A new pandemic – new questions: postnatal care of infants born to mothers with suspected or confirmed COVID-19

COVID-19 infection is primarily a community-acquired airborne respiratory infection, making pediatric and neonatal populations extremely vulnerable to the disease. Since the beginning of the coronavirus pandemic, many questions regarding mother and infant health have arisen, one of the most discussed issues being the management of infants born to mothers with suspected or confirmed COVID-19. Is it advisable to separate the child from the positive mother immediately after birth? What are the recommendations for breastfeeding? Are there any short and long-term follow-up indications or are there any possible long-term complications that we should take into account in those children? And not lastly, what are the most respectful and ethical measures both for mother and infant? We aim to analyze and compare the existing guidelines regarding the management of infants born to mothers with suspected or confirmed COVID-19 and to discuss the similarities and discrepancies between the available protocols. © 2022, Amaltea Medical Publishing House. All rights reserved.

COVID-19 in pregnancy, childbirth and puerperium: The CRONOS registry.

Coronavirus disease 2019 (COVID-19) is an infectious disease that can lead to severe respiratory symptoms. Pregnant women have an increased risk for a severe course. Therefore, the Association of the Scientific Medical Societies in Germany (AWMF) Guidelines 015/092 "SARS-CoV-2 in pregnancy, childbirth, and the puerperium" were established to standardize care in the COVID-19 pandemic. The guideline group used data from the "COVID-19 related obstetrics and neonatal outcome study" (CRONOS) to generate evidence-based recommendations for action. CRONOS collects data from more than 130 affiliated maternity hospitals nationwide in Germany. According to the study, pregnant women positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are often asymptomatic;however, in 1 out of 25 detected infections there is a severe course requiring intensive medical treatment. Thromboembolism occurs in 1 out of 30 women hospitalized for COVID-19. An infection of the neonate of a mother infected peripartum is occasionally detected (about 1 out of 20 infants) and usually remains without consequence in the short-term outcome. Many other questions have been answered using CRONOS data. The registry is still open and recruiting and will also provide more in-depth information on different virus variants and vaccination in the future with more than 6000 cases. CRONOS is exemplary for an unprecedented cooperation of gynecologists during the pandemic.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

The role of fathers in supporting the development of their NICU infant

Contemporary models of NICU care emphasize the critical role of parents in supporting their infant's development. Fathers play an important, but underutilized, role throughout their infant's NICU journey. This narrative review describes the main direct and indirect mechanisms through which fathers support the development of their NICU infant, and the barriers and facilitators to this support as described in current research. Studies have identified several mechanisms through which fathers can directly enhance their infant's health and development. Several studies described the benefits of fathers providing kangaroo care, but infant-directed speech, tactile stimulation, and parent scent also appear to yield developmental benefits. However, most of the literature focused on the indirect ways that fathers support their infants through the coparenting alliance, assuming additional responsibilities that allow mothers to spend more time engaged in infant care, and by providing financial support for the family. Reduced access to the NICU setting has been identified as a key barrier to fathers' direct involvement in infant care, which has been further exacerbated due to additional restrictions imposed due to the COVID-19 pandemic. Additionally, negative perceptions held by fathers, mothers, and nursing staff regarding the role of fathers in preterm infant care may also represent a barrier to fathers' engagement. Nursing staff were identified as playing a crucial role in promoting fathers' capacity to support the development of their infants. This research can help to inform interventions and policies geared toward optimizing infant development by improving the involvement of fathers during a NICU admission, and beyond. © 2023 Neonatal Nurses Association

Parental experiences of live video streaming technology in neonatal care in England: a qualitative study.

BACKGROUND: The use of bedside cameras in neonatal units facilitates livestreaming of infants to support parental and family bonding when they are unable to be physically present with their baby. This study aimed to explore the experiences of parents of infants previously admitted for neonatal care and who used live video streaming to view their baby in real-time. METHODS: Qualitative semi-structured interviews were conducted after discharge with parents of infants admitted for neonatal care on a tertiary level neonatal unit in the UK in 2021. Interviews were conducted virtually, transcribed verbatim and uploaded into NVivo V12 to facilitate analysis. Thematic analysis by two independent researchers was undertaken to identify themes representing the data. RESULTS: Seventeen participants took part in sixteen interviews. Thematic analysis identified 8 basic themes which were grouped into 3 organizational themes: (1) family integration of the baby including parent-infant, sibling-infant, and wider family-infant attachment facilitated through livestreaming, (2) implementation of the livestreaming service including communication, initial set up of the livestreaming service, and areas for improvement, and (3) parental control including emotional, and situational control. CONCLUSIONS: The use of livestreaming technology can provide parents with opportunities to integrate their baby into their wider family and friendship community and gain a sense of control over their baby's admission for neonatal care. On-going parental education around how to use, and what to expect from, livestreaming technology is required to minimise any potential distress from viewing their baby online.

COVID-19 pandemic and neonatal health: What we know so far?

COVID-19 first time appeared in December 2019 in Wuhan, China. The number of cases increased rapidly in china and outside and the World Health Organization declared a pandemic on 11th March 2020. The pregnant and postpartum women, child, and neonatal populations are vulnerable to this disease due to immunological and physiological changes. This paper analyzed the published evidence for assessing the effect of COVID-19 on neonatal health and health care. Online published literature was searched from PubMed, Google Scholar, and other official webpages using keywords: "coronavirus/COVID-19/new coronavirus 2019"/SARS-CoV-2 and neonatal health/care/outcomes" and reviewed to prepare this article. COVID-19 is the potential to transmit either mother to fetus or mother/caregiver to neonates. However, neonates born from infected mothers did not show significant clinical features. Pharyngeal-swab, amniotic-fluid, cord-blood, and breast-milk test results were not found positive. Health facility-based vaginal/caesarian delivery was considered a low risk of transmission. However, recommended to separate neonates with infected mothers/caregivers and test immediately after birth to avoid the possible transmission. Mothers/caregivers should take routine preventive measures such as washing hands frequently and avoiding contact with infected people. If neonates suffered from the server acute respiratory distress requires intensive care urgently. Despite the possibility of the intrauterine transmission of COVID-19 direct evidence is still lacking so it needs more studies for further confirmation. The International Pediatric Association suggested preventive programs, curative care, vaccination, and telemedicine care as the minimum services and called on its members to address these cares during the pandemic. Copyright © 2020, Kathmandu University. All rights reserved.

Reducing error in drug prescribing in a neonatal unit (RED quality improvement project)

1008 Figure 1[Figure omitted. See PDF] 1008 Figure 2[Figure omitted. See PDF]ConclusionPrescribing is a complex, challenging task and a high-risk area of clinical practice.1 Preventing prescribing errors is critical to improving patient safety.2 Studies have identified a range of factors underpinning poor prescribing at individual, environmental and organizational levels.3 Through our project, we have demonstrated that these errors can be reduced to a minimum by sheer commitment, effective team engagement, supervision, teaching, and training of the staff. Currently the biggest barrier to sustaining the change are staffing issues within the department and the impact of COVID-19, however going forward embedding the correct culture is paramount.ReferencesDepartment of Health. Building a Safer NHS for Patients. London: NHS, 2001.Bruna Carolina de Araújo. How to Prevent or Reduce Prescribing Errors: An Evidence Brief for Policy. Front Pharmacol. Published online 2019 Jun 12. doi:10.3389/fphar.2019.00439Ross S, Loke YK. Do educational interventions improve prescribing by medical students and junior doctors? A systematic review. Br J Clin Pharmacol 2009;67: 662–70.

Neonatal RSV positive bronchiolitis with fulminant viral septic shock

AimsMain purpose of presenting this clinical case is that RSV BRONCHIOLITIS can present with lobar pneumonia,Fulminant viral septic shock with DIC,pulmonory haemorrhage and asystole. Viral VS Bacterial sepsis- clinically difficult to differentiate.Methods1 month old girl,unwell for 2 days with cough,decrease oral intake, seen by GP in the morning and diagnosed as BRONCHIOLITIS,same day evening presented to the hospital with apnoea in the car arrived at PAU within 3 mins of apnoea.O/E-no HR or breathing,bleeding from nose and mouth,pale looking,mottled, CRT 5 sec.CPR started and connected to monitor showed asystole.Immediate cardiac arrest call was activated.Intubated, cannula inserted, 2 doses of adrenaline given IV,Bolus of normal saline 10mls/kg thrice,partial septic screening done and covered with triple antibiotics amoxycillin,gentamycin and cefotaxime.After 10 mins of resuscitation baby responded. Given vitamin K and transfused with O negative blood and FFP.Blood gas showed mixed metabolic and respiratory acidosis and hence connected to ventilator started on morphine,maintenance fluids,ionotropes,morphine infusion and transferred to tertiary centre. In tertiary centre admitted for 11 days,extubated to CPAP on day 5, weaned to high flow on day 6, RA on day 9. Ionotropes for 1 day,acylovir, vitamin k for 9 and 6 days respectively.Neuroprotective measures followed.ResultsNPA for RSV positive, covid 19 PCR negative, blood c/s,CSF c/s and CSF PCR for bacteria and viruses negative, X ray chest consolidation upper lobes bilateral,CT Angiogram subsegmental consolidation and possible intraparenchymal haemorrhage. Initial Echo pulmonory hypertension and repeat Echo normal.MRI Brain -hypersensitivity in posterior putamina. Deranged coagulation profile.APTT more than 180, PT 16.2, INR 1.4ConclusionRSV positive bronchiolitis with all complications can mimic bacterial sepsis and its clinically difficult to differentiate between viral and bacterial septic shock.As this baby’s blood C/S was negative only positive thing was RSV in NPA, We have to consider this case as RSV BRONCHIOLITIS with fulminant septic shock with pneumonia, DIC, Pulmonory Haemorrhage leading to Asystole.Management of bacterial and viral Septic shock is pretty much the same except in certain cases we may have to use antivirals drugs when indicated.

Timely and ethical access to genetic investigations on the neonatal unit: a collaboration between Leeds Centre for Newborn Care and The Yorkshire Regional Genetics Service

AimsGenomic testing is often important in the management of neonates in tertiary care. Tests need to be timely, and families need to be adequately counselled to allow informed decision making. Both teams identified several interventions to improve genetics management on the neonatal unit, particularly in response to the Covid pandemic.Our objectives were to improve current practices by focussing on two areas:1. Access to genetics expertise, with an emphasis on virtual working2. Current practices surrounding consent for genetic investigationsMethodsIn response to the Covid pandemic a Neonatal-Genetics virtual MDT was implemented in September 2020. Data was retrospectively collected from the medical notes of all neonates referred to genetics during a fifteen-month period (December 2019-March 2021) to allow for comparison of data before and after this intervention. Data was collected on consent documentation for genetic tests (QF-PCR, microarray) in the neonatal unit. As consent documentation appeared sparse, a survey was disseminated to all clinicians on the unit in February 2021 to assess knowledge of genomic testing and consent-taking. An email survey was sent to 6 neonatal units in Yorkshire and the Humber in August 2021 to explore regional variations in consent processes.ResultsThere was an increase in referral rate from 1.5% to 2.3% after MDT introduction but a 33% reduction in the proportion of babies requiring in-person geneticist reviews. Anecdotally, the MDT was considered a positive change by both teams by facilitating continued communication. Only 11% of neonates (n=2 of 17) had adequate consent documentation for genomic tests by the neonatal team. Of 27 respondents of the staff survey, only 2 (7%) had received formal training in consent for genomic tests and only 22% (n=6 out of 27) felt confident in consenting and explaining genetic testing to parents. All (100%) respondents felt a teaching session on genomic testing would be helpful, and all respondents agreed that it would be beneficial to develop a guideline to aid the consent process. None of the regional neonatal units contacted had a formal education program or standardised guideline in place. In response to this, a teaching programme was devised and a checklist created to facilitate the consent process for genetic testing. The teaching sessions were well-received, attendees scored the sessions an average of 4.8 out of 5 (n=19 respondents) for overall usefulness and quality.ConclusionIntroducing an MDT allowed for streamlined working during the pandemic and facilitated ongoing discussions of neonates with evolving phenotypes, whilst reducing the burden of inpatient reviews for a busy regional genetics service. Our data identified a paucity of genetic test consent documentation and our survey suggested that staff training and confidence around genomic testing/consent was a contributing factor. Therefore, an educational package for clinicians was developed. This was well-received, and a checklist was created to simplify and standardise documentation. A repeat analysis will be undertaken this year to assess the efficacy of these interventions. The intention is to expand the education package and consent checklist to units within our region and beyond.

Positivity in adversity: Greatix launch during Covid Pandemic

617 Table 1 617 Table 2AcknowledgementsMeena Muthumeenal, Clinical Governance Lead, Broomfield Hospital, Mid South Essex NHS Foundation TrustPaul Knox, Lead Practitioner Broomfield and Braintree Community Theaters, Greatix admin for the Trust.Elizabeth Dyson, Paediatric ward clerk

Neonatal discharge after cardiac surgery, can it be any safer?

AimsIn the United Kingdom, all the newborn babies are expected to be fully examined by a trained health care professional within 72 hours of birth, unless they are too unwell or too young i.e. less than 34 weeks of gestation. This is the nationwide known Newborn and Infant Physical Examination;NIPE screening programme. It is generally acceptable that primary and secondary care can achieve ninety five percent compliance with this national guidance. However, it is not easy to specify a benchmark for tertiary care system.MethodsWe carried out a quality improvement project to improve our compliance with these guidelines in the East Midlands Congenial Heart Centre, University Hospitals of Leicester. First, we retrospectively identified the neonates admitted in 2019/2020 to the EMCHC in the first 3 days of life by using the admission log book. We checked the status of the NIPE on the national registry to address where and when the check was done. These helped in figuring out the initial compliance with the national guidance. After analysing the data and presenting the results, several measures were put in place to improve the compliance. A re-audit was performed few months later, using the same data collection and data analysis measures. Raising awareness, provide access & training to all professionals, putting a system check for NIPE on the daily basis and whenever the patients move between units were effective measures to achieve a jump in the performance. This minimises the risk of having missed baby checks.ResultsSixty-one neonates were admitted to EMCHC within 72 hours of birth between first of August 2019 and end of August 2020. After exclusion of the deceased patients and patients with no records (n = 3 & 1), 50% (n=28) of the babies had had NIPE done before discharge. The percentage was lower, 24% when excluding the babies had their checks before transferring to the cardiac centre. This spotted the improvement opportunity. Education sessions and presentations were conducted to raise the staff awareness of the problem. Granting website access to all practitioners on starting their rotation and work in the centre as a part of their induction package was a key recommendation after identifying the reasons of the defect. The patients usually admitted to the intensive care unit after surgery then stepped down to the cardiac ward to complete their recovery before discharge. Adding a mandatory question on the discharge letter from PICU and on the daily review in the cardiac ward were the main system check to improve the performance. Data recollected early in January 2021 showed reduced number of admissions due to COVID-19 epidemic (n=21). However, compliance with the national guidance has risen to 76% (n=16).ConclusionWe believe this quality improvement project not only raised the compliance with the national guidelines, but also was a good step towards safe discharge of these babies from the cardiac centre. Such measures can save the budget spent on missed screening and the cost of any overlooked congenital anomaly would have been picked up during NIPE.

Family integrated care: understanding the views and experiences of staff on a tertiary neonatal unit

1402 Figure 1Survey respondent by role[Figure omitted. See PDF] 1402 Table 1However, practitioners described the value of parent engagement in ward rounds, and in cares for their infant. Nursing staff discussed how they planned routines with the parents to ensure participation at every opportunity, and the importance of regular communication. There was however concern from some that there is still an inconsistent approach to FiCare on the unit preventing parental empowerment, and was described as practitioner dependent. Some also questioned whether non-English speaking families were less involved in their babies care due to the language barrier.A recognised challenge for the integration of FiCare on the neonatal unit will be the involvement of siblings as COVID-19 restrictions ease.ConclusionThis survey has highlighted the importance of staff involvement in developing this model of care within the NICU setting.In order to further develop this model of care we will undertake a survey of parent’s views and experiences. In addition it is essential that we establish regular cot-side use of interpreting services to overcome the barriers faced by non-English speaking families.ReferencesFiCare: A framework for Practice. BAPM. 2021.Lee. Neonatal Nurs. 2018;26;24:1-3.Karan. J Trop Pediatr. 1983;29(2):115-8.

Neonatal complications of SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance

1206 Figure 1Weekly number of neonates admitted who have confirmed SARS-CoV-2 by date of diagnosis, UK, 1st March 2020 to 7th November 2021[Figure omitted. See PDF] 1206 Table 1Maternal and neonatal mortality in association with SARS-CoV-2 infection, UK 01/03/2020-31/10/2021ConclusionUsing population level surveillance data we describe neonatal complications directly and indirectly attributable to SARS-CoV-2 infection during the first three pandemic waves. This study demonstrates the low risk to neonates despite the emergence of new variants. Continued surveillance will allow the impacts of new variants on the neonatal population to be characterised.ReferencesGale C, Quigley MA, Placzek A, et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. Lancet Child Adolesc Heal 2021;5:113–21.Vousden N, Ramakrishnan R, Bunch K, et al. Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort. Medrvix 2021. doi:10.1101/2021.07.22.21261000.Knight M, Kurinczuk JJ, Tuffnell D, Brocklehurst P. The UK Obstetric Surveillance System for raredisorders of pregnancy. BJOG An Int J Obstet Gynaecol 2005;112:263–5.

A study on the outcome of preterm babies born less than 30 weeks gestation in a level 2 Neonatal Unit

1106 Table 1 1106 Table 2ConclusionWe noted less preterm delivery in 2019 comparing to previous data. We attribute this to improved in-utero transfer and improved maternal care. Survival rate (13.6%) was similar when compared to previous study (14.8%). Our unit is not meeting the standards achieving 2 year follow up rather less than previous data from 2015/2016. We are unsure whether an effect of COVID19 and logistics in parents visiting hospital is contributing to these changes. Following previous study, education of the team on the importance of 2 year follow up was carried out. This may have contributed to the improved present data. Our audit reiterates a need for a robust MDT neurodevelopmental clinic encompassing both the neonatal and community teams, in order to improve standard of care, so that these babies are given a chance to achieve their maximum neurodevelopmental potential.

Precautions and screening of newborn babies born to COVID-19 positive mothers – variations in practice on London Neonatal Units

596 Figure 1(A) Number of isolation rooms available in unit (B) Location where babies born to COVID-19 positive mothers are admitted (C) where babies born to COVID-19 positive mothers are nursed[Figure omitted. See PDF] 596 Figure 2(A,B,C) PPE worn when caring for babies born to COVID119 positive mothers depending on level of respiratory support. (D) timing of COVID-19 PCR swaps on babies born to COVID19 positive mothers post admission[Figure omitted. See PDF]ConclusionThere is significant variability across the region with regards to babies’ admission location, testing schedule, and staff PPE. Despite BAPM guidance advocating for oropharyngeal swabs, all respondents indicated use of either nasal or combined nasal/throat PCR testing. A sizable proportion of units (41%) perform testing on Day 0, whilst guidance advises that tests taken soon after birth may not be reliable and are therefore not clinically indicated.1 Notably, the timing of maternal visiting after a positive COVID-19 test varied from day 6 to day 14 across different units. Further guidance, education, and information sharing will aid standardisation of practice.ReferenceCovid-19 Pandemic: Frequently Asked Questions within Neonatal Services, British Association of Perinatal Medicine (January 2022).

Characteristics of neonates with laboratory confirmed SARS-CoV-2, experiences from one centre

AimsTo characterise the clinical features and outcomes of neonates with laboratory confirmed SARS-CoV-2.There is limited literature on neonates with COVID-19 and recognising the mode of transmission whether vertical or horizontal is challenging. This case series adds to existing knowledge.MethodsCase records and investigations of neonates with confirmed NPA RT-PCR for SARS-CoV-2 were reviewed.ResultsThis is a single centre case series of 5 neonates with confirmed SARS-CoV-2.4/5 of the neonates were born preterm and one was born at term. Maternal NPA/NS RT-PCR SARS-CoV-2 was positive in 2 cases.One of the mothers had COVID-19 pneumonia, the baby tested positive on NPA RT-PCR for SARS-CoV-2 within 24 hours of birth. CRP was less than 1 and the baby had a good outcome. 3 babies were suspected to have SARS-CoV-2 infection from nosocomial transmission and were not born to a mother with confirmed SARS-CoV-2 infection. In those babies where the infection was presumed to be by nosocomial transmission, all were preterm and infection occurred more than 7 days after birth in these babies hospitalised in neonatal units.The most common presenting symptoms were tachypnoea and respiratory distress. However 4/5 of the neonates were premature hence the symptoms could not be attributed specifically to COVID-19 infection. Chest X ray showed ground glass appearance of the lungs in two neonates. CRP was less than 1 in 3 neonates, CRP was 11 and 55 in two of the neonates. All were treated with IV antibiotics, had good outcomes and were discharged home. The ethnicity of three of the neonates was White, two were Afro Caribbean.ConclusionSARS- CoV-2 infection in neonates is rare and they appear to have a mild infection compared to the severity of infection in adults. The neonates in this case series had good outcomes and were discharged home. Whether one of the neonates acquired the infection by vertical or horizontal transmission was not easy to determine.

Comparative study on neonatal outcomes during pre-COVID and COVID period- a single centre study

AimsWith the declaration of the pandemic in March 2020, concerns on its impact on neonatal outcomes were raised. This study was conducted to compare neonatal diagnoses and outcomes during pre-COVID and COVID periods in a local neonatal unit (LNU) in the United Kingdom.MethodsA retrospective study was conducted between 1st January 2019 – 31st May 2021. Admissions into the neonatal/post-natal wards were screened via electronic record system. Data was categorised as pre-COVID (January 2019- March 2020, 15months) and COVID periods (April 2020- May 2021, 14 months). Preterm births, congenital anomalies, hypoxic ischemic encephalopathy (HIE), deaths were included. P-value was calculated using Chi-square test, <0.05 was considered significant.Results8825 were the total births recorded. 1809 (20%) neonatal admissions were identified. 638 (7%) neonates were included in the analysis (based on inclusion criteria). Live births between pre-COVID and COVID periods were similar (median – 4412, p 0.99). Neonatal admissions during the COVID period were higher in comparison to pre-COVID (943 vs 866, p <0.01). No ethnical differences were observed between two periods (p 0.65). One preterm neonate at day 13 was COVID positive. On comparison of gestational ages (pre-COVID and COVID periods)- <27 weeks (0.2% vs 0.16%, p 0.56), 27-32 weeks (0.5% vs 1.3% p <0.01), 32-37 weeks (3.2% vs 5.4%, p<0.01). Congenital anomalies during pre-COVID and COVID periods (15% vs 10%, p 0.21) were the same. HIE in COVID period was higher in comparison to pre-COVID (0.06% vs 0.23%, p 0.03). Neonatal deaths were the same (0.09% vs 0.02%, p 0.2).ConclusionThis observational study captures a large number of neonatal births and outcomes during pre-COVID and two COVID peaks in the region. We report very low COVID test positivity rate in neonates in this cohort. We conclude that neonatal admissions during COVID increased due to preterm and complex term admissions. Interestingly, HIE incidence was high during COVID period, this needs further validation.

Neonatal admission temperature audit in royal maternity hospital in Belfast

368 Figure 1Total admissions[Figure omitted. See PDF] 368 Figure 2Place of birth[Figure omitted. See PDF]ConclusionAfter sharing these results in unit and hospital safety meetings the following corrective measures were implemented. As around 38% of hypothermic deliveries were born in OR, the temperature of OR to be adjusted to 25 °C at least and to plan to resuscitate in OR not in a side room (as implicated by Covid-19 regulations). The clinical team are planning to start continuous temperature monitoring while transferring the babies from delivery suites to the unit.ReferenceOnalo R. Neonatal hypothermia in sub-Saharan Africa: a review. Niger J Clin Pract 2013;16(2):129-38. doi:10.4103/1119-3077.110120

Unscheduled neonatal attendances

1391 Figure 1 1391 Figure 2ConclusionThe data in this cohort reflects the fact that most neonates presenting to ED were clinically well, however, some require a period of observation prior to safe discharge. The referral pathway (figure 1) was intended for babies <14 days and identifies those appropriate for discussion with the neonatal team, in particular where the main presenting problem is a feeding issue, jaundice or weight loss. In addition, it excludes any baby with possible respiratory infective symptoms that would preclude them from NNU admission. The referral pathway (figure 1) allows for a conversation between ED and neonatal teams, aiming to ensure babies with routine neonatal issues are assessed in the most appropriate area, while acknowledging the need for flexibility due to out of hours neonatal staffing, cot capacity and need for observation prior to discharge.

COVID-19 in Schwangerschaft, Geburt und Wochenbett

Coronavirus disease 2019 (COVID-19) is an infectious disease that can lead to severe respiratory symptoms. Pregnant women have an increased risk for a severe course. Therefore, the Association of the Scientific Medical Societies in Germany (AWMF) Guidelines 015/092 "SARS-CoV-2 in pregnancy, childbirth, and the puerperium" were established to standardize care in the COVID-19 pandemic. The guideline group used data from the "COVID-19 related obstetrics and neonatal outcome study" (CRONOS) to generate evidence-based recommendations for action. CRONOS collects data from more than 130 affiliated maternity hospitals nationwide in Germany. According to the study, pregnant women positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are often asymptomatic;however, in 1 out of 25 detected infections there is a severe course requiring intensive medical treatment. Thromboembolism occurs in 1 out of 30 women hospitalized for COVID-19. An infection of the neonate of a mother infected peripartum is occasionally detected (about 1 out of 20 infants) and usually remains without consequence in the short-term outcome. Many other questions have been answered using CRONOS data. The registry is still open and recruiting and will also provide more in-depth information on different virus variants and vaccination in the future with more than 6000 cases. CRONOS is exemplary for an unprecedented cooperation of gynecologists during the pandemic.

The impact of the COVID-19 pandemic on nursing care and nurses' work in a neonatal intensive care unit.

PURPOSE: This study was conducted to determine the effects of the COVID-19 pandemic process on nursing care and nurses' work in neonatal intensive care units. DESIGN AND METHODS: The study was conducted using a qualitative method. The data were collected by voice recording with a one-on-one in-depth interview technique, and a semi-structured question form was used in the interviews. The data obtained from voice recordings were evaluated using the qualitative content analysis method. RESULTS: The main themes and subthemes of the study were as follows: (1) decrease in physical contact with newborns due to fear of transmitting Covid-19 (decrease in physical contact between neonatal nurses and newborns, decrease in physical contact between mothers and newborns, decrease in physical contact between fathers and newborns), (2) communication problems between healthcare professionals and parents (3) changes in the working conditions for neonatal nurses (increase in the frequency and duration of work intense working speed, exhaustion and decreased motivation due to use of protective equipment). CONCLUSION: The COVID-19 pandemic process led to a decrease in nurses' and parents' touching newborns, nurses' experiencing problems with parents due to measures taken, heavier working conditions and a decrease in motivation for nurses. PRACTICE IMPLICATIONS: This study will inform future research to be directed to nursing care and the work of nursing who work on the front line in the COVID-19 pandemic process.