Assessing the impact of the COVID-19 pandemic on parental satisfaction in two European neonatal intensive care units.

BACKGROUND: Neonatal units across the world have altered their policies to prevent the spread of infection during the COVID-19 pandemic. Our aim was to report parental experience in two European neonatal units during the pandemic. METHODS: Parents of infants admitted to each neonatal unit were asked to complete a questionnaire regarding their experience during the COVID-19 pandemic. At King's College Hospital, UK (KCH), data were collected prospectively between June 2020 and August 2020 (first wave). At the Hospital Clínic Barcelona (HCM), data were collected retrospectively from parents whose infants were admitted between September 2020 and February 2021 (second and third wave). RESULTS: A total of 74 questionnaires were completed (38 from KCH and 36 from HCM). The parents reported that they were fully involved or involved in the care of their infants in 34 (89.4%) responses in KCH and 33 (91.6%) responses in HCM. Quality time spent with infants during the pandemic was more negatively affected at KCH compared with HCM (n=24 (63.2%) vs n=12 (33.3%)). Parents felt either satisfied or very satisfied with the updates from the clinical care team in 30 (79.0%) responses at KCH and 30 (83.4%) responses in HCM. The parents felt that the restrictions negatively affected breast feeding in six (15.8%) responses at KCH and two (5.6%) responses in HCM. Travelling to the hospital was reported overall to be sometimes difficult (39.2%); this did not differ between the two units (14 (36.8%) respondents at KCH and 15 (41.6%) from HCM). Furthermore, the self-reported amount of time spent giving kangaroo care also did not differ between the two countries. CONCLUSION: Restrictive policies implemented due to the COVID-19 pandemic had a negative impact on the perception of quality of time spent by parents with their newborns admitted to neonatal units.

Myasthenia Gravis and COVID-19 - A Clinical Checkmate.

Myasthenia gravis (MG) patients with coronavirus disease (COVID-19) pose a unique challenge for intensive care management. Higher risk of infection is observed in patients with MG due to the immunosuppressant medications they are prescribed. The underlying component of respiratory muscle weakness predisposes these patients to experience a more severe form of illness. In the case of diagnosis of COVID-19 in MG patients, judicious continuation of immunosuppressants, avoiding drugs that worsen MG along with the continuation of cholinesterase inhibitors is prudent. Early diagnosis in cases with high-index of suspicion, extra precautions, COVID-appropriate behavior, and early immunization is paramount for the health of MG patients during this pandemic.

Myasthenia Gravis and COVID-19 – A Clinical Checkmate

Myasthenia gravis (MG) patients with coronavirus disease (COVID-19) pose a unique challenge for intensive care management. Higher risk of infection is observed in patients with MG due to the immunosuppressant medications they are prescribed. The underlying component of respiratory muscle weakness predisposes these patients to experience a more severe form of illness. In the case of diagnosis of COVID-19 in MG patients, judicious continuation of immunosuppressants, avoiding drugs that worsen MG along with the continuation of cholinesterase inhibitors is prudent. Early diagnosis in cases with high-index of suspicion, extra precautions, COVID-appropriate behavior, and early immunization is paramount for the health of MG patients during this pandemic.

Introduction of 24 h Resident Consultant Cover in a Tertiary Neonatal Unit-Impact on Mortality and Clinical Outcomes.

BACKGROUND: We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes. METHODS: Retrospective cohort study in a tertiary medical and surgical neonatal unit between 2010-2020 of all liveborn infants admitted to the neonatal unit. Out of hours cover was rearranged in 2014 to ensure 24 h presence of a senior trained neonatologist (resident consultant). RESULTS: In the study period, 4778 infants were included: 2613 in the pre-resident period and 2165 in the resident period. The median (IQR) time to first consultation by a senior member of staff was significantly longer in the pre-resident period [1.5 (0.6-4.3) h] compared to the resident period [0.5 (0.3-1.5) h, p < 0.001]. Overall, mortality was similar in the pre-resident and the resident periods (3.2% versus 2.3%, p = 0.077), but the mortality of infants born at night was significantly higher in the pre-resident (4.5%) compared to the resident period (2.5%, p = 0.016). The resident period was independently associated with an increased survival to discharge (adjusted p < 0.001, odds ratio: 2.0) after adjusting for gestational age, admission temperature and duration of ventilation. CONCLUSIONS: Following introduction of a resident consultant model the mortality and time to consultation after admission decreased.

Development of perioperative checklist for infants requiring surgical intervention

14 Table 1Variables Compliance, Pre-QIP, n(%) Compliance, Post QIP, n(%) Pre-operative Blood investigations 26(100) 22(100) Cross match & arranging blood products 26(100) 22(100) Consent 26(100) 22(100) Starvation 26(100) 22(100) IV access & IV fluids 26(100) 22(100) ITU cot 26(100) 22(100) Cranial scan 26(100) 22(100) Post-operative Operative notes review 26(100) 22(100) Anaesthetic notes review 26(100) 22(100) Ventilation plan 9(34.6) 20(91) Imaging 26(100) 22(100) IV access 26(100) 22(100) Fluid prescription 11(42.3) 18(81.8) Blood investigations 25(96.1) 22(100) Cranial scan 26(100) 22(100) Updating parents 21(80.7) 22(100) Analgesia 26(100) 22(100) Abstract 14 Table 2PRE-OPERATIVE PREPARATION CLINICAL COMMUNICATION YES NO N/A YES NO CROSS MATCH BLOOD PRODUCTS ARRANGED PRE-OPERATIVE BLOODS (FBC, U&E, COAGULATION) SURGICAL CONSENT IV ACCESS ANAESTHETIC REVIEW NBM IV ANTIBIOTICS IV FLUIDS ITU COT CRANIAL USS ID BAND COVID SWAB (<24 hrs) POST-OPERATIVE CARE CLINICAL COMMUNICATION YES NO N/A YES NO VENTILATION PLAN ANAESTHETIC NOTES REVIEWED ANALGESIA PLAN OPERATIVE NOTES REVIEWED IMAGING PARENTS UPDATE(MEDICAL) CRANIAL USS PARENTS UPDATE(SURGICAL) FLUIDS PRESCRIPTION FLUIDS LOSSES POST-OPERATIVE BLOODS (FBC, U&E, COAGULATION) POST OPERATIVE EXAMINATION IV ANTIBIOTICS ConclusionsIntroduction of a structured peri-operative checklist as a standard practice, significantly improved the compliance with most protocol recommendations and optimized safety during surgical care of infants.