Las manifestaciones clínicas del SARS-Cov-2 en niños difieren a la de los adultos, con afección respiratoria, gastrointestinal, dermatológica y/o cardiovascular. La mayoría de los niños son asintomáticos o presentan síntomas leves de la infección por COVID-19. Sin embargo, en los últimos meses se ha identificado un pequeño número de niños que desarrollan respuesta inflamatoria sistémica significativa. A continuación, realizamos una revisión sobre las manifestaciones extrapulmonares del SARS-Cov-2.

Introducción: La estenosis aórtica es relativamente frecuente en niños. El objetivo de este trabajo fue de caracterizar los resultados y la evolución de esta patología luego del manejo quirúrgico y percutáneo. Material y Métodos: Estudio retrospectivo de pacientes de cero a 19 años, tratados de estenosis aórtica subvalvular, valvular y supravalvular, en el Hospital de Clínicas, entre 1998 y 2019. Fueron excluidos los casos asociados a otras lesiones congénitas. Resultados: Fueron tratados 20 pacientes, edad de 3 días a 17 años, predominio masculino (80%). La estenosis fue valvular en 65% de los casos, subvalvular 20%, supravalvular 5% y múltiple en 10%. El 61% de los valvulares recibió tratamiento percutáneo, y los demás valvuloplastia quirúrgica. En el seguimiento, la tasa libre de reintervención fue de 47% a 10 años; el 50% de ellos tiene insuficiencia valvular aórtica moderada a severa. De los 13 casos de estenosis valvular, tratados percutánea o quirúrgicamente, 4 están aguardando recambio valvular. De 4 pacientes con estenosis subvalvular, 3 tienen insuficiencia aórtica leve, y gradiente medio de 20 mmHg. De dos pacientes con estenosis supravalvular, uno quedó con estenosis residual importante.  En cuanto a clase funcional, todos los pacientes se encuentran en grados 1 y 2 de la escala de NYHA. No se presentaron complicaciones inmediatas en los sometidos a procedimientos percutáneos o quirúrgicos. Fallecieron dos pacientes (10.5%). Conclusiones: La estenosis aórtica afecta principalmente la región valvular, y el tratamiento tanto quirúrgico como percutáneo permiten aliviar la obstrucción hasta el momento de un reemplazo valvular. Correspondencia: Dong Chin Suh. Correo:  dongchinsl@gmail.com Conflicto de interés: Los autores declaran no poseer conflicto de interés. Recibido: 25/03/2020 Aceptado:29/06/2020

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increases the risk of intubation, providers are wary to aggressively fluid-resuscitate septic patients who are at risk of fluid overload-namely, patients with congestive heart failure (CHF) or end-stage renal disease (ESRD). We sought to assess whether an initial fluid dose of 30 ml/kg in septic CHF or septic ESRD patients, compared to a fluidrestrictive strategy, leads to increased intubations. We also analyzed mortality rates and hospital length of stay (LOS). Methods: At our ED, data on septic patients > 17 years of age are prospectively tracked for quality metrics. Patients who trigger the sepsis flag are up-triaged for quicker provider evaluation to assess whether to implement a sepsis bundle, including whether or not to administer 30 ml/kg of fluids. All patients who are ultimately deemed to have had an infectious source that triggered the flag have multiple metrics logged and tracked. This prospectively collected set of data was retrospectively analyzed. Inclusion criteria were septic patients with past medical history of CHF or ESRD who were given fluids. Patients were excluded if they were under do-notresuscitate (DNR) or comfort-measures-only (CMO) status, as well as if amount of administered fluid was unknown. Primary outcome was intubation frequency. Secondary outcomes were hospital LOS and mortality. Student t-test and chi-square tests was used for analyses. Results: Table 1 demonstrates the outcomes in patients who were given at least 30 ml/kg compared to those who were not. In particular, there were no differences between groups in intubation rates. There were also no differences in hospital LOS or in mortality (although the sample was not sufficiently powered for mortality). Overall, 13.8% (95% CI 9.5%-19.2%) of septic patients with CHF and/or ESRD received 30 ml/kg of fluids in the ED whereas 21.0% (95% CI 18.7%-23.4%) of septic patients without either CHF or ESRD received 30 ml/kg of fluids in the ED (p<0.02). Conclusions: Our analysis suggests that patients with a history of CHF and/or ESRD who become septic and receive at least 30 ml/kg of fluids in the ED are not any more likely to be intubated than the patients who receive fluid-restrictive regimen of < 30 ml/kg. This analysis has limitations, including that there may be baseline differences between the patients who did receive 30 ml/kg of fluids in the ED vs. those who did not. However, our results are in line with some previously presented data. Therefore, an initial bolus of 30 ml/kg of fluids in septic CHF/ ESRD patients appears to be safe-possibly even beneficial-and can potentially be included in a triage bundle set for sepsis care in the ED. At our site, CHF/ESRD patients were significantly less likely to receive 30 ml/kg of fluids in the ED than non-CHF/ESRD patients, but adherence to the 30 ml/kg target was low for all patients. Implementing a 30 ml/kg fluid order from triage could enhance compliance with the Surviving Sepsis guidelines-and still leave providers the option of holding fluids when they clinically deem it appropriate.

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