Background The incidence of COVID-19 is still rapidly increasing, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aims to describe the characteristics of pediatric COVID-19 cases with fatal outcomes in Indonesia's tertiary referral hospital. Methods This is a cross-sectional study with data collected from the medical records of COVID-19 patients admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from March to October 2020. Results During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, of which 20 (40%) patients with positive tests for SARS-CoV-2 had a fatal outcome. The fatality was higher in patients ≥10 years old, categorized with severe disease upon admission, with PaO 2 /FiO 2 ratios of ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase, and presepsin levels were found in all fatal COVID-19 cases. One patient met the criteria of multisystem inflammatory syndrome in children (MIS-C). Conclusion Our work highlights the high mortality rate in pediatric patients positive for the COVID-19 test. Further studies are needed to understand better the role of SARS-CoV-2 in elaborating the mechanisms leading to death in children with comorbidities.

Background While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia. Methods This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021. Results The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors. Conclusions Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Introduction and importance Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making. Case presentation Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure. Clinical discussion Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year. Conclusion The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight.