Dataset Information

Longitudinal Survey of COVID-19 Burden and Related Policies in U.S. Neonatal Intensive Care Units.

ABSTRACT:

Objective

This study aimed to determine the prevalence of confirmed novel coronavirus disease 2019 (COVID-19) disease or infants under investigation among a cohort of U.S. neonatal intensive care units (NICUs). Secondarily, to evaluate hospital policies regarding maternal COVID-19 screening and related to those infants born to mothers under investigation or confirmed to have COVID-19.

Study design

Serial cross-sectional surveys of MEDNAX-affiliated NICUs from March 26 to April 3, April 8 to April 19, May 4 to May 22, and July 13 to August 2, 2020. The surveys included questions regarding COVID-19 patient burden and policies regarding infant separation, feeding practices, and universal maternal screening.

Results

Among 386 MEDNAX-affiliated NICUs, responses were received from 153 (42%), 160 (44%), 165 (45%), 148 (38%) across four rounds representing an active patient census of 3,465, 3,486, 3,452, and 3,442 NICU admitted patients on the day of survey completion. Confirmed COVID-19 disease in NICU admitted infants was rare, with the prevalence rising from 0.03 (1 patient) to 0.44% (15 patients) across the four survey rounds, while the prevalence of patients under investigation increased from 0.8 to 2.6%. Hospitals isolating infants from COVID-19-positive mothers fell from 46 to 20% between the second and fourth surveys, while centers permitting direct maternal breastfeeding increased 17 to 47% over the same period. Centers reporting universal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) screening for all expectant mothers increased from 52 to 69%.

Conclusion

Among a large cohort of NICU infants, the prevalence of infants under investigation or with confirmed neonatal COVID-19 disease was low. Policies regarding universal maternal screening for SARS-CoV-2, infant isolation from positive mothers, and direct maternal breastfeeding for infants born to positive mothers are rapidly evolving. As universal maternal screening for SARS-CoV-2 becomes more common, the impact of these policies requires further investigation.

Key points

· In this cohort, neonatal COVID-19 is rare.. · Policies regarding isolation and breastfeeding for infants are rapidly evolving.. · Most hospitals are now providing universal screening for expectant mothers for SARS-CoV-2..

SUBMITTER: Ahmad KA

PROVIDER: S-EPMC7869047 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Longitudinal Survey of COVID-19 Burden and Related Policies in U.S. Neonatal Intensive Care Units.

Ahmad Kaashif A KA Darcy-Mahoney Ashley A Kelleher Amy S AS Ellsbury Dan L DL Tolia Veeral N VN Clark Reese H RH

American journal of perinatology 20201019 1

<h4>Objective</h4>This study aimed to determine the prevalence of confirmed novel coronavirus disease 2019 (COVID-19) disease or infants under investigation among a cohort of U.S. neonatal intensive care units (NICUs). Secondarily, to evaluate hospital policies regarding maternal COVID-19 screening and related to those infants born to mothers under investigation or confirmed to have COVID-19.<h4>Study design</h4>Serial cross-sectional surveys of MEDNAX-affiliated NICUs from March 26 to April 3, ...[more]

PMID: 33075846

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Project description:BackgroundMetabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs.MethodsA questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018.ResultsThe survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8 and 32.5% of the NICUs).ConclusionThis survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments.

Project description:BACKGROUND:Traditional neonatal uvulectomy is unsupervised, unscientific and potentially dangerous cultural malpractice. It is often accompanied with life threatening neonatal morbidities such as infection, septicemia, anemia, aspiration and oropharyngeal injury. However, there is no current regional and even national data of its public health importance in the health care system. Therefore, this study was aimed at assessing the burden, associated factors and reasons of traditional uvulectomy among neonatal admissions at Debre Tabor General Hospital, North Central Ethiopia, from September 2018 to August 2019. METHODS:A quantitative cross sectional study supplemented with phenomenological study was employed on 422 mother-neonate pairs. Eight mothers who were not included in the quantitative part were involved as key informants of the qualitative study. Systematic and purposive sampling techniques were used to select study participants for the quantitative and qualitative parts of the study respectively. Multivariable logistic regressions were fitted to investigate significant predictors of traditional neonatal uvulectomy at p-value ? 0.05 and 95% CI. Moreover, the qualitative data were carefully transcribed, coded, screened, thematized, synthesized and then triangulated with the quantitative results. RESULTS:The burden of postuvulectomy admission was 67 (15.88%). Most of these admissions had post uvulectomy sepsis [59 (88.1%)] followed by anemia (55.23%). From multivariable analysis, factors that had significant odds of association with traditional neonatal uvulectomy include: having male neonate [AOR = 4.87; 95% CI: 1.10, 21.59], antenatal couple counseling about traditional neonatal uvulectomy [AOR = 0.053; 95% CI: 0.01, 0.35], home delivery [AOR = 6.02; 95% CI: 1.15, 31.61], postnatal couple counseling about traditional neonatal uvulectomy [AOR = 0.101; 95% CI: 0.02, 0.65], prior history of traditional neonatal uvulectomy [AOR = 7.15; 95% CI: 1.18, 43.21] and knowing at least one adverse effect of traditional neonatal uvulectomy [AOR = 0.068; 95% CI: 0.01, 0.44]. Furthermore, maternal perception of "there is no modern medicine to treat elongated and swollen neonatal uvula' was the most explained reason to practice traditional neonatal uvulectomy. CONCLUSION AND RECOMMENDATION:The burden of traditional neonatal uvulectomy was high. Fortunately, its predictors are modifiable. Therefore, several advocacy teams of neonatal health consisting of mainly women health development armies, elders, religious fathers, health professionals and criminal prosecutors should be actively mobilized against traditional neonatal uvulectomy. Besides, parental couple counseling about the adverse effects of traditional neonatal uvulectomy should be properly implemented in the routine antenatal and postnatal continuum of care in South Gondar Zone, North Central Ethiopia.

Dataset Information

Longitudinal Survey of COVID-19 Burden and Related Policies in U.S. Neonatal Intensive Care Units.

Objective

Study design

Results

Conclusion

Key points

Publications

Longitudinal Survey of COVID-19 Burden and Related Policies in U.S. Neonatal Intensive Care Units.

Similar Datasets

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