Pediatric COVID-19 Management Experience in 15 Hospitals in Bolivia

Abstract

Introduction: Pediatric Coronavirus Disease 2019 (COVID19) has a different behavior; severe cases represent 0.9 to 2.4%, with atypical presentations such as Pediatric Multisystemic Inflammatory Syndrome (PIMS) or toxic shock. Its management in resource-limited settings is based on scant scientific evidence. The present study aims to describe the pediatric therapeutic approach carried out in COVID-19 in different hospitals in Bolivia and mortality. Methods. A multicenter, observational study was carried out in 5 tertiary pediatric hospitals and 8 general hospitals. Cases confirmed by polymerase chain reaction (RT-PCR) or with sufficient clinical/ epidemiological criteria, admitted to the different collaborating establishments, were included. Results: 140 patients were included, 41 (29.3%) required management in a Pediatric Intensive Care Unit (PICU) or Intermediate care, with mortality in 18 cases (12.9%); Supportive treatment in PICU considered more frequently the use of macrolides (p=0.02), vancomycin (p=0.000), ivermectin (p=0.017), corticosteroids (p=0.035), enoxaparin (p=0.002), vasoactive drugs (p=0.009), less severe cases more frequently used antipyretics (p=0.016) and dexamethasone (p=0.011). Regarding mortality, a significant association is identified with progressive requirements of oxygen therapy (p=0.001), invasive ventilation (p=0.001), use of clindamycin (p=0.012), renal replacement therapy (p=0.006) and vasoactive drugs (p=0.000). Conclusion: Similarity is evident in other studies in children in terms of management, although the mortality of severe cases reaches 12.8%, it can be reduced by identifying the most useful treatments and avoiding those that do not show benefit; the limited number of patients makes it necessary to carry out larger controls and collaborations.