SARS Cov 2 infection in children–recognizing the clinical manifestations and planning appropriate initial evaluation or management Flashcards
In a child with SARS Cov 2 or COVID-19 what is the range of clinical manifestations of the infection?
Clinical manifestations have a range of no symptoms at all to life-threatening or even fatal outcomes.
What is the most common manifestation of COVID for children and how long does the illness usually last?
Most commonly children are asymptomatic. And symptoms should usually resolve within 1 to 2 weeks.
What are the most common presentation/symptoms of COVID 19 in symptomatic children?
Fever, cough, sore throat, headache, shortness of breath, rhinorrhea, myalgia, abdominal pain, nausea, vomiting, diarrhea, and loss of taste or smell (which can present as food refusal in children who are nonverbal).
What are some of the less common clinical manifestations of COVID-19 infection in children?
Neurologic problems like seizures (febrile and nonfebrile) and encephalopathy and dermatologic problems (maculopapular or urticarial rashes), cardiovascular problems (myocarditis), and renal problems (acute kidney injury). Hypoglycemia and leukopenia were seen in premature infants.
What does MIS–C stand for in children?
Multisystem inflammatory syndrome in children.
How common is MIS-C in children?
It is very rare complication of COVID-19 infection
What are the symptoms of MIS-C?
They include persistent fever, rash, hypotension, myocarditis, GI symptoms, and elevated inflammatory markers.
What 2 other diseases or syndromes are similar to MIS–C?
Kawasaki disease and toxic shock syndrome and further evaluation must be done to distinguish between them.
What is long COVID?
Long COVID is used to describe any post COVID 19 conditions that either persistently remain, recur or even manifest as new symptoms that affected the physical or mental health of the patient for at least 12 weeks after the initial confirmed infection, and cannot be explained by another diagnosis and affects daily functioning.
What are the most common long COVID symptoms?
They include altered sense of smell or taste, fatigue, sleep disturbance, headache, muscle and joint pain, weakness, respiratory issues and palpitations.
What are some general management concerns for treating patients with COVID-19? And are they still valid?
Concerns over the use and safety of NSAIDs, ACE inhibitors and ARB’s have been refuted and are safe to use in patients who do not have any other contraindications.
With managing COVID-19 patients on an outpatient basis what are the red flag symptoms that would prompt additional evaluation in an urgent care or ER?
Severe respiratory distress, cyanosis, difficulty breathing, chest pain, inability to take p.o. liquids, and having any signs of shock such as decreased urinary output, difficulty arousing, mottled skin, cold and clammy skin, or altered mental status.
For patients with mild to moderate symptoms that are at high risk for progression to severe sx, what outpatient antiviral therapy can be consider for patient with with a COVID-19 infection and should anti-therapy be considered?
Should be considered on a case-by-case basis and if started within 5 to 7 days of symptom onset. Examples of medication include p.o. nirmatrelvir–ritonavir and IV remdesivir. Monoclonal antibodies are no longer provided as an outpatient therapy.
What are the clinical criteria for a patient with COVID-19 to be admitted to the hospital?
Lower respiratory disease that is either severe or critical
Underlying disease that causes the risk of severe disease such as immunodeficiency
Fever in a patient less than 30 days of age.
What is the mainstay of inpatient treatment for children with COVID-19?
Supportive care is the mainstay and may include respiratory support, fluids, electrolyte support, empiric antibiotics is indicated, monitoring labs including CRP, D-dimer, ferritin and LDH and treatment of thromboprophylaxis in the form of pneumatic compression or early mobility.
