Clinical analysis of liver dysfunction in pregnant patients with mild SARS CoV-2 infection

Objective: The current study aimed to describe the clinical characteristics of mild SARS-CoV-2 infected pregnant women with abnormal liver function (ALF), explore the association between ALF with maternal and fetal outcomes. Method(s): This retrospective analysis included 87 pregnant patients with mild SARS-CoV-2 infection admitted and treated from December 1, 2022, to 31, 2022 in the department of Obestircs at Beijing Obstetrics and Gynecology Hospital. We evaluated patients for demographic and clinical features, laboratory parameters and pregnancy complications. Result(s): 27 Patients in this cohort had clinical presentations of ALF. Compared with the control group, the peripheral blood platelet (PLT), D-dimer quantitative determination (D-Dimer), lactate dehydrogenase (LDH), total protein (TP), albumin (ALB), indirect bilirubin (DBIL), gamma- glutamyltranspeptidase (GGT) and total bile acid (TBA) showed significantly differences (p<0.05). 12 cases (44.44%) complicated with pregnancy induced hypertension (PIH), 14 cases (51.85%) complicated with intrahepatic cholestasis of pregnancy (ICP), 2 cases (7.4%) complicated with acute fatty liver during pregnancy (AFLP) and 5 cases (14.81%) complicated with postpartum hemorrhage in patients with abnormal LFT were significantly higher than those in the control group (p<0.05). Compared with the control group, the incidence of premature delivery (22.22%) and fetal distress (37.04%) in the experiment group were significantly higher (p<0.05), and the incidence of neonatal asphyxia was not significantly different (p>0.05). Conclusion(s): Pregnant women are generally susceptible to mild SARS-CoV-2 and may induce ALF. ALF is associated with increased risk of mother and infant. The maternal and infant outcomes of those who terminated pregnancy in time are acceptable. Therefore, pregnant women with COVID-19 who received antiviral treatment should be closely monitored for evaluating liver function and relevant indicators. The long-term outcomes in the future are worth to further study.Copyright © 2023

Characteristics of cardiotocography in pregnant women with mild COVID-19 in the third trimester.

Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.

A Research of Emergency Service Admission Due To Home Accidents Before and During The Covid-19 (Sars-Cov-2) Pandemic In Ankara (Turkey)

Home accidents can cause serious injuries, disabilities, and deaths. Approximately 40 million people were treated in hospitals annually because of injuries occurring in homes, and these injuries were responsible for approximately 76% of preventable deaths. The aims of this study are to compare the home accidents in the one-year period during the pandemic and the home accidents in the one-year period before the pandemic, and to reveal how the home accidents are affected in which part of the home and in which types of injuries. A retrospective study was made of the records of patients injured in home accidents between pre-pandemic and pandemic one-year periods. The patients were classified according to age groups, gender, season, day and time of the home accident, accident type, part of the home, trauma localization and type, and severity of injuries. While 46.5% of the 581 injured patients were before the pandemic, 53.5% were in the pandemic period. The injuries increased as the number of households staying at home increased compared to the pre-pandemic period. Likewise, there was a significant increase in the number of falls from balconies and windows during the pandemic period. It is still not possible to make a definite prediction about the course of the pandemic. In this context, it is of great importance to provide information on prevention from home accidents, especially in television programs and distance education activities.Copyright © 2023, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.

Histomorphological Spectrum of Lung Lesions at Autopsy-A Tertiary Care Centre Experience

Background and aims: A wide variety of pathological conditions involve the lungs. In autopsy, the lungs are examined for disease, injury and other findings suggesting cause of death or related changes.Aims & Objectives: The present study aimed to study the histomorphological spectrum of lung lesions at autopsy and to assess the frequency of different types of lesions;and to associate histomorphological changes with cause of death.Material and Methods: It was a one-year observational study conducted in the Department of Pathology, Govt. Medical College, Jammu. Lung tissue pieces from all medicolegal autopsies received were fixed, examined grossly, processed;paraffin embedded sections obtained were stained with Hematoxylin and Eosin stain and examined under microscope. Findings were recorded and tabulated. Result(s): Out of 264 cases, males were predominantly affected (84%);median age was 38 years. The various changes observed were congestion (68%), edema (45.4%), pneumonia (5%), granulomatous inflammation (3%), diffuse alveolar damage (1.5%), haemorrhage (14.4%), interstitial changes (60%), malaria (0.4%) and malignancy (0.4%). Natural deaths were the commonest cause (75, 28%) followed by asphyxial deaths (65, 24.6%). Conclusion(s): Histopathological examination of lung autopsies highlights many incidental findings, establishes underlying cause of death, serves as a learning tool and also holds scope for detection of newer diseases.Copyright © 2023 JK Science.

The post-pandemic re-organization of birth centres and its impact on perinatal asphyxia in the province of Reggio Emilia

Objective. The pandemic forced the re-organization of birth hospitals in the province of Reggio Emilia. In 2018 there were four difference birth centres, in 2021 only two out of four were still working. The OBJECTIVE of the study was to evaluate if the centralization of birth centres had worsened the stillbirth rate and perinatal asphyxia (PA) outcome during the SARSCoV- 2 pandemic period (years 2020-21) compared to the pre-pandemic period (years 2018-19). Materials and Methods. Retrospective review of birth rate, recovery for PA rate and stillbirth rate in the province of Reggio Emilia. Results. Statistical data showed a decrease of overall births from 2018 to 2021 (7516 newborns in 2018-19 to 6363 in 2020- 21), in accordance with the national trend. The percentage of newborns in the NICU in Reggio Emilia increased from the pre-pandemic period (59.66%) to the pandemic period (83.66%). Regarding the stillbirth rate, we observed a decrease from the pre-pandemic period (3.20%) to the pandemic period (2.36%). As far as concerned the PA rate, the percentage showed a reduction from the pre-pandemic (0.44%) to the pandemic period (0.36%). We also observed a decrease of the hypoxic-ischemic encephalopathy (HIE) rate from 0.16% to 0.12%. Finally, three different outcomes were evaluated in patients admitted for perinatal asphyxia: mortality, brain imaging lesions and seizures. During the pandemic we observed a significant decrease in all of these (Table 1). Conclusions. Centralization of birth centres did not worsen perinatal diseases as far as concerns stillbirth, PA and HIE rate. On the contrary, we observed an enhancing of patients' outcomes.

Fatal Asphyxia Potentially Caused by COVID-19-Induced Exacerbation of Pre-existing Tracheal Stenosis.

We report a case of cardiac arrest due to asphyxia caused by coronavirus disease 2019 (COVID-19) in a patient with no history of tracheal intubation but with a history of subglottic stenosis. A 54-year-old man suffered a cardiac arrest at home. The patient had tracheal stenosis; therefore, it was difficult to intubate. The patient had COVID-19, which was presumed to have aggravated the existing tracheal stenosis and caused asphyxiation. The patient died seven days later. This is, to our knowledge, the first report of a patient with subglottic stenosis potentially aggravated by COVID-19, resulting in asphyxia-related cardiopulmonary arrest. The patient could not be saved, but emergency physicians should be aware that airway obstruction can be caused by viral infections, including severe acute respiratory syndrome coronavirus 2 infections. Physicians should consider the difficulty in performing oral intubation and cricothyrotomy and be aware of alternative methods to secure the airway.

Nasopharyngeal SARS-CoV-2 load and perinatal outcomes after maternal infection diagnosed close to delivery.

BACKGROUND: The occurrence of COVID-19 during the pregnancy can cause several negative maternal and neonatal outcomes. Nasopharyngeal viral load is associated with inflammatory markers and might influence the disease severity in non-pregnant patients, but there are no data about the relationship between viral load and perinatal outcomes in pregnant patients. OBJECTIVE: To investigate the hypothesis that nasopharyngeal SARS-CoV-2 load (estimated with real-time polymerase chain reaction delta cycle (ΔCt), measured in hospital clinical laboratories) is associated with perinatal outcomes, when COVID-19 is diagnosed in the third trimester of pregnancy. STUDY DESIGN: International, retrospective, observational, multi-center, cohort study enrolling 390 women (393 neonates, three pairs of twins), analyzed with multivariate generalized linear models with skewed distributions (gamma) and identity link. The analyses were conducted for the whole population and then followed by a subgroup analysis according to the clinical severity of maternal COVID-19. RESULTS: The estimated viral load in maternal nasopharynx is not significantly associated with gestational age at birth (adjusted B: -0.008 (95%CI: -0.04; 0.02); p = 0.889), birth weight (adjusted B: 4.29 (95%CI: -25; 35); p = 0.889), weight Z-score (adjusted B: -0.01 (95%CI: -0.03; 1); p = 0.336), 5' Apgar scores (adjusted B: -0. -9.8e-4 (95%CI: -0.01; 0.01); p = 0.889), prematurity (adjusted OR: -0.97 (95%CI: 0.93; 1.03); p = 0.766) and the small for gestational age status (adjusted OR: 1.03 (95%CI: 0.99; 1.07); p = 0.351). Similar results were obtained in subgroup analyses according to COVID-19 clinical severity. CONCLUSIONS: The estimated maternal nasopharyngeal viral load in pregnant women affected by COVID-19 during the third trimester is not associated with main perinatal outcomes.

Socio-Demographic Profile of Victims of Hanging Cases: An Autopsy Based Cross-Sectional Study Done in Police Morgue of a Medical College of West Bengal

Background: The word asphyxia is of Greek derivation and means "a stopping of the pulse". Any death is asphyxial in nature. But forensic pathology understands asphyxia as the interference with the exchange of oxygen and carbon dioxide in the body. Hanging and strangulation constitute asphyxia by compressing vital structures within the neck. Hanging is one of the ten leading causes of death in the world accounting for more than a million deaths annually. In India, hanging is one of the common methods of committing suicide. 2021 NCRB report also depicts the alarming rate of increase of suicide in the country. Over the past 30 years specially during and after the COVID-era the incidence of suicide by hanging is on increase, especially among young adults. 2021 NCRB report also depicts the alarming rate of increase of suicide in the country. Material(s) and Method(s): A cross-sectional study was conducted following the complete enumeration method over the body of deceased died due to hanging and came for medico-legal autopsy in Burdwan police morgue of West Bengal with specific Inclusion and Exclusion criteria. Study done on total 129 (N= 129) bodies of hanging cases Detailed information regarding the deceased, circumstances of death, its different sociodemographic parameters hanging were collected from the inquest, investigating officer and relatives. Result(s): Results showed that most of the victims of hanging were males. Highest incidence was in the age group of 21 to 30 years. Most of the victims were Hindus by faith. Conclusion(s): In Covid and Post-Covid era number of hanging cases has been increased mostly due to familial and socio-economical constrains. Copyright © 2022 Ubiquity Press. All rights reserved.

A cross-sectional evaluation of maternal and perinatal outcomes in pregnancies complicated with COVID-19

Aim: Pregnancy is considered a vulnerable period for women regarding increased risk of respiratory tract infections, altered immunity, and metabolic changes in their bodies. COVID-19 pandemic also possesses a significant risk on pregnant women, but the data on the disease course is insufficient. Therefore, this study aimed to evaluate the maternal and perinatal outcomes in pregnant women diagnosed with COVID-19. Materials and Methods: This cross-sectional study retrospectively evaluated the hospital records of pregnant women admitted to the Obstetrics and Gynecology Department of 19 MayisUniversity Hospital between 01/04/2020 to 30/12/2021 regarding gestational week at birth, basal gestational, and labor characteristics, delivery complications, and perinatal and maternal COVID-19 outcomes.

Suicides During the Pandemic: A Retrospective Study

Suicide is defined as a fatal self-injurious act with some evidence of intent to die.1 Suicide occurs more often in older than in younger people, but is still one of the leading causes of death in the late childhood and adolescence. Every year, more than 1,00,000 people commit suicide in our country.1 Suicide accounts for 1.4% of all deaths, and is the 15th leading cause of death globally.2,3 Suicide is associated with an impulsive nature. Several risk factors concerning family structure and interactions have been linked to a suicidal behaviour. Direct conflicts with parents and siblings, Occupational status and social acceptance have a great impact, but so do the absence of communication and a lack of empathy.12 Interpersonal losses are also strongly associated with suicide cases. But in developing countries one of the major reason always remains unemployment and poverty. There are different rates of suicides and suicidal behaviour between males and females (among both adults and adolescents). While females more often have suicidal thoughts, males die by suicide more frequently.5 Hence, this study was planned with a purpose to know the magnitude and the socio-cultural factors of the problem of suicides, so that a sound prevention program could be suggested, planned and implemented for reducing the incidence of suicides.

COVID-19 Infection in Parturients: Comparative Neonatal and Maternal Outcomes in a Single-institute Regional Hospital in Thailand

Objective: Chonburi province is ranked fourth in Thailand in terms of COVID-19 cases. The objective was to compare neonatal and maternal outcomes among pregnant women with and without COVID-19 infection delivered in Chonburi hospital. Materials and Methods: The present study was a retrospective matched cohort study that included all pregnant women who delivered between January 1 and August 31, 2021, at Chonburi Hospital, Thailand. The exposure group comprised women with a current or previous positive COVID-19 PCR test, while the comparators were the PCR negative group. The matching ratio was 1:4, based on gestational and maternal age, parity, and the closest delivery date. Clinical data were obtained from medical records. Results: Forty-six pregnant women had a positive COVID-19 PCR, 24 (52.17%) were Thai and 22 (47.83%) were of other ethnicities. Most (60.87%) were asymptomatic or required no medical assistance. Three (6.52%) had severe pneumonia and required respiratory support. Neither maternal death nor vertical transmission was detected. Compared with 184 COVID-19-negative pregnant women, no significant differences in low APGAR score of less than 7, and preeclampsia in the 46 COVID-19-positive pregnant women were observed. However, COVID-19-positive pregnant women showed an increased rate of neonatal respiratory distress (RD) (relative risk [RR] 2.55;95% confidence interval [CI] 1.04 to 6.21] and clinical early-onset neonatal sepsis (RR 3.60;1.55 to 8.36). Additionally, a higher cesarean section rate was observed in the COVID-19 positive group (RR 1.45, 1.11 to 1.85). Conclusion: There were no significant differences in neonates with APGAR of less than 7 between the cohort of 46 pregnant women who tested positive for COVID-19 and those who tested negative. However, a higher rate of cesarean delivery, presumed early-onset neonatal septicemia, and RD in the COVID-19 positive group were noted and should be monitored.

Pregnancy Outcomes with Coronavirus Infection (COVID-19)

Introduction: The clinical therapy of COVID-19 infection during pregnancy is still insufficient and limited. The current literature on COVID-19 infection during pregnancy and childbirth is summarized in this article, with a focus on maternal and neonatal outcomes. Material and methods: From June 1 to September 7, 2020, a systematic search of pertinent medical subject heading (MeSH) terms, covered by the electronic databases Web of Science and Scopus, PubMed, Google Scholar, and SID key phrases including coronavirus or COVID-19 and pregnancy was undertaken. The search and selection criteria were restricted to English and Farsi literature. COVID-19 in pregnancy articles of all types were considered in the study. The references of relevant studies were also searched. After deleting duplicate and ineligible items, a total of 21 articles were collected. Result: We found 21 studies with a total of 6,569 pregnant women who had COVID-19 infection: only one publication provided disease severity: 368 (95.6%) mild cases, 14 (3.6%) severe cases, and three (0.8%) serious cases. A total of 6,569 women gave birth more often by caesarean than by vaginal delivery. With multiple organ dysfunction syndromes (MODS), some women developed symptoms that necessitated ICU admission. The most commonly administered treatments for pregnant women with COVID-19 were hydroxychloroquine, Beclomethasone, Calamine, diclofenac sodium, Methylprednisolone, Azithromycin, Ganciclovir, Chinese herbal medicine, and Oseltamivir. The most commonly reported symptoms were fever and cough, followed by rhinorrhea, chest tightness, dyspnea, nasal congestion, and myalgias. Maternal outcomes included premature rupture of membranes, maternal death (21), gestational diabetes, preeclampsia, placental abruption, fetal distress, anemia, preterm birth (< 37 weeks), and fetal growth restriction, miscarriage, hypertension, and influenza. Neonatal intensive care unit (NICU) admission, prematurity, birth weight 2,500 g, preterm delivery (37 weeks), fetal discomfort, neonatal asphyxia, stillbirth (5), and neonatal death (9) were among the outcomes for babies. All of the infants had good Apgar scores. Conclusion: Prenatal and neonatal outcomes appear to be favorable in the majority of cases. Pregnant women and babies should be considered particularly vulnerable populations in terms of COVID-19 preventive and management strategies.

Implementation of solar powered oxygen delivery in a conflict zone: preliminary findings from Somalia on feasibility and usefulness.

Access to therapeutic oxygen in low-resource settings remains a significant global problem. Solar powered oxygen (SPO2) delivery is a reliable and cost-effective solution. We followed implementation research methodology to gather data on engineering parameters (remote monitoring), nurse training (before and after knowledge questionnaire), patients treated with SPO2 (descriptive case series), and qualitative user feedback (focus group discussions). In January 2021, SPO2 was installed at Hanano General Hospital in Dusamareb, Galmudug State, Somalia, in a conflict-affected region. Daily photovoltaic cell output (median 8.0 kWh, interquartile range (IQR) 2.6-14) exceeded the electrical load from up to three oxygen concentrators (median 5.0 kWh, IQR 0.90-12). Over the first six months after implementation, 114 patients (age 1 day to 89 years, 54% female) were treated for hypoxaemic illnesses, including COVID-19, pneumonia, neonatal asphyxia, asthma, and trauma. Qualitative end user feedback highlighted SPO2 acceptability. Violent conflict was identified as a contextual factor affecting local oxygen needs. We provide the preliminary findings of this implementation research study and describe the feasibility, fidelity, rapid adoption, usefulness, and acceptability of SPO2 in a low-resource setting characterized by violent conflict during the COVID-19 pandemic. Our findings demonstrated the lifesaving feasibility of SPO2 in volatile settings.

Placental pathologies and fetal outcome in pregnant women with COVID-19: A retrospective study

Objective: To describe histopathologic findings in the placentas in women with coronavirus disease 2019 (COVID-19) during pregnancy. Methods: In a cross-sectional study, 38 pregnant women with COVID-19 and undergoing delivery between March 2020 and January 2022, were included. The patients had positive polymerase chain reaction (PCR) test for SARS-CoV-2 infection and the placentas after delivery were sent for histopathologic evaluation based on the Amsterdam Placental Workshop Group Consensus Statement and assessed by two pathologists. Results: Our results showed that maternal vascular malperfusion was the most common and was present in 17 cases (44.7%). These features included accelerated villous maturation (36.8%) distal villous hypoplasia (5.3%), placental infarction (5.3%) and intervillous fibrin deposition (10.5%). Other pathologic findings included focal calcification (10.5%), intravillous congestion and hemorrhage (10.5%), sub-chorionic hemorrhage (5.3%), acute villitis, chronic histiocytic intervillositis and delayed villous maturation each in one case (2.6%). Twelve out of 38 cases showed no significant pathologic changes. Fetal outcomes included neonatal intensive care unit admission rate of 13.2%, dyspnea 31.6%, newborn's anosmia 7.9%, intrauterine fetal demise 2.6%, asphyxia 2.6% and neonate COVID infection 5.3%. Conclusions: Microvasculopathy, as a sign of maternal vascular malperfusion, is a common finding in placentas from SARS-CoV-2 positive pregnant women in the present study. Further studies with larger sample sizes and comparative studies between COVID-19 positive and negative, as well as information from patient follow-up are suggested.

Outcomes of infants with hypoxic-ischemic encephalopathy during COVID-19 pandemic lockdown in Canada: a cohort study.

PURPOSE: To evaluate change in the severity of hypoxic-ischemic encephalopathy (HIE) and associated morbidities between pre- and during COVID-19 pandemic periods in Canada. METHODS: We conducted a retrospective cohort study extracting the data from level-3 NICUs participating in Canadian Neonatal Network (CNN). The primary outcome was a composite of death in the first week after birth and/or stage 3 HIE (Sarnat and Sarnat). Secondary outcomes included rate and severity of HIE among admitted neonates, overall mortality, brain injury on magnetic resonance imaging (MRI), neonates requiring resuscitation, organ dysfunction, and therapeutic hypothermia (TH) usage. We included 1591 neonates with gestational age ≥ 36 weeks with HIE during the specified periods: pandemic cohort from April 1st to December 31st of 2020; pre-pandemic cohort between April 1st and December 31st of 2017, 2018, and 2019. We calculated the odds ratio (OR) and confidence intervals (CI). RESULTS: We observed no significant difference in the primary outcome (15% vs. 16%; OR 1.08; 95%CI 0.78-1.48), mortality in the first week after birth (6% vs. 6%; OR 1.10, 95%CI 0.69-1.75), neonates requiring resuscitation, organ dysfunction, TH usage, or rate of brain injury. In the ad hoc analysis, per 1000 live births, there was an increase in the rate of infants with HIE and TH use. CONCLUSIONS: Severity of HIE, associated morbidities, and mortality were not significantly different during the pandemic lockdown compared to a pre-pandemic period in Canada. Anticipated risks and difficulties in accessing healthcare have not increased the mortality and morbidities in neonates with HIE in Canada.

To Evaluate the Clinical Profile of Neonates Born to COVID Positive Mothers during Pandemic at GIMS Hospital, Kalaburagi

Background: The incidence of mother-to-newborn Covid 19 transmission is low. However, data are limited on the factors associated with neonatal clinical or viral testing outcomes. This study aims at evaluation of clinical profile of neonates born to COVID positive mothers. Objective: To determine the number of neonates from 01 April 2020 to 30 August 2021 with lab confirmed COVID-19 infection born to Covid 19 positive mothers. To assess the clinical features of neonates born to Covid 19 positive mothers. Methods & Materials: Study design: Retrospective cohort study Study period: 01 April 2020 to 30 August 2021 Study Place: Gulbarga institute of medical science kalaburagi, Karnataka India. Conclusions: Perinatal covid 19 infection may have adverse effects on newborns causing problems such as fetal distress, premature labour, Hyperbilirubinemia, respiratory distress, oxygen requirement, sepsis, birth asphyxia and even death. However vertical transmission of Covid 19 is yet to be confirmed Aims and objectives: To determine the number of neonates from 01 April 2020 to 30 August 2021with RTPCR confirmed COVID-19 infection born to Covid 19 positive mothers. To assess the clinical features of newborns born to Covid 19 positive mothers. Inclusion criteria: All neonates born to Covid 19 positive mothers METHODS: Manual medical records of mother and baby were reviewed. Data on maternal demographic factors (age, residence, socioeconomic status), co morbidities, symptoms of COVID 19, Data on newborn demographic factors (gestational age, sex, birth weight, mode of delivery, Apgar score) were collected . All neonates born to covid 19 positive mother were reviewed for clinical and lab data till time of discharge. Clinical data such as respiratory distress, oxygen desaturation, poor feeding, apnea, seizures, tachycardia, fever, hypothermia, jaundice in those neonates was reviewed. Associated morbid factors such as Birth asphyxia, prematurity, relative sepsis were analysed. Lab data such as TLC, CRP, Sr Ferritin, Sr LDH, D-Dimer, Procalcitonin, RTPCR analysis of nasopharyngeal and throat swab of neonates born to covid positive mothers were reviewed. Chest x ray was reviewed. Those having clinical symptoms/ signs were admitted in NICU. Asymptomatic hemodynamically stable Covid19 negative neonates were isolated on mother side. Sample size: 200 neonates born to covid19 positive mothers. Sample size was determined based on the incidence of covid19 positive rates of neonates born to covid positive mothers, using formula 4PQ/L2. Results: Among these 200 pregnant women with confirmed Covid 19 infection, fever and cough were the common symptoms noted. Of the newborns born to these mothers, 92 were male neonates and 108 were female neonates, 153 were full-term neonates and 32 were born premature;15 were small-for-gestational-age (SGA) neonates. Clinically, the initial presentations in the neonates were respiratory distress(n=5) and failure to breathe at birth(n=4), but other presentations such as fever(n=1), poor feeding(n=3),rapid heart rate(n=4), hyperbilirubinaemia (n=5) abnormal Xray(n=3) and oxygen requirement(n=4) were also observed. All neonates were improved and discharged. Nasopharyngeal and throat swab specimens were collected from these neonates 2to3days after birth for Covid 19 RT-PCR tests, out of which 02 neonates showed positive results. One COVID-19 positive baby presented with failure to breathe at birth was treated with antiviral and antibiotics. The other baby also had similar presentation was treated with antiviral and oxygen. Both neonates improved and discharged.

IS HBB ENOUGH? EXPERIENCES WITH QI ACTIVITIES FOR BIRTH ASPHYXIA IN AN LMIC HOSPITAL THROUGH GLOBAL VIRTUAL TEAMWORK

Purpose of Study Birth asphyxia is a major cause of neonatal mortality in low- and middle-income countries (LMIC). A Blended Learning Program was set up by Georgetown University (GU) faculty for quality improvement (QI) activities in several district hospitals in Ghana (funded by GU Global Health Initiative). Birth asphyxia was selected as the top priority by the Ghana staff, specially focusing on resuscitation at birth. The in- country workshop was cancelled due to the COVID pandemic. However, facilitation of QI activities was carried out using digital technology. We share the impact of this program in one Ghana regional hospital. Methods Used Hospital staff had received in-country training in AAP-Helping Babies Breathe (HBB) course earlier. Using Zoom and WhatsApp, the GU faculty worked with health care providers to facilitate QI activities to improve resuscitation at birth. This included setting up a QI team, correct documentation of Apgar scores, refresher courses, practices on a manikin, promoting having at least two persons at each birth and ensuring appropriate equipment being kept in readiness. Monthly changes in proportion of babies ≥ 34 wks. gestational age whose Apgar score rose from £ 6 at 1 min. to ≥ 7 at 5 min of age were monitored. Pre-and post-intervention periods were Oct-Dec 2019 and Jan 2020 to Mar 2021. The program was considered exempt from review by the GU IRB. Summary of Results Figure 1 indicates the proportion of babies in whom the Apgar score rose from £ 3 at 1 min to > 4 at 5 min and those in whom the score rose from 4-6 at 1 min to ≥ 7 at 5 min. No significant difference was noted between the pre and post intervention periods. Table 1 shows that among 112 newborns with a 1minute Apgar score of £ 3, the scores remained at £ 3 at 5 minutes in about 50% of babies despite resuscitation attempts until the 4th quarter;17 (37%) of these infants died. Table 2 shows that in 639 infants with Apgar scores of 4-6, the scores did not improve to > 7 in 75 babies (11.7%);there were 5 deaths (0.8%) attributed to birth asphyxia in this group. Conclusions The improvement in Apgar scores showed that HBB had a positive effect. However, to have the full desired impact on outcome in newborns with birth asphyxia, it is essential to go beyond 'HBB' to a more comprehensive 'Mother-Baby Approach' where management addresses prevention and treatment. This includes (a) Counseling in the antenatal period promoting mothers to reach the facility at the appropriate time in labor (b) 'Helping Mothers Deliver' through capacity building of the maternal health staff for competency in optimal management of labor and delivery (c) 'HBB' to improve competence related to neonatal resuscitation (d) Better communication and coordination between maternal and newborn health staff and (e) Post resuscitation care of the baby. (Table Presented).

Covid-19: Pregnancy and childbirth outcomes after treatment with recombinant interferon α-2b

Objective. To evaluate pregnancy and childbirth outcomes after the combined use of VIFERON® (interferon α-2b with antioxidants) rectal suppositories (3,000,000 IU) and VIFERON® gel for external and local use (36,000 IU/g) in the treatment of new coronavirus infection (COVID-19) in pregnant women against the background of standard complex therapy. Patients and methods. A total of 140 pregnant women diagnosed with COVID-19 were examined and divided into two groups: group 1 consisted of 70 patients who received VIFERON® and standard complex therapy;group 2 – 70 patients who received only standard therapy. Results. Patients from group 1 had a significantly decreased incidence of preterm birth, perinatal loss, and severe birth asphyxia. Most of these pregnant women gave birth at 38-40 weeks of gestation, and no antenatal fetal death was recorded. Conclusion. Inclusion of VIFERON® (rectal suppositories and gel for external and local use) in the complex treatment of COVID-19 in pregnant women contributed to more prompt relief of symptoms and improved pregnancy and childbirth outcomes.