ABSTRACT
Background and Objective(s): Preterm birth is associated with a significant health, emotional, and financial burden on families. Racial, ethnic, and social inequities in the United States during COVID-19 did not spare infants born preterm and their families. While the rates of preterm birth declined during the lockdown, the highest proportions of preterm births continued to be in the Black, Indigenous, and other People of Color (BIPOC) groups. Limited data exists on factors influencing access to rehabilitation services for high-risk infants during COVID-19. We aim to identify barriers and facilitators impacting access to intervention in parents of preterm infants as measured by enrollment and retention in an intervention arm of a multisite rehabilitation clinical trial. Study Design: RCT. Study Participants & Setting: Fifty-seven extremely to very preterm infants (<29 weeks gestation) participating in an ongoing Supporting Play, Exploration, and Early Development (SPEEDI) trial. Intervention was conducted in the neonatal intensive care unit (NICU), home, and/or via telehealth. Materials/Methods: All infants were recruited in the NICU and randomized into SPEEDI intervention or usual care group. The intervention group received 10 sessions of therapist-guided, parent-provided intervention, delivered in two phases (5 sessions per Phase) across 4 months. Both groups continued to receive early intervention services in the community. The intervention was adapted to telehealth in response to COVID-19 and an online platform with videos and activities was created for parents. Enrollment and retention were descriptively analyzed in two time periods;pre-COVID (Before 03/12/20), and COVID (03/13/20 -03/ 12/21) with emphasis on distinctions between in-person vs telehealth participation. Result(s): Enrollment during the COVID period was reduced by 41.18% compared to pre-COVID. Thirty-five preterm infants participated in the intervention during both periods, of which 54% were white and 46% belonged to BIPOC groups. The overall completion rate (i.e.10/10 intervention sessions completed) was 65%, 11% missed >=1 visit, and 26% either withdrew from intervention or were lost to follow-up. The completion rates did not differ for pre-COVID (99%) and COVID (98%) periods. For withdrawals, 55% occurred during COVID, 66% of participants who withdrew self-identified as Black, and 77% had a sibling at home. Of the 63 sessions scheduled during COVID, 31.7% were in-person and 68.2% via telehealth. There was a 68% decline in in-person sessions during COVID compared to pre-COVID. The completion rate for telehealth during COVID was 97% (42/43). Conclusions/Significance: Caregiver engagement in intervention, provision of intervention materials online, and quick adaptation of interventionists to telehealth via training sessions and standardized protocols were identified as facilitators to retention. Navigating siblings at home and the burden of COVID were the primary barriers to retention. The impact of race on retention and participation in intervention and research for high-risk infants should be monitored.
ABSTRACT
Background: The COVID-19-associated multisystem infammatory syndrome in children (MIS-C) is characterized by Kawasaki disease (KD)-like features and circulatory shock [1]. The genesis of SARS-CoV-2 variants triggered successive waves of mass infections followed by MIS-C outbreaks. Objectives: To compare MIS-C phenotypes across the waves of the COVID-19 pandemic. To identify predictors of pediatric intensive care unit (PICU) admission and treatment with biologic agents. Methods: Youth aged 0-18 years, fulflling the WHO case defnition of MIS-C, and admitted to the Alberta Children's Hospital during the COVID-19 pandemic (May 2020-December 2021) were included. Clinical, laboratory, imaging, and treatment data were captured (KD-like manifestations, signs of shock and/or hypotension, peak C-reactive protein (CRP) and ferritin, platelet count nadir, peak NT-proBNP and troponin, liver enzyme abnormalities, sodium and albumin nadir, echocardiogram fndings, biologic agents). Results: 57 consecutive MIS-C patients (median age 6 years, IQR 4-6;72% males) were included. 31 patients (54%) required PICU admission. All received immunoglobulins, 44 (77%) received corticosteroids, 8 patients (14%) were treated with biologic agents. Patients presenting during the third (mainly driven by Alpha variant) or fourth wave (mainly driven by Delta variant) presented with higher ferritin and NT-proBNP levels, and more liver enzyme abnormalities, hypoalbuminemia and thrombocytopenia compared to those presenting during the frst or second wave (Table 1, Figure 1). PICU admission was associated with the presence of shock/hypotension, higher CRP, ferritin, and NT-proBNP levels, lower albumin levels, and the presence of ventricular dysfunction on echocar-diogram (Table 1). A logistic regression model combining peak NT-proBNP, tro-ponin and ferritin levels explained 70% (Nagelkerke R2) of the variance in PICU admission and correctly classifed 91% of the cases. NT-proBNP was the sole signifcant contributor (p=0.017). Treatment with biologic agents was associated with higher CRP (mean 148.8 mg/l versus 251.7 mg/l;p=0.024) and ferritin (797 μg/l versus 1280 μg/l;p=0.049) levels. Conclusion: A shift in MIS-C phenotype was identifed across the successive COVID-19 waves, including the predominance of features associated with macrophage activation syndrome in later stages. These fndings may refect the impact of distinct SARS-CoV-2 variants. NT-proBNP emerged as the most important MIS-C feature predicting PICU admission, underscoring the importance of monitoring.
ABSTRACT
This paper documents part of the process of preparing to fully reopen the physical Self- Access Learning Center (SALC) in a university in Japan after being somewhat interrupted during two years of the COVID-19 pandemic. Self-access is becoming increasingly complex, multi-faceted and multi-disciplinary and it is necessary to revisit SALC mission statements periodically, particularly after major events or changes. A group of language educators working at the university examined literature and theories from a range of perspectives in order to inform the future directions of the SALC. In a series of meetings over a one-semester period, one or two team members led a guided discussion based on some key papers, talks or other resources related to eight themes. After a semester of such discussions, they returned to the mission statement and re-examined it, making it more theoretically robust and specific, acting as a guide for SALC services for a new era. © 2022 by the authors.