DISORDERS OF THE RESPIRATORY SYSTEM PART 3.1 (based on T) Flashcards
What is the mode of transmission of COVID-19 in neonates?
Intrauterine (transplacental transmission),
intrapartum (exposure to infected maternal blood, feces, or secretions), and
immediate postpartum (respiratory secretions, contact with infected individuals, possible breast milk transmission).
How does COVID-19 present in the neonate?
Most neonates are asymptomatic or have mild disease.
Symptoms include temperature instability, lethargy, irritability, respiratory distress (grunting, nasal flaring, tachypnea), and gastrointestinal symptoms like feeding intolerance and diarrhea.
What is the current protocol for diagnosing COVID-19 in the neonate?
Neonates born to COVID-19-positive mothers are tested at 24 hours of life.
If negative, repeat at 48 hours.
If still negative, discharge.
If positive, assess for symptoms and treat accordingly.
How are neonates with COVID-19 managed?
Supportive care with oxygen, fluids, and antibiotics if sepsis is suspected.
COVID-19 alone is not an indication for C-section, and infected mothers deliver in designated facilities.
What are the policies for delivery of a suspected or confirmed COVID-19 mother?
Delivery is based on maternal indications.
COVID-19 is not an indication for C-section.
Mothers deliver in COVID-designated facilities with infection control measures in place.
What defines a suspected COVID-19 infection in neonates?
Newborns born to a mother with a history of COVID-19 from 14 days before to 28 days after delivery, or newborns directly exposed to infected individuals (family members, caregivers, medical staff).
What defines a confirmed COVID-19 infection in neonates?
Confirmed by RT-PCR positivity for SARS-CoV-2 nucleic acid in respiratory tract or blood specimens,
or virus gene sequencing highly homologous to known SARS-CoV-2 strains.
What are the key findings in placental pathology associated with COVID-19?
Chronic histiocytic intervillositis, trophoblast necrosis, and syncytiotrophoblast infection, which increase the risk of transplacental virus transmission.
What are the most common clinical outcomes of neonatal COVID-19?
Most neonates recover well.
Adverse outcomes include preterm birth, low birth weight, NICU admission, and pneumonia.
Congenital anomalies are not conclusively linked.
What is the highest risk period for neonatal infection?
The highest risk occurs when maternal infection is near the time of delivery.
Risk decreases if the mother tested positive more than 14 days before delivery.
How does late-onset neonatal COVID-19 present?
Occurs 5-35 days after birth and may present with respiratory distress, gastrointestinal symptoms, fever, or multisystem inflammatory syndrome in neonates (MIS-N).
What is multisystem inflammatory syndrome in neonates (MIS-N)?
A hyperimmune response to maternal antibodies against SARS-CoV-2, presenting with myocarditis, myocardial dysfunction, coronary aneurysms, DIC, NEC-like illness, hypoxemia, and renal failure.
What are the criteria for MIS-C according to the CDC?
- Age <21 years.
- Fever >38°C for ≥24 hours.
- ≥2 organ systems involved (cardiovascular, respiratory, renal, neurologic, hematologic, gastrointestinal, dermatologic).
- Elevated inflammatory markers.
- No alternative diagnosis.
- Recent SARS-CoV-2 infection or exposure.
What are the WHO criteria for MIS-C?
- Age 0-19 years.
- Fever for ≥3 days.
- Multisystem involvement (≥2 of rash, hypotension, cardiac dysfunction, coagulopathy, gastrointestinal symptoms).
- Elevated inflammatory markers.
- No other microbial cause.
- Evidence of SARS-CoV-2 infection or exposure.
What are common laboratory findings in neonatal COVID-19?
Normal CBC or leukocytosis/leukopenia, lymphopenia, monocytosis, mild thrombocytopenia, elevated inflammatory markers (CRP, ESR, procalcitonin), elevated creatinine kinase, LDH, alkaline phosphatase, ALT, AST.
What are common radiographic findings in neonatal COVID-19?
Chest X-ray: patchy infiltrates, interstitial changes, ground-glass opacity, consolidation, pleural effusion, pneumothorax.
Chest CT: ground-glass opacities, multiple consolidations.
Abdominal X-ray: intestinal ileus.
What is the protocol for neonates born to COVID-19 mothers according to the AAP?
Test at 24 hours of life.
If negative, repeat at 48 hours.
If negative again, discharge.
If positive, evaluate for fever, respiratory distress, or sepsis, and provide supportive care.
What is a mutation in the context of viruses?
A single change in a virus’s genome.
What is a lineage in virology?
A group of closely related viruses with a common ancestor.
What is a sublineage?
A lineage that is a direct descendant of a parent lineage, such as BA.2.75 being a sublineage of BA.2.
What defines a viral variant?
A viral genome that may contain one or more mutations.
What is recombination in SARS-CoV-2?
A process in which the genome of two SARS-CoV-2 variants combine during viral replication to form a new variant different from both parent lineages.
What conditions must be met for recombination to occur in SARS-CoV-2?
A person must be infected with two variants at the same time.
What is a recombinant lineage?
A lineage that results from recombination of two SARS-CoV-2 variants.
What does VOl stand for in SARS-CoV-2 classification?
Variant of interest.
What does VOC stand for in SARS-CoV-2 classification?
Variant of concern.
What does VOHC stand for in SARS-CoV-2 classification?
Variant of high consequence.
What does VBM stand for in SARS-CoV-2 classification?
Variants being monitored.
What system is used to classify SARS-CoV-2 lineages?
The PANGO lineage system.
How does the PANGO lineage system classify variants?
In a hierarchical manner like a family tree, naming lineages with an alphabetical prefix and numerical suffix.
What are key characteristics of Variants Being Monitored (VBM)?
Variants with potential or clear impact on medical countermeasures, increased transmissibility, or severe disease but are no longer widely detected.
What factors may change the classification of a SARS-CoV-2 variant?
New data on transmissibility, disease severity, and immune escape.
What is the general incubation period for COVID-19?
Up to 14 days.
What was the mean incubation period for the Delta variant?
4.3 days.
What was the mean incubation period for the Alpha and Beta variants?
5 days.
What was the median incubation period for the Omicron variant?
3-4 days.
How is COVID-19 primarily transmitted?
Through inhalation of infected respiratory droplets or mucosal contact after touching contaminated surfaces.
In what medical procedures can airborne SARS-CoV-2 transmission occur?
Aerosol-generating procedures such as intubation, CPR, bronchoscopy, and NIPPV.
What has been documented regarding SARS-CoV-2 shedding in stool?
Prolonged viral shedding in the stool of infected children, but unclear if infectious.
What evidence exists for transplacental transmission of SARS-CoV-2?
Cases have shown placental infection and neonatal COVID-19 positivity.
Has vertical transmission of COVID-19 been confirmed?
It has not been definitively confirmed but cannot be excluded.
Has transmission of SARS-CoV-2 through breast milk been confirmed?
Viral RNA has been detected in breast milk, but transmission has not been proven.
What is the most common way children are infected with COVID-19?
Through close contact with infected family members.
Can children transmit COVID-19 to adults and other children?
Yes, but their exact role in transmission is still unclear.
What are the most common underlying conditions that predispose children to COVID-19?
Immunosuppression (30.5%), respiratory conditions (21%), cardiovascular conditions (13.7%), congenital malformations (10.7%).
What are other risk factors for severe COVID-19 in children?
Obesity, prematurity, endocrine, renal, hematologic, neurologic, and gastrointestinal conditions.
What are the two most common symptoms of COVID-19 in children?
Fever (59.1%) and cough (55.9%).
What percentage of children with COVID-19 are asymptomatic?
19.3%.
What are less common symptoms of COVID-19 in children?
Rhinorrhea, fatigue, sore throat, dyspnea, abdominal pain, nausea, headache, pharyngeal erythema, decreased oral intake, rash.
What clinical finding was observed in children during the Omicron wave?
A significant increase in croup cases.
What should be considered even if a child has only mild symptoms?
Testing for SARS-CoV-2.
How might ACE2 receptors affect COVID-19 severity in children?
Children may have lower ACE2 receptor activity, reducing viral entry.
What is one theory about children’s resistance to severe COVID-19?
Their exposure to other viruses may provide cross-protective immunity.
How does immune aging contribute to severe COVID-19 in adults?
Thymic involution reduces adaptive immune response over time.
Why might children have a stronger early response to SARS-CoV-2?
Their innate immune system is more active than in adults.
What role does inflammation play in COVID-19 severity?
Adults have higher levels of pro-inflammatory cytokines, leading to stronger inflammatory responses.
Which children are at risk of severe COVID-19?
Those with obesity, diabetes, cardiac, lung, and neurological disorders.
What trend was seen in pediatric hospitalizations during Omicron?
Hospitalization rates were four times higher than during the Delta peak.
What effect does COVID-19 vaccination have on pediatric hospitalization?
It reduces the risk of hospitalization and severe outcomes.
What is Evusheld?
A monoclonal antibody used for pre-exposure prophylaxis, but not currently authorized for emergency use.
What are the currently authorized COVID-19 vaccines under EUA?
Moderna (bivalent), Pfizer-BioNTech (bivalent), Novavax (adjuvanted).
What tests are recommended for diagnosing acute COVID-19?
NAATs (RT-PCR) and antigen tests.
Should newborns born to COVID-19-positive mothers be tested?
Yes, at least once before hospital discharge.
What does the AAP recommend for newborns with COVID-19 symptoms?
Immediate SARS-CoV-2 testing.
What role does testing play in school settings?
It helps prevent transmission among students, staff, and families.
What inflammatory markers are associated with severe COVID-19 in children?
D-dimers and ferritin.
What are common chest X-ray findings in children with COVID-19?
Patchy infiltrates or opacities.
What is the most common CT finding in pediatric COVID-19 cases?
Patchy ground-glass opacities.
What defines mild COVID-19 disease?
Symptomatic patients meeting the case definition for COVID-19 without evidence of viral pneumonia or hypoxia.
What defines moderate COVID-19 disease in children?
Clinical signs of non-severe pneumonia (cough or difficulty breathing + fast breathing and/or chest indrawing) with no signs of severe pneumonia; SpO2 ≥ 95% on room air.
What are the tachypnea thresholds for moderate COVID-19 disease?
3-12 months: ≥50 bpm,
1-5 years: ≥40 bpm,
5-12 years: ≥30 bpm,
≥12 years: ≥20 bpm.
What defines severe COVID-19 disease in children?
Pneumonia with at least one of the following: central cyanosis or SpO2 < 95%, severe respiratory distress (grunting, very severe chest indrawing), general danger signs (inability to breastfeed, lethargy, unconsciousness, or convulsions).
What are the tachypnea thresholds for severe COVID-19 disease?
Same as moderate:
3-12 months: ≥50 bpm,
1-5 years: ≥40 bpm,
5-12 years: ≥30 bpm,
≥12 years: ≥20 bpm.
What defines critical COVID-19 disease (ARDS)?
Onset within 1 week of pneumonia or worsening respiratory symptoms, bilateral opacities on imaging, respiratory failure not explained by cardiac failure or fluid overload.
What are the oxygenation impairment criteria for ARDS in adults?
Mild: 200 < PaO2/FiO2 ≤ 300 mmHg,
Moderate: 100 < PaO2/FiO2 ≤ 200 mmHg,
Severe: PaO2/FiO2 ≤ 100 mmHg (all with PEEP ≥ 5 cmH2O).
What defines sepsis in adults with COVID-19?
Acute life-threatening organ dysfunction due to a dysregulated host response to infection, with signs such as altered mental status, difficulty breathing, low SpO2, low urine output, hypotension, or metabolic abnormalities.
What defines sepsis in children?
Suspected/proven infection with ≥2 SIRS criteria, one of which must be abnormal temperature or WBC count.
What defines septic shock in adults?
Persistent hypotension despite volume resuscitation, requiring vasopressors to maintain MAP ≥ 65 mmHg and serum lactate > 2 mmol/L.
What defines septic shock in children?
Hypotension or 2-3 of the following: altered mental status, abnormal HR, prolonged capillary refill, fast breathing, mottled/cool skin, high lactate, low urine output, temperature abnormalities.
What is acute thrombosis in COVID-19?
Acute venous thromboembolism (e.g., pulmonary embolism), acute coronary syndrome, acute stroke.
What is the WHO case definition for MIS-C?
Children 0-19 years with fever >3 days AND two of the following: rash/conjunctivitis/muco-cutaneous inflammation, hypotension/shock, myocardial dysfunction/pericarditis/valvulitis/coronary abnormalities, coagulopathy, GI symptoms, AND elevated inflammatory markers, AND no other microbial cause, AND COVID-19 evidence or exposure.
When does MIS-C typically occur after SARS-CoV-2 infection?
2-6 weeks after infection.
What are common symptoms of post-COVID conditions (PCCs)?
Headache, fatigue, and involvement of multiple organ systems; symptoms lasting ≥4 weeks after infection.
Who is at higher risk for PCCs?
People who had severe acute COVID-19 illness compared to those with mild/asymptomatic infections.
What is the management for mild-to-moderate COVID-19?
Outpatient supportive care, possible therapeutics for at-risk patients, and education on reducing transmission.
What is the management for severe-to-critical COVID-19?
Hospitalization with treatment for hypoxemic respiratory failure, ARDS, septic shock, cardiac dysfunction, thromboembolism, hepatic/renal dysfunction, CNS disease, and exacerbation of comorbidities.
What conditions can MIS-C overlap with?
Kawasaki Disease, Toxic Shock Syndrome, Severe Acute COVID-19.
What should be considered for pediatric routine care during the pandemic?
Catch-up immunization for children >1 month behind on vaccinations.
