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Purpose We aim to describe the action plan and clinical results of a COVID-19 unit for adult patient care in units intended for critically ill children, proposing a clinical/administrative framework. Methods We reviewed the preparedness of the PICU team before the surge of cases of COVID-19 and the organizational/administrative issues to increase critical beds in a six-bed PICU allocated to adult critical care in a government-funded general hospital in Latin America. We analyzed the prospectively collected administrative/clinical data of severe COVID-19 cases admitted to PICU during the peak of the first wave of the pandemic. Results We describe a 6-step preparedness plan: recruitment and education, admission criteria, children diversion, team hierarchy, and general and respiratory equipment. The 6-bed PICU was allocated to adult care for 20 weeks, progressively increasing capacity to a 23-bed dedicated COVID-19 unit managed by the PICU team. A six-block bed organizational units were implemented, and personnel increased from 40 to 125 healthcare workers in 24 h shifts. COVID-19 incidence in personnel was 0.5/1000 workdays. One hundred thirty-six patients were admitted, median age 59 (51,65) years old, 68% were male, and 63% had P/F ≤ 100. In addition, 48% received mechanical ventilation, the median length of stay was 7 (3,17), and in-hospital mortality was 15%. Conclusions We propose an organizational framework for the role of PICU in the hospital action plan to increase adult critical beds. The cohort of patients admitted to a PICU repurposed as a COVID-19 ICU had good outcomes. These data are valuable to plan coordinated actions of the healthcare system for future scenarios.

Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection is an infrequent and poorly understood illness. It can present as severe multiorgan failure in children, potentially lethal. Immunomodulation is the empiric treatment because a dysregulated immune response is the primary pathophysiologic mechanism. We present an infant with severe MIS-C, refractory to usual treatment, successfully treated with plasmapheresis.

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La mielitis flácida aguda (MFA) es una enfermedad neuroinflamatoria de la medula espinal caracterizada por la aparición aguda de parálisis flácida asimétrica de predominio proximal y una lesión longitudinal de la sustancia gris de la médula espinal. Afecta principalmente a los niños y se ha descrito desde el año 2014 . Objetivo: Reportar una enfermedad pediátrica neurológica grave emergente en Chile. Casos Clínicos: Tres niños, (2 sexo femenino), rango de edad 4 - 6 años, previamente sanos, que tras infección respiratoria alta febril, presentaron una parálisis aguda asimétrica de predominio proximal en extremidades, que progresó en dos de ellos hacia tetraparesia. En todos se aisló enterovirus en el aspirado nasofaríngeo. En el líquido cefalorraquídeo presentaron pleocitosis, la resonancia magnética demostró hiperintesidad en T2 de la sustancia gris de la médula cervical. Todos ingresaron a cuidados intensivos (UCI) y dos requirieron ventilación mecánica (VM) . La terapia con corticoides, inmunoglobulina y plasmaféresis fue ineficaz. A 12 meses de seguimiento, un paciente permaneció tetrapléjico y dependiente de VM, otro falleció de arritmia ventricular en la UCI, el tercero permanece en rehabilitación con recuperación parcial. Conclusiones: Estos son los primeros reportes de esta enfermedad neurologica emergente en nuestro país. Frente a un niño con una parálisis aguda de extremidades de predominio proximal y asimétrica, los pediatras debemos tener un alto índice de sospecha de una MFA. Dado que puede progresar rápidamente y llevar a una insuficiencia respiratoria, la sospecha de MFA debe ser considerada como una emergencia médica.