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.