Introduction: Pediatric critical care patients with COVID-19 treated in Peru have higher mortality than those previously reported from other countries. Pediatric providers have reported a high number of patients without comorbidities presenting with hemorrhagic strokes associated with COVID-19. We present a study analyzing the factors associated with mortality in this setting.Methods: Prospective case-control study that included patients < 17 years old admitted to a pediatric critical care unit with a positive test confirming COVID-19. The primary outcome was mortality, and secondary outcomes were laboratory results and length of stay. Fisher’s exact test and the Mann-Whitney U test were used for the analysis.Results: Forty-seven patients were admitted to critical care. The mortality of our study is 21.3%. The mortality of patients with neurological presentation was 45.5%, which was significantly higher than the mortality of acute COVID-19 (26.7%) and MIS-C (4.8%), p 0.18. Other risk factors for mortality in our cohort were strokes and comorbidities. Only one patient presenting with hemorrhagic stroke had an undiagnosed comorbidity.Conclusion: Cerebrovascular events associated with COVID-19 in pediatric patients, including infants, must be recognized as one of the more severe presentations of this infection in pediatric patients.

Fetus in fetus es un hallazgo clínico infrecuente, reportado menos de 100 casos en la literatura (FIF) [1]. Se presenta principalmente en recién nacidos, con una incidencia de aproximadamente 1 de cada 500 000 nacidos vivos. [2]. Hasta donde sabemos, existe un solo caso reportado de FIF con presentación pulmonar a nivel mundial. En Perú no existe notificación de casos de FIF con presentación pulmonar, y nuestro hallazgo se trató de un neonato de 15 días de vida, con dificultad respiratoria y hipoxemia severa, requirió soporte ventilatorio mecánico, e imágenes radiográficas torácicas donde evidencia tumoración mediastinal posterior, encontrándose durante la cirugía Fetus in fetus toráxico [Figura 2], poco descrito en la literatura, y que, gracias a la intervención quirúrgica temprana, se obtuvo buenos resultados clínicos. Muchas veces la intervención tardía puede producir un desenlace fatal, por la ubicación mediastinal que comprime estructuras de órganos vitales. Wu y col. informaron un paro cardíaco en un bebé debido a un enorme FIF en el mediastino posterior [4] Las ayudas imagenológicas juegan un rol importante en su diagnóstico.