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Introduction: Endemic coronaviruses have been found in acute bronchiolitis, mainly as a coinfecting virus. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for respiratory illness in hospitalized children. The characteristics of patients with bronchiolitis have not been extensively described. Methods: Cross-sectional study of patients with bronchiolitis and SARS-CoV-2 infection enrolled in a prospective multicenter cohort of children hospitalized with COVID-19 in Spain from March 1, 2020 to February 28, 2021. Results: Twelve of 666 children infected with SARS-CoV-2 who required hospital admission met the diagnostic criteria for bronchiolitis (1.8%). Median age was 1.9 months (range: 0.4-10.1). Six cases had household contact with a confirmed or probable COVID-19 case. Main complaints were cough (11 patients), rhinorrhea (10), difficulty breathing (8), and fever (8). Eleven cases were classified as mild or moderate and one as severe. Laboratory tests performed in seven patients did not evidence anemia, lymphopenia, or high C-reactive protein levels. Chest X-rays were performed in six children, and one case showed remarkable findings. Coinfection with metapneumovirus was detected in the patient with the most severe course; Bordetella pertussis was detected in another patient. Seven patients required oxygen therapy. Albuterol was administered in four patients. One patient was admitted to the pediatric intensive care unit. Median length of admission was 4 days (range: 3-14). No patient died or showed any sequelae at discharge. Two patients developed recurrent bronchospasms. Conclusion: SARS-CoV-2 infection does not seem to be a main trigger of severe bronchiolitis, and children with this condition should be managed according to clinical practice guidelines. Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) 4.090 JCR (2021) Q1, 21/130 Pediatrics 0.927 SJR (2021) Q1, 49/320 Pediatrics, Perinatology and Child Health No data IDR 2021 UEM

Introduction: Acute focal bacterial nephritis is an interstitial bacterial infection, localised in the renal parenchyma, which can be more serious than acute pyelonephritis. The aim of this study is the analysis of predictive factors that may lead to its early diagnosis, which is essential for an adequate therapeutic approach. Patients and methods: A retrospective, multicentre case and control study. The participant centres were hospitals in Castellon and Valencia. The study period was 2010–2018, with the cases being patients with focal bacterial nephritis and the patients with pyelonephritis as controls. Results: A total of 158 (1:1) patients were included. The median age of the cases was 2 years and there were 75% females. There were no differences in the clinical presentation. In the univariate analysis, focal nephritis was associated with malformations of the urinary tract, bacteraemia, the neutrophil count, and procalcitonin, as well as febrile convulsions of borderline significance. Procalcitonin values ≥2 ng/mL had an OR of 4.9 (95% CI; 1.77–13.85) of presenting with focal nephritis. In the multivariate analysis, the urological malformations still maintained statistical significance and borderline significance for procalcitonin. Conclusions: The urinary tract malformations predispose the development of focal bacterial nephritis. In patients with a urinary tract infection and predictive factors of acute focal bacterial nephritis it would be worthwhile performing a renal Doppler ultrasound in the acute phase for its appropriate diagnosis and treatment. Resumen: Introducción: La nefritis focal bacteriana aguda es una infección intersticial bacteriana, localizada en el parénquima renal, que entraña mayor gravedad que la pielonefritis aguda. El objetivo del estudio es el análisis de factores predictivos que permitan su diagnóstico precoz, fundamental para un adecuado abordaje terapéutico. Pacientes y métodos: Estudio multicéntrico de casos y control retrospectivo. Centros participantes: hospitales de Castellón y Valencia. Periodo de estudio: 2010-2018. Casos: nefritis focal bacteriana. Controles: pielonefritis aguda. Resultados: Se incluyó a un total de 158 pacientes (1:1). La mediana de edad de los casos fue 2 años. El 75% de sexo femenino. No existieron diferencias en la presentación clínica. En el análisis univariante la nefritis focal se relacionó con malformaciones del tracto urinario, bacteriemia, recuento de neutrófilos y la procalcitonina, así como las convulsiones febriles en el límite de la significación. Valores de procalcitonina ≥ 2 ng/mL tiene una OR de 4,9 (IC del 95: 1,77-13,85) de presentar nefritis focal. En el análisis multivariante las malformaciones urológicas mantuvieron la significación estadística y la procalcitonina en el límite de la significación. Conclusiones: Las malformaciones del tracto urinario predisponen al desarrollo de nefritis focal bacteriana. Ante pacientes con infección del tracto urinario y factores predictivos de nefritis focal bacteriana aguda, sería recomendable la realización de una ecografía Doppler renal en fase aguda para un diagnóstico y un tratamiento adecuado.

Objectives: To evaluate electrocardiogram markers to predict coronary involvement in patients with Kawasaki disease by assessing measures of ventricular repolarization parameters on the 12-lead electrocardiogram. Study design: This cross-sectional study included 180 Spanish and Japanese patients ≤14 years of age with Kawasaki disease, with or without coronary involvement, from 2011 to 2016. We manually measured the Tp-Te/QT ratio and QTc interval (with Bazett's formula) in 12-lead electrocardiogram in the acute and recovery period and explored their potential association with coronary involvement. Results: No association was found between Tp-Te/QT ratio obtained manually in V5 and V6 leads and coronary involvement in the acute (V5:0.25 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .80; V6:0.24 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .86) or the recovery (V5: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.19-0.25], P = .68; V6: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.17-0.25], P = .50) period. By contrast, QTc in V5 and V6 was significantly lower in patients with Kawasaki disease and coronary involvement in the acute period (V5: 378 ms [IQR, 364-395 ms] vs 390 ms [IQR, 371-411 ms], P = .04; V6: 377 ms [IQR, 364-392 ms] vs 390 ms [IQR, 371-410 ms], P = .01). A QTc interval of

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Malaltia de Kawasaki (KD); Nens Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Enfermedad de Kawasaki (KD); Niños Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Kawasaki disease (KD); Children Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1–May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV–) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified. CG is funded by the Spanish Ministry of Science and Innovation—Instituto de Salud Carlos III and Fondos FEDER (Contrato Río Hortega CM19/00015).

Background: Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analysed the effects of steroids, intravenous immunoglobulin (IVig), and their combination on the probability of discharge over time, probability of switching to second-line treatment over time, and persistent fever after 2 days of treatment. Methods: We did a retrospective study to investigate the effect of treatments (IVig plus steroids, steroids alone or IVig alone) on children with MIS-C from 1 March to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Findings: 30/132 (22·7%) patients were initially treated with steroids alone, 29/132 (21·9%) with IVig alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVig than with IVig plus steroids (hazard ratio [HR] 1·65, 95% CI 1·11–2·45, p=0·013), but with a higher probability of needing second-line therapy versus IVig plus steroids (HR 3·05, 95% CI 1·12-8·25, p=0·028). Patients on steroids had a lower probability of persistent fever after 2 days of treatment (odds ratio [OR] 0·55, 95% CI, 0·28–1·05, p=0·081) versus patients on IVig plus steroids, and those on the combination had a lower probability versus IVig alone (OR 0·21, 95% CI, 0·09–0·46, p=0·0001). Interpretation: The benefits of each approach may vary depending on the outcome assessed. IVig seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever after 2 days of treatment, and combination therapy reduced the need for escalating treatment. Funding Information: Instituto Salud Carlos III, PI20/00095, SERMAS-Fundacion para la Investigacion Biomedica Hospital 12 de Octubre, Spanish Society of Paediatrics, SERMAS-Fundacion para la Investigacion Biomedica Hospitales Infanta Sofia y Henares, Fundacion Universidad Europea de Madrid. Declaration of Interests: No conflicts of interest. Ethics Approval Statement: The study was approved by the Ethics Committee of Hospital 12 de Octubre, Madrid (code 20/101), and other participating hospitals. Participants were enrolled after signed or verbal consent from parents/guardians and by the consent of patients older than 12 years.

Resumen Introduccion El objetivo es analizar el impacto de la pandemia COVID-19 en las urgencias e ingresos hospitalarios pediatricos. Metodos Estudio de cohortes retrospectivo, de los pacientes atendidos en un hospital terciario, desde el 14 de marzo hasta el 26 de abril de 2020 comparandose con el mismo periodo de los 3 anos anteriores. Resultados Se observa una notable reduccion global de las visitas a urgencias e ingresos en todas las areas pediatricas, manteniendose la asistencia en neonatologia y los ingresos programados en oncologia. Discusion La reduccion de la actividad global en la urgencia pediatrica no es solo explicable por la disminucion de las enfermedades transmisibles. Ha podido contribuir la disminucion de la demanda inadecuada y de los ingresos inapropiados. La disponibilidad de camas pediatricas haria innecesaria la reduccion de la actividad quirurgica programada y permitiria redistribuir recursos a areas con mayor presion asistencial.

We conducted a multicenter clinical validity study of the Panbio coronavirus disease 2019 Antigen Rapid Test of nasopharyngeal samples in pediatric patients with coronavirus disease 2019-compatible symptoms of ≤5 days of evolution. Our study showed limited accuracy in nasopharyngeal antigen testing: overall sensitivity was 45.4%, and 99.8% of specificity, positive-predictive value was 92.5%.

Introduction: Juvenile recurrent chronic parotitis (JRCP) is a rare disease of unknown cause. There is a growing interest in its autoimmune aetiology and its relationship with dysfunctions of cellular and humoral immunity, although there is no agreed protocol for complementary investigations for its study. A consecutive series of cases is presented where the immune alterations and associated autoimmune disorders are investigated, proposing a study algorithm. Patients and methods: A retrospective study was carried out on patients who had JRCP during the period from 2013 to 2016 and a follow-up of at least 2 years. After its clinical and ultrasound diagnosis, complementary examinations were systematically carried out to investigate infectious, immune, and autoimmune diseases. Results: Of a total of 36 patients with inclusion criteria, 16 (44%) were found with some analytical alteration of a non-specific immunological nature (positive ANA, high IgG, low complement factor 4), or associated with a specific diagnosis, as occurred in 11 patients: Selective IgA deficiency (2), Sjögren’s syndrome associated or not with systemic lupus erythematosus (3), coeliac disease associated or not with diabetes mellitus (4), Hashimoto’s thyroiditis (1), and acquired immunodeficiency syndrome (1). Conclusion: Juvenile recurrent chronic parotitis can be considered a sentinel sign of other diseases of immunological/autoimmune aetiology for which the diagnosis, monitoring and early treatment can improve its prognosis. Viral infectious aetiology, with the exception of HIV, is not a priority in the study of recurrences. Resumen: Introducción: La parotiditis crónica recurrente juvenil (PCRJ) es una enfermedad infrecuente de causa desconocida. Existe un creciente interés por su etiología autoinmune y su relación con disfunciones de la inmunidad celular y humoral aunque no existe un protocolo consensuado de investigaciones complementarias para su estudio. Se presenta una serie consecutiva de casos donde se investigan las alteraciones inmunes y trastornos autoinmunes asociados, proponiendo un algoritmo de estudio. Pacientes y métodos: Se realizó un estudio retrospectivo de pacientes que presentaron PCRJ durante el periodo de 2013 a 2016 y seguimiento de al menos 2 años. Tras su diagnóstico clínico y ecográfico se realizaron de forma sistemática exámenes complementarios para investigación de patologías infecciosas, inmunes y autoinmunes asociadas. Resultados: De un total de 36 pacientes con criterios de inclusión, se encontraron 16 (44%) con alguna alteración analítica de carácter inmunológico inespecífico (ANA positivo, IgG elevada, factor 4 del complemento bajo) o asociada a un diagnóstico específico como ocurrió en 11 pacientes: déficit selectivo de IgA (2), síndrome de Sjögren asociado o no a lupus eritematoso sistémico (3), celiaquía asociada o no a Diabetes mellitus (4), tiroiditis de Hashimoto (1) y síndrome de inmunodeficiencia adquirida (1). Conclusión: La parotiditis crónica recurrente juvenile puede considerarse un signo centinela de otras enfermedades de etiología inmunológica/autoinmune cuyo diagnóstico, seguimiento y tratamiento precoz puede mejorar su pronóstico. La etiología infecciosa vírica, exceptuando el VIH, no es prioritaria en el estudio de recurrencias.