POST-MORTEM MRI to INVESTIGATE PERINATAL LOSS at COUNTIES MANUKAU HEALTH, AUCKLAND, NEW ZEALAND

Background: Magnetic Resonance Imaging (MRI) may be useful as an alternative to perinatal post-mortem autopsy. Our service has high rates of perinatal loss, and low rates of post-mortem autopsy. We have offered post-mortem MRI for the last 5 years, however how MRI is currently being used, have not been reviewed. Aim(s): To describe: (i) the number of perinatal post-mortem MRIs performed, (ii) the reasons for offering MRI, (iii) whether the MRI was contributory to diagnosing cause of perinatal loss or adding extra information. Method(s): Cases were identified crosschecking perinatal loss and radiology data from 2010 to 2021. Anonymised summaries of clinical notes and investigation results of all cases were reviewed by two multidisciplinary groups, each of whom had MRI reports for half of the cases. Congruency of final classification of cause of death was compared and groups reported for each case whether MRI provided new information. Result(s): Between 2018 and 2021 there were 426 perinatal losses, of which 17 were investigated with MRI. In all cases MRI was offered after parents declined autopsy and was performed in addition to other investigations (maternal blood tests, placental karyotype, and histology). MRI changed the final PDC code in 1 case, provided additional findings in 2 cases, confirmed antenatally diagnosed anomalies in 4 cases and was non-contributory to diagnosing cause of death in 11/17 cases. Conclusion(s): In our service, post-mortem MRI has been used infrequently as part of the investigations into perinatal loss. When used, it has been most useful in confirming presence of structural anomalies diagnosed antenatally. Conclusion(s): High COVID-19 community prevalence was associated with increased MROP numbers at our clinical site, but inferences are limited by a lack of standardisation of operative reporting.

PARENTS' EXPERIENCE of BABY LOSS during the COVID-19 PANDEMIC in AOTEAROA NEW ZEALAND

Background: The COVID-19 pandemic resulted in rapid and unparalleled changes to the provision of health care globally. New Zealand (NZ) experienced a lower rate of COVID-19 deaths compared with other high-income countries, related to the swift reaction to close borders and implement strict lockdowns, known colloquially as the 'go hard, go early' response. Healthcare workers reduced non-essential contact implemented social-physical distancing and wore personal protective equipment. This influenced the delivery of maternity care and perinatal bereavement support. There is limited information of the impact of the pandemic on parents bereaved by perinatal loss, and none in the NZ context. Our aim is to explore the experiences of NZ parents bereaved by late miscarriage, stillbirth and neonatal death during the COVID-19 pandemic. Method(s): Semi-structured interviews with bereaved parents via video-call technology analysed using qualitative Framework Analysis. Result(s): We interviewed 26 bereaved parents. Their losses comprised 15 stillbirths, 4 late-miscarriages, 1 neonatal death. Four key themes were identified, (1) Distant and impersonal care, (2) Exclusion of partners, (3) Negotiating hospital rules, and (4) Hindered access to social & cultural support. Conclusion(s): This study adds important insights into perinatal bereavement care in NZ during the COVID-19 pandemic, which impacted negatively on parents' already difficult experience of baby loss. The degree of impact was related to periods of greater restriction and institutional responses to the pandemic. The unique context of NZ's model of maternity care, with a known maternity provider and culturally responsive care mitigated some of the difficulties imposed by the pandemic.

CONTINUING DIABETES in PREGNANCY CARE during COVID-19 in A MULTI-ETHNIC, SOCIOECONOMICALLY DIVERSE POPULATION in AOTEAROA NEW ZEALAND

Background: Diabetes in pregnancy (DIP) affects 6% of pregnancies annually in Aotearoa New Zealand, and 12% of pregnancies in our service at The Whatu Ora Counties Manukau, a multi-ethnic, socioeconomically diverse region. At the onset of the 2020 COVID-19 pandemic, telephone clinics (teleclinics) replaced face-to-face visits for those with DIP. However, there is limited information on the views of patients affected by DIP in Aotearoa about their maternity care, and their care since the COVID-19 pandemic. Aim(s): To explore the views of patients within Counties Manukau about their maternity care for DiP, including their perceptions of teleclinics. Method(s): Semi-structured interviews with women via telephone. Interviewers were matched by ethnicity with participants. Responses were analysed using a qualitative Framework Analysis. Result(s): We interviewed 20 women: New Zealand Maori ( n = 5), Pacific ( n = 4), Asian ( n = 5), and other ethnicity (European/New Zealand European) ( n = 4). Three key themes were identified, (1) 'shock, shame and adjustment', (2) 'learning to manage DIP' and (3) 'preparation for birth.' Participants primarily reported positive care experiences and appreciated both face-to-face and teleclinics. Women of Maori and Pacific ethnicity reported that the visible presence of healthcare professionals of a similar ethnicity within the DIP service would enhance their comfort and facilitate cultural understanding. Conclusion(s): This study adds important insights into the pregnancy care experience of a multi-ethnic and socioeconomically diverse group of women with DIP. Continuing teleclinics may be useful outside of a pandemic setting. More work is required to improve support and communication around diagnosis and management, particularly for gestational diabetes.

CARE, CONNECTION AND SOCIAL DISTANCING: THE CHALLENGES OF BABY LOSS DURING A PANDEMIC

Background: The COVID-19 pandemic has brought unprecedented disruption to our lives. Lockdowns, social distancing, and restrictions on movement, have compounded our stress and anxiety, made access to healthcare more difficult, and often kept us apart from family and other social support. PUDDLES is an international collaboration exploring the impact of the COVID-19 pandemic on parents who experience baby loss including miscarriage, stillbirth, and neonatal death, in seven different countries. We aimed to explore parents' experience of accesing care and support during perinatal loss in Aotearoa New Zealand as part of the PUDDLES collaboration. Methods: We conducted in-depth semi-structured interviews (n = 22) with bereaved parents, including stillbirths (n = 15, 12 mothers/birthing parents, 3 couples, 2 partners), miscarriages (n = 4, all mothers), and neonatal death (n = 1, mother). Data were analysed using template analysis to explore parents' experience of access to services, care and support during the pandemic and following their bereavement. Results: Preliminary findings emerging from this work-inprogress suggest pandemic-related impacts varied according to alert levels and locality. Themes used in template analysis were 1) Resilient Service and Care, 2) Restriction and Isolation, 3) Respectful Care, and 4) Left to Our Own Devices. Results indicate that the greatest impact of the pandemic was separation from partners and other family and social support during a critical time. Standards of bereavement care varied regionally. Conclusions: A national guideline for care after perinatal loss would ensure consistent access to quality care for bereaved parents. Social isolation is added challenge for parents experiencing baby loss during a pandemic.

Social media as the rising voice of ICU nutrition

INTRODUCTION: Twitter has become an information source for healthcare professionals on a variety of critical care topics. The role Twitter plays as a resource for evidence to guide nutrition therapy is unknown. The purpose of this study is to describe dissemination of Pediatric and Adult critical care nutrition knowledge via Twitter, including frequency, scope of network, disciplines involved, and citation of literature. METHODS: Symplur Analytics was used to analyze the digital footprint of nutrition using the #ICU and #PedsICU hashtags between July 1, 2019 through June 30th, 2020. The top 1000 hashtags and keywords used in combination with #ICU or #PedsICU were examined to identify the most common nutrition related terms. RESULTS: The final dataset included 2837 tweets by 1349 users resulting in 7.5 million impressions. Data is presented as n (%). Most users tweeted once, with 222 users tweeting more than one tweet. Over half of tweeters were female [n=710 (53%)]. Most nutrition tweeters were non-physician healthcare providers [n=297 (22%)] with the next highest profession being doctors [n= 228 (17%)]. Fifty users tweeted 21% of the tweets (range 4-96 tweets/user);16 of these were dietitians, 13 physicians, and 12 organizations. Geographic data was available on 451 of the users;most tweets emanated from the US (n=149), the UK (n=132), Australia (n=20) and Canada (n=16). The most common hashtags used in this dataset were #COVID19, #FOAMcc and #CriticalCare and the most common keywords, ?enteral?, ?patients?, and ?early?. Eight of the 11 most tweeted links were journal articles and webinars from professional societies, and 3 were industry sponsored podcasts/webinars. CONCLUSIONS: This is the first analysis of the role Twitter plays in the dissemination of critical care nutrition therapy information. A limitation to this approach is variability in spelling across the globe. Future research should focus on identifying and analyzing those spellings not represented here to formulate a more comprehensive approach to information sharing. Identification and promotion of a single hashtag may further enhance the usability of ICU and Peds ICU nutrition knowledge internationally.