ABSTRACT
The new coronavirus emergency spread to Italy when little was known about the infection's impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother-child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother-newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery room;the average caesarean section rate of 33.7% remained stable compared to the national figure. On average, 39.0% of mothers were separated from their newborns at birth, 26.6% practised skin-to-skin, 72.1% roomed in with their babies, and 79.6% of the infants received their mother's milk. The infants separated and not separated from their SARS-CoV-2 positive mothers both had good outcomes. At the beginning of the pandemic, childbirth raised awareness and concern due to limited available evidence and led to "better safe than sorry" care choices. An improvement of the peripartum care indicators was observed over time.
ABSTRACT
Background: Pandemic SARS-CoV2 infection was characterized by a severe respiratory syndrome whit a worst course in elderly with comorbidity. Oncology patients (pts) may be at risk for an unfavorable course of infection (1). For this, oncologists had to choose how maintaining therapeutic benefit, minimizing risk of treatments (txs). Oncologist associations had recommended to reduce risk but encouraging continuation of txs. Indeed, one of the risks for oncological pts was inability to receive necessary medical service (2). In this study we reported our experience. Methods: We analyzed pts with solid tumors which received 1 cycle of therapy from 9 to 30 March 2020 at Medical Oncology Unit of Azienda Ospedaliero Universitaria Careggi. We subsequently followed pts over time to evaluate delays in subsequent cycles, and its cause (COVID19 or not related). Results: We analyzed 118 pts (27% affected by lung cancer), divided in age groups (172 were over 50, 96 over 70 and 16 over 80), setting (86% metastatic disease, 8% adjuvant and 7% neoadjuvant/perioperative and type of txs (32% immunotherapy). There were 26 delay in second cycles, 24 in third and only 2 in fourth. In 18 cases delay was scheduled to minimize risk of COVID19 contagion. Expected neutropenia risk did not significantly influenced delay, while age influenced in pts over 60 (13,3% of delay in 80-90 group, 13,3% in 70-79, 17,3% 60-69 and 5,3% in 50-59). Adjuvant txs showed greater delays than metastatic and neoadjuvant /perioperative. 14% of immunotherapies (no difference in lung cancer vs others) was delayed vs 16% of other txs. Conclusions: The SAR-CoV2 pandemic infection obligated oncologists to establish the risk/benefit ratio of a delay in txs, in absence of data. In our experience, the age> 60 and adjuvant setting have more often delayed txs, while type of therapy and the risk of neutropenia have had less impact. In contrast to cancer society's recommendations, there have been no greater delays in immunotherapy in lung cancer than in other diseases. The delay was more frequent in the first phase of the pandemic, probably due to the progressive reorganization of the cancer department.