VIROLOGY,PATHOPHYSIOLOGY,EPIDEMILOGY,CLINICAL FEATURES,IAP MANAGEMENT GUIDELINE OF PED COVID ,MIS-C,PREVENTION,PSYCHOSOCIAL SUPPORT

1. COVID 19 IN CHILDREN
DR.RITAJYOTI SENGUPTA

2. family of enveloped,
positive-sense, single-stranded RNA
viruses with glycoprotein spikes -
giving crown like appearance.
severe acute respiratory
syndrome coronavirus 2 (SARS-
CoV-2)
Spreads by respiratory droplets from
infected people during sneezing &
coughing talking

3. 4 structural proteins: spike (S), envelope (E),
membrane (M), and nucleocapsid (N).
important in viral
assembly
By binding to a receptor
protein called
angiotensin-converting
enzyme 2 (ACE2) located on
the surface membrane of
host cells--- mediates host
cell invasion
forms a
complex with
RNA
(nucleocapsid)
and aids in the
viral RNA
synthesis and
replication
• VIRION approximately 125 nm in diameter and its genome ranges from
26-32 kb, the largest of all RNA viruses.

4. host cell produced serine protease
TMPRSS211.---- results in S protein priming and fusion
The virus
then enters the host cell via endocytosis.
Organs more vulnerable to SARS-CoV-2
infection due to high ACE2 receptor expression levels :
pneumocytes type II of the lungs, heart,
oesophagus, kidneys,
bladder, and ileum
Upon entrance to the host cells, the viral genome is
released as a single-stranded positive RNA.
Subsequently, host cell protein translation machinery is
hijacked --- translated into viral polyproteins----
cleaved into effector proteins by viral proteinases ---
resulting in immune suppression.
And by RdRp to make more viral genomic RNA for
replication

7. PATHOGENESIS

9. Epidemiology
• Incubation period ranges from 2– 14 days, with an average of
5 days.
• • 80% of infections are mild or asymptomatic
• • 15% of infections are severe (requiring oxygen therapy)
• • 5% of infections are critical (requiring intensive care
• unit [ICU] admission and ventilation)
• Fatality is 1-3%
• • The proportion of severe and critical-to-mild
cases is higher than in influenza infections
• reproductive number (R₀), the number of people
who acquire the infection from an infected person,
was estimated to be 2.2 to 3.3
Children at all ages were sensitive to COVID-19,
and no significant gender difference.
Almost 1-5% of all COVID-19 patients
accounted for
children between 0-14 age group.
unknown whether the SARS-CoV-2 can be
transmitted through breast milk.
• Droplet transmission Could
occur through close contact during breast
feeding.
• No CASES of intrauterine
transmission of the virus were
documented.

10. Perinatal-Neonatal Management of
COVID-19 as
Covid RT PCR POSITIVE OR SUSPECTED
pregnant mother’s delIvery:-
resuscitation of neonate should be done in a
physically separate adjacent room
If not feasible, RESUSCITATION WARMER
should be physically separated from the
mother’s delivery area by a distance of at least
2 meters.
•
Minimum number of personnel should attend
and wear a full set of PPE including N95 mask
Neonatal resuscitation should follow standard
guidelines.
Stable neonates exposed to COVID-19 from
mothers or other relatives should be roomed-
in with their mothers and be exclusively
breastfeed
d.Mother should wash hands frequently
including before breastfeeding and wear
mask.
TESTING--History of
exposure to COVID-19
positive adult (irrespective
of symptoms) Mother had
COVID-19 infection within
14 days before birth, or
History of contact with
COVID-19 positive persons
Timing of test: At birth (if
mother had COVID-19) or
at detection of the history
of contact with COVID-19
National Neonatology
Forum, Indiann

11. Clinical Features
A new emerging pediatric
multisysteminflammatory syndrome
potentially associated with
COVID-19 was reported.

13. SEVERE COVID

22. Methylprednisolone 0.75 mg/kg, maximum dose 30 mg once a day
Continue for 5-7 days and taper, up to 14 days, depending on clinical assessment on daily basis

27. COVID-19 is a viral infection without
any specific antiviral treatment
antimicrobials have no role in the
management of uncomplicated
asymptomatic and mild cases: COVID-
19 infectionfor therapy or prophylaxis
Moderate and severe cases:
antimicrobials should not be prescribed
unless clinical suspicion of a
superadded infection
Septic shock: empirical antimicrobials
(according to body weight) frequently
added to cover all likely pathogens
based on clinical judgement, patient
host factors, local epidemiology and
antimicrobial policy of the hospital
Steroids are not
indicated and are
harmful in asymptomatic
and mild cases of COVID-
19
Indicated only in
hospitalized severe and
critically ill COVID-19
cases
Steroids should be used
at the right time, in right
dose and for the right
duration
Anticoagulants
Not indicated routinely
All hospitalized children
should be monitored for
thrombosis; on suspicion,
confirmed by appropriate
investigations and start on
low molecular weight
heparin in therapeutic
doses for
period of 12 weeks with
monitoring