Quality of Care at childbirth during the COVID-19 pandemic: findings of the IMAgiNE EURO study in Belgium (preprint)

Objectives To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time. Design A cross-sectional observational study. Setting Data of the IMAgiNE EURO study in Belgium. Participants Women giving birth in a Belgian facility from March 1, 2020, to May 1, 2023, responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources, and organizational changes related to COVID 19. Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann Kendall test. Results 897 women were included in the analysis, 67%(n=601) with spontaneous vaginal birth, 13.3%(n=119) with instrumental vaginal birth and 19.7%(n=177) with cesarean section. We found high QMNC scores but also specific gaps in all domains of QMNC. On provision of care, 21.0%(n=166) of women who experienced labor and 14.7%(n=26) of women with a cesarean reported inadequate pain relief; 64.7%(n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1%(n=279) reported unclear communication, 32.9%(n=295) reported that they were not involved in choices,11.5%(n=104) stated not being treated with dignity and 8.1%(n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). The multivariable analyses showed significantly lower QMNC scores for women with an instrumental vaginal birth. Over time there was a significant increase in QMNC score for experience of care and key organizational changes due to COVID-19. Conclusions and relevance Although overall QMNC scores were high, findings also suggest gaps in QMNC. Underlying causes of these gaps should be explored to design appropriate interventions and policies.

Prevailing emotions in women’s suggestions on how to improve the quality of care around the time of childbirth during the COVID-19 pandemic (preprint)

Background Recent evidence showed major gaps in the quality of maternal and newborn care (QMNC) even across high-income countries of the WHO European Region. Collecting women’s views and emotions is crucial for quality of care improvement actions and requires innovative strategies and methods to enable quick and effective data analyses.Aims This study from the IMAgiNE EURO dataset aimed at identifying prevailing emotions in suggestions provided by women, after hospital birth in Italy during the COVID-19 pandemic.Methods Data were collected from mothers who gave birth in Italy, using a validated online anonymous questionnaire. This guided women across 40 WHO Standard-based Quality Measures and gathered women’s views via a final open-ended question. We explored answers provided in Italian between March 2020 and March 2022, using sentiment analysis, a text mining technique. It allows for identifying how single emotive words in the text shape the overall emotional content. Based on sentiment analysis, we developed word clouds illustrating graphically the emotional content of the 100 most frequent emotive words.Results Responses from 2,143 women were analysed. The dataset included a total of 79,204 words. The prevailing emotion in the text was trust (3,384 words) followed by anticipation (2,053 words), fear (1,409 words) and sadness (1,291 words). Many of most common words were verbs concerning actions, such as: “allow” (n = 201), “support” (n = 170), “assist” (n = 161), and “improve” (n = 144).Conclusions Sentiment analysis was useful in providing a set of preliminary findings on women’s emotions related to the quality of maternal and newborn care. It may be used to improve the documentation of service users’ emotions and attitudes toward quality of care, providing information useful for researchers and health-care providers. This approach may be considered a valuable and time-saving opportunity for the extraction of important information from large datasets of free-text patient feedback data.

COVID-19 in patients with Pulmonary Alveolar Proteinosis A European multicenter study

Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) signaling is essential in both alveolar macrophages (AMs) differentiation and activation of lung immune cells [1]. Differentiated AMs are crucial in both the elimination of alveolar microbes and surfactant clearance. The disruption of the GM-CSF axis in alveolar macrophages leads to the development of pulmonary alveolar proteinosis (PAP) [1]. In the majority of patients this relates to the presence of autoantibodies against GM-CSF autoimmune (a)PAP but there are multiple other causes [1, 2, 3]. GM-CSF deficient animals may have impaired lung inflammatory response to commensal microbes and humans with PAP may occasionally develop opportunistic lung infections [4]. The mainstay of pharmacological treatment in aPAP is inhaled GM-CSF which is off-label but increasingly used worldwide [5, 6, 7, 8, 9].

Characteristics and risk factors for SARS-CoV-2 among children in Italy: a cross-sectional study in 20 pediatric centers (preprint)

Background: No study has described factors associated with COVID-19 diagnosis in children. Aim: Describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 pediatric centers across Italy. Methods: Cases aged 0-18 years tested for SARS-CoV-2 between February 23 and May 24 2020 were included. Our primary analysis focused on children tested because of COVID-19 suggestive symptoms. Results: Among 2494 children tested for SARS-CoV-2, 2148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of SARS-CoV-2 included, beside fever (82.4%) and respiratory signs or symptoms (60.4%), also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other flu-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARS-CoV-2 were: exposure history (adjusted OR 39.83 95%CI 17.52-90.55 p<0.0001), cardiac disease (adjusted OR 3.10 95%CI 1.19- 5.02 p<0.0001), fever (adjusted OR 3.05 % 95% CI 1.67-5.58 p=0.0003), and anosmia/ageusia (OR 4.08 95%CI 1.69 -9.84 p=0.002). Among 190 (7.6%) children diagnosed with SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted in ICU, while 100% recovered. Conclusion: Recommendations for SARS-CoV-2 testing in children should be updated based on the evidence of broader clinical features. Exposure history, fever, and anosmia/ageusia are strong risk factors for COVID-19 in children, while other symptoms do not seem helping discriminating in between the SARS-CoV-2 positive and the negative cases. This study confirm that COVID-19 is a mild disease in the general population of children in Italy. Further studies are needed to understand the risk, clinical spectrum and outcomes of COVID-19 in children with specific preexisting conditions.