV-2 infection to reduce the risk of nosocomial infections. In order to describe the clinical presentations associated with SARS-CoV-2 infection, it was conducted a retrospective evaluation of the electronic medical records of patients admitted to the COVID PICU from April to October 2020. Data were collected, such as serologic and molecular test for SARS-CoV-2, age, sex, nutritional status, admission priority⁴, length of stay in PICU, some comorbidity, and death. A three-group classification was carried out based on the clinical diagnosis and test results for SARS-CoV-2. COVID-19 group (acute respiratory distress syndrome (ARDS), record of contact with COVID-19 cases and testing for SARS-CoV-2); MIS-C group, according to WHO criteria⁵; and Non-COVID-19/Non-MIS-C group, patients admitted for a condition unrelated to SARS-CoV-2, but on suspicion of the disease, they had to go to the separate area. This last group has been divided into two subgroups: SARS-CoV-2(+) with at least one positive SARS-CoV-2 test, and SARS-CoV-2(-) subgroup.

The first patient was seen on April 20th and the last patient was released on October 23rd, 2020. Thirty-six patients were seen (Table 1), three patients (8.3%) had COVID-19, with acute respiratory affectation and two of them contracted the disease during their hospital stay in a non-COVID area. Thirteen patients (36.1%) had MIS-C, with hemodynamic impairment, and as reported in other studies, all had negative molecular test and positive serologic test, mainly IgG. One of the patients with a final diagnosis of MIS-C, who was the first seen, was admitted with a diagnosis of COVID-19 at the end of April, when the definition of MIS-C had not been disseminated, so the diagnosis was made after reviewing the clinical record. In Non-COVID-19/Non-MIS-C group (55.5%), in the SARS-CoV-2(+) subgroup (38.9%), the main problem of care was not related to the SARS-CoV-2 infection, but they were admitted to the COVID PICU to take precautionary measures against the possibility of spreading the infection. They were admitted as patients with suspected COVID-9 or suspected MIS-C that were finally ruled out; and in the SARS-CoV-2(-) subgroup (19. 4%), all were admitted for respiratory failure and suspected COVID-19, however, infection was ruled out and other causes were found to explain the respiratory problem, mostly related to comorbidity.

In our experience, we have mainly attended patients with suspicion and/or record of SARS-CoV-2 or MIS-C infection. Acute SARS-CoV-2 infectious disease, which can spread up to 10 days after symptom onset when mild or moderate, or up to 10-20 days when severe⁶, has been uncommon considering the magnitude of care in the adult population and could accelerate the normalization of care for other non-infectious diseases in the pediatric population affected by the pandemic.