ABSTRACT
Objective. The aim of the study was to intercept early problems and difficulties in onset and stabilization phases of breastfeeding, in a population of healthy full-term newborns - during the COVID-19 pandemic - through a Clinical Governance Project, supported by the Department of Neonatology and Pediatrics, which introduced a speech therapist, as part of the professional team acting synergistically with neonatologists, pediatricians, pediatric nurses, midwives and gynecologists. Materials and Methods. Over a period of two months (2020), n = 72 newborns, 38 males and 34 females, were recruited (mean age:1.3 days) in the Departments of Neonatology and Obstetrics and Gynecology of Castelli Hospital, ASLRM6. Lingual frenulum neonatal screening (Martinelli, 2015) was administered to all the newborns and the frenulum was classified as normal, doubtful or impaired. Breastfeeding difficulties were evaluated and speech therapist counseling was performed, to support early onset and stabilization of breastfeeding. Results. Lingual frenulum screening resulted normal in 36 (50%), doubtful in 20 (28%) and impaired in 16 (22%) of total newborns. An alteration of both lingual and upper labial frenulum was found in 16 (22%) of the newborns studied. n = 23 newborns (32%) showed alterations able to hinder breastfeeding: these cases were successfully managed by helping the mothers to change the breastfeeding position, adopting a rugby hold position. Conclusions. According to our preliminary results, speech therapist counselling, in the critical COVID-19 pandemic, allowed early detection of lingual frenulum alterations, and their impact on the onset of breastfeeding. We found that altered lingual frenulum was associated with breastfeeding difficulties: in these patients, speech therapist intervention resulted useful in managing early breastfeeding problems.
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Background: Complication and complexity are two aspects that the cancer patient carries with him during the time he spends in cancer treatment. The tumor is to be considered a disease that is part of the biological complications that affect one or more organs of our body, which refer to a very specific treatment, to surgical interventions of a certain type, to any pain therapy, etc. Complexity, on the other hand, represents a term that refers to the description of the ensemble that make up the individuality of the cancer patient. Therefore, within the treatment, various elements that are part of the patient's world and that can represent a strength in the oncological path must be taken into consideration. Material(s) and Method(s): 80 patients from the oncology ward participated in the research, recruited in 2019 (n = 40) and in 2020-2021 (N = 40). The semi-structured clinical psychological interview, lasting one hour, was used as a data collection tool, which examined the evaluation of the patient's depression, anxiety and altered emotional states regarding the presence or fewer family affections during hospitalization, visits from friends, knowledge of one's status as a cancer patient. Result(s): From the analysis of the data it emerges that the oncological patients who suffered from depression, anxiety or elements attributable to altered emotional states in 2019 are 32.50% of the sample examined while in 2020 and 2021 the recorded incidence includes about 90.00% of the sample. This higher incidence derives mainly from the consequence of the closure to visits by family members in the medical oncology ward for the sars-cov-2 pandemic, rather than from the other factors taken into consideration, leading, in the most serious cases, to requests for early discharge by of the patient himself. Conclusion(s): Understanding the worlds within the cancer patient should not be seen as an obstacle to treatment but as a resource to be used to improve patient compliance. Placing the complexity of the individual at the center of the analysis determines a decrease in anxiety, depression and altered emotional states with an increase in the doctorpatient relationship, effectiveness of treatments, circulation of information and trust in care.
ABSTRACT
INTRODUCTION COVID-19 pandemic has represented an unexpected stress test for Italian Health System, and a real challenge for health workers and organizations. Hospital of Castelli, opened in December 2018 as the Hub of ASLRM6, with a catchment area of more than 570,000 persons, was identified, since the beginning of pandemic, as the unique birth point of the territory, supporting safety and organization for newborns and families. This decision allowed reorganization and definition of specific care pathways for Neonatal and Obstetric Department. METHODS The Neonatology-Pediatrics and Obstetrics- Gynecology Complex Units, both located on the 1st floor of the hospital, close to Delivery rooms, were protected by isolating the entire 1st floor from the upper and ground floors, hosting COVID wards. All pregnant women were screened, before admission to delivery room, with RT-PCR for Sars-CoV- 2 naso-pharyngeal (NF) swab performed within 48 h prior to delivery ('green' pathway). In case of imminent delivery, a 'red' pathway for unknown or suspected Sars-CoV-2 pregnant women was defined, as a part of the delivery Unit, but completely separate and independent from the green pathway. Mother and newborn managed in the red pathway, waiting for the result of RT-PCR, if in good clinical conditions, were put in the same, single room, strictly isolated in a separate section of Obstetric ward, 2mt away from each other. Mother could start breastfeeding soon after delivery, wearing individual protection devices. If neonatal symptoms or need for admission in Neonatal ward were present, newborn was put in a separate, isolation room in the Neonatal Pathology Unit. If maternal RT-PCR NF swab resulted positive, mother and newborn were transferred, within first hours after delivery, to one of the COVID-Hub hospitals for Obstetrics and Neonatology in Rome (Policlinico 'A.Gemelli' or Policlinico Umberto I). Newborns of Sars-CoV-2-positive mothers underwent RT-PCR for Sars-CoV-2, prior to transfer. RESULTS From 31 March 2020 to 31 March 2021 a total of n.5 mothers resulted positive for Sars-CoV-2 and were transferred with their newborns to a COVID-Hub hospital. All the positive mothers were asymptomatic or paucisymptomatic;their newborns were in good clinical conditions and all resulted negative at RT-PCR for Sars-CoV-2 NF swab performed prior to the transfer. No Sars-CoV-2 outbreaks developed in our hospital in the period studied. Positive mothers and their newborns had a good clinical outcome and were discharged from the COVID hospital within 7-10 days after delivery. They underwent home follow-up by local medical care service (SISP) and basic pediatricians, supported, where possible, by telemedicine services. CONCLUSIONS an appropriate organization, based on specific, defined and separate clinical pathways, for COVID-19- unknown or suspected mothers and infants, is crucial for facing the ongoing pandemic, providing safety and good quality medical care for mothers and newborns.