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3.
Neonatology ; 119(5): 619-628, 2022.
Article in English | MEDLINE | ID: covidwho-2020583

ABSTRACT

INTRODUCTION: Our objective was to compare neonatal outcomes and resource use of neonates born to mothers with SARS-CoV-2 positivity during pregnancy with neonates born to mothers without SARS-CoV-2 positivity. METHODS: We conducted a two-country cohort study of neonates admitted between January 1, 2020, and September 15, 2021, to tertiary neonatal intensive care unit (NICU) in Canada and Sweden. Neonates from mothers who were SARS-CoV-2 positive during pregnancy were compared with three randomly selected NICU neonates of mothers who were not test-positive, matched on gestational age, sex, and birth weight (±0.25 SD). Subgroup analyses were conducted for neonates born <33 weeks' gestation and mothers who were SARS-CoV-2 positive ≤10 days prior to birth. Primary outcome was duration of respiratory support. Secondary outcomes were in-hospital mortality, neonatal morbidity, late-onset sepsis, receipt of breast milk at discharge, and length of stay. RESULTS: There were 163 exposed and 468 matched neonates in Canada, and 303 exposed and 903 matched neonates in Sweden. There was no statistically significant difference in invasive or noninvasive respiratory support durations, mortality, respiratory and other neonatal morbidities, or resource utilizations between two groups in both countries in entire cohort and in subgroup analyses. Receipt of breast milk at discharge was lower in the Canadian neonates of mothers who were SARS-CoV-2 positive ≤10 days before birth (risk ratio 0.68, 95% CI: 0.57-0.82). CONCLUSION: Maternal SARS-CoV-2 positivity was not associated with increased durations of respiratory support, morbidities, mortality, or length of hospital stay in Canada and Sweden among neonates admitted to tertiary NICU.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19/epidemiology , Canada/epidemiology , Cohort Studies , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Intensive Care Units, Neonatal , Male , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , SARS-CoV-2
4.
Arch Psychiatr Nurs ; 41: 295-299, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2007436

ABSTRACT

AIM: This study had two objectives: (1) to investigate the psychosocial difficulties experienced by parents of babies treated in a neonatal intensive care unit during the coronavirus pandemic and (2) to determine parent-infant attachment. MATERIALS AND METHODS: This study adopted phenomenology, a qualitative research design in order to answer the research questions design. The sample consisted of 20 parents of babies treated in the neonatal intensive care unit (NICU) of a City Hospital in Turkey between July and August 2021. Participation was voluntary. Data were collected using a sociodemographic characteristics questionnaire and a semi-structured qualitative interview form. Each participant was interviewed face to face. Each interview was recorded and transcribed. The data were analyzed using content analysis. RESULTS: Participants had a mean age of 32.2 ± 3.61 years and at least secondary school degrees. Babies were admitted to the NICU for congenital anomalies (n = 3) or preterm birth (n = 7). Participants experienced anxiety, worry, and loneliness and produced less milk because they could not see and touch their babies. Their greatest source of support was their spouses. CONCLUSION: Parents of babies treated in the NICU during the COVID-19 pandemic experience anxiety, sadness, unhappiness, and loneliness. The preventive measures against the pandemic affect parents psychosocially. Healthcare professionals should plan and implement care practices and establish effective communication with parents to identify their physiological, psychological, and social needs and help them produce breastmilk and bond with their babies.


Subject(s)
COVID-19 , Premature Birth , Infant , Female , Infant, Newborn , Humans , Adult , Intensive Care Units, Neonatal , Pandemics , Parents/psychology
5.
Int J Environ Res Public Health ; 19(15)2022 08 03.
Article in English | MEDLINE | ID: covidwho-1994061

ABSTRACT

Evidence that music therapy stabilises vital parameters in preterm infants is growing, but the optimal setting for therapy is still under investigation. Our study aimed to quantify the effect of physical contact during live music therapy in preterm infants born < 32 weeks' gestational age (GA) on post-therapy vital sign values. Live music therapy was delivered twice-weekly until discharge from hospital to 40 stable infants < 32 weeks' GA. Baseline and post-therapy heart rate, respiratory rate, oxygen saturation and physical contact during each session were recorded. 159 sessions were performed with, and 444 sessions without, physical contact. Descriptive and multivariable regression analyses based on directed acyclic graphs were performed. The mean GA was 28.6 ± 2.6 weeks, and 26 (65%) infants were male. Mean absolute values for heart and respiratory rates lowered during music therapy regardless of physical contact. The mean post-therapy SaO2 was higher compared to baseline values regardless of physical contact (mean differences -8.6 beats/min; -13.3 breaths/min and +2.0%). There were no clinically relevant changes in vital sign responses between therapy sessions, with or without physical contact, or adjusted post-therapy values for any of the studied vital signs. Physical contact caused better baseline and post-therapy vital sign values but did not enhance the vital sign response to music therapy. Thus, the effect of music therapy on preterm infants' vital signs is independent of physical contact and parents' presence during music therapy in the neonatal intensive care unit.


Subject(s)
Music Therapy , Music , Female , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Male , Vital Signs
7.
Health Expect ; 25(4): 1384-1392, 2022 08.
Article in English | MEDLINE | ID: covidwho-1961573

ABSTRACT

BACKGROUND: Currently, parents whose sick babies are undergoing three days of cooling therapy for hypoxic-ischaemic encephalopathy in neonatal intensive care units (NICUs) are not permitted to cuddle their cooled babies, due to concerns of warming the baby or dislodging breathing tubes or vascular catheters. Parents want to stay and care for their cooled babies and have reported that bonding is adversely affected when they are not permitted to hold them. DESIGN AND PARTICIPANTS: Qualitative interviews with 21 parents of cooled babies in NICU (11 mothers and 10 fathers) and 10 neonatal staff (4 consultants and 6 nurses) explored their views and experiences of an intervention to enable parents to cuddle their cooled babies (CoolCuddle). Thematic analysis methods were used to develop the themes and compare them between parents and staff. RESULTS: Five themes were produced. Three themes were comparable between parents and staff: Closeness, a sense of normality and reassurance and support. An additional parent theme reflected their mixed feelings about initial participation as they were apprehensive, but felt that it was an amazing opportunity. Parents and staff described the closeness between parents and babies as important for bonding and breastfeeding. Fathers particularly appreciated the opportunity to hold and bond with their infants. Parents valued the reassurance and support received from staff, and the cuddles helped them feel more normal and more like a family at a very stressful time. In a final staff theme, they discussed the skills, number of staff and training needed to undertake CoolCuddle in NICU. CONCLUSIONS: Parents cuddling their babies during cooling therapy enhanced parent-infant bonding and family-centred care in NICU and was positively received. Adverse perinatal mental health, impaired mother-infant bonding and their effects on the establishment of breastfeeding may be ameliorated by introducing CoolCuddle. PATIENT CONTRIBUTION: Our parent advisors contributed to the interview topic guides and endorsed the themes from the analysis.


Subject(s)
Hypothermia, Induced , Intensive Care, Neonatal , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Intensive Care, Neonatal/methods , Intensive Care, Neonatal/psychology , Object Attachment , Parents/psychology
8.
Early Hum Dev ; 172: 105631, 2022 09.
Article in English | MEDLINE | ID: covidwho-1926362

ABSTRACT

BACKGROUND: Neonatal intensive care unit (NICU) follow up programs are in place to ensure infant health and development are monitored after discharge. The COVID-19 Public Health Epidemic (PHE) negatively impacted the ability to conduct in-person NICU follow up visits. AIMS: This study examines using telemedicine in NICU follow up clinics and compares the rates of referral for further medical and/or educational developmental evaluation. A second objective of the study examines if telemedicine can be implemented in the future to ensure access to families while maintaining high levels of caregiver satisfaction. METHOD: Data were obtained retrospectively from clinical records from one state's NICU follow-up program. Patterns of referral for further developmental evaluation and caregiver satisfaction prior to the COVID-19 PHE and during the first year of the COVID-19 PHE were examined. A total of 658 NICU follow up visits (384 in-person and 274 telemedicine) were included. RESULTS: Chi Square analyses revealed significantly more medically related referrals were made during telemedicine visits compared to in-person visits, χ2 (1) = 5.55, p .05. There were no significant differences between the clinic types in the number of educationally based referrals made, χ2 (1) = 0.028, p > .05. CONCLUSION: The rates of referral for further evaluation made from in-person and telemedicine clinics were comparable, and caregivers were highly satisfied with telemedicine clinic visits. NICU follow up via a virtual platform saves time, money and is equally effective or better in identifying the need for referral for further evaluation.


Subject(s)
COVID-19 , Telemedicine , COVID-19/epidemiology , Follow-Up Studies , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Referral and Consultation , Retrospective Studies
9.
J Paediatr Child Health ; 58(10): 1747-1752, 2022 10.
Article in English | MEDLINE | ID: covidwho-1916256

ABSTRACT

AIM: During the first wave of coronavirus disease 2019 (COVID-19), visiting guidelines in neonatal units changed to maintain the health and safety of staff, neonates, and families. In the neonatal intensive care unit/special care nursery (NICU/SCN), restrictions were placed on parental contact and extended family excluded. Our team was interested in evaluating the effect of these restrictions on parental stress and discharge confidence. METHODS: A prospective descriptive study utilising survey methodology was undertaken. The survey was developed and previously used by the NICU research group to evaluate parental knowledge and understanding, parental role, communication, and parental stress (admission/discharge). We have also included a section regarding COVID19 visiting restrictions (ETH.2020.LRE.00124). The survey used a five-level Likert scale. Statistical analysis was completed using SPSS version 21. RESULTS: Notably, 33 surveys were returned. Results showed visiting restrictions reduced social contact between partners 26/33 (84%), with their other children 14/16 (87.5%) and extended family 28/33 (84.8%). Parents indicated that they had high levels of confidence in understanding their babies' medical needs (78-93%) and gaining hands-on experience caring for their baby (87-100%). However, 11/33 (33%) of parents reported concerns with discharge processes and gaining consistent information as challenges during their baby's admission. Notably, 17/33 (51.5) stated their NICU/SCN experience had been very to extremely stressful. Parents openly described how the restrictions had affected their mental/emotional health identifying the need to treat parents as one unit, and a gap in the psychological support available for families. CONCLUSION: Support services and consistency of communication with NICU/SCN families need to be enhanced and prioritised during periods of restrictions, especially peri-discharge.


Subject(s)
COVID-19 , Intensive Care Units, Neonatal , Child , Communication , Humans , Infant , Infant, Newborn , Parents/psychology , Patient Discharge
10.
Arch Dis Child Fetal Neonatal Ed ; 107(4): 344-345, 2022 07.
Article in English | MEDLINE | ID: covidwho-1901943
11.
Acta Paediatr ; 111(9): 1771-1778, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1895947

ABSTRACT

AIM: To describe the impact of the COVID-19 restrictions on the caregiving activities and psychological well-being of fathers with infants admitted to neonatal units. METHODS: Cross-sectional study using adapted COPE-IS and COPE-IU tools. Participants' recruitment occurred online via social media and parents' associations. Online survey in English, French and Italian were distributed and promoted via websites and social media platforms of parent's associations. The study was undertaken across 12 countries in Asia, Australia, Africa and Europe. RESULTS: A total of 108 fathers of NICU infants completed the survey. COVID-19 related restrictions were categorised into 3 types: no restrictions, partial and severe restrictions. Fathers who experienced partial restrictions reported more involvement in caregiving activities but high levels of emotional difficulties and sleeping problems compared to those who experienced full or no restrictions. CONCLUSION: Given the impact on the psychological well-being of fathers, restrictions should be avoided as much as possible in the neonatal unit and fathers given free access to their infants if they follow appropriate infection control precautions.


Subject(s)
COVID-19 , Sleep Wake Disorders , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Parents/psychology
12.
BMJ Open Qual ; 11(2)2022 05.
Article in English | MEDLINE | ID: covidwho-1874570

ABSTRACT

BACKGROUND: Preterm infants may remain in neonatal intensive care units (NICUs) to receive proper nutrition via nasogastric tube feedings. However, prolonged NICU stays can have negative effects for the patient, the family and the health system. AIM: To demonstrate how a patient-centred, design thinking informed approach supported the development of a pilot programme to enable earlier discharge of preterm babies. METHOD: We report on our design thinking-empathy building approach to programme design, initial outcomes and considerations for ongoing study. RESULTS: Through the use of design thinking methods, we identified unique needs, preferences and concerns that guided the development of our novel early discharge programme. We found that stable, preterm infants unable to feed by mouth and requiring nasogastric tubes can be cared for at home with remote patient monitoring and telehealth support. In addition, novel feeding strategies can help address parental preferences without compromising infant growth. CONCLUSION: A patient-centred, design thinking informed approach supported the development of a pilot programme to enable earlier discharge of preterm babies. The programme resulted in a reduced length of stay, thereby increasing NICU bed capacity and limiting hospital turn-aways.


Subject(s)
Intensive Care Units, Neonatal , Patient Discharge , Hospitals , Humans , Infant , Infant, Newborn , Infant, Premature , Parents
13.
Medicina (Kaunas) ; 58(6)2022 May 26.
Article in English | MEDLINE | ID: covidwho-1869701

ABSTRACT

Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union's most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement.


Subject(s)
COVID-19 , Pre-Eclampsia , Pregnancy Complications , Adult , Female , Hospital Mortality , Hospitalization , Humans , Infant , Infant Mortality , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Pandemics , Pregnancy , Retrospective Studies , Romania/epidemiology
14.
J Pediatr Nurs ; 66: 44-48, 2022.
Article in English | MEDLINE | ID: covidwho-1867665

ABSTRACT

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.


Subject(s)
COVID-19 , Neonatal Nursing , Nurses, Neonatal , Nurses , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Pandemics , Qualitative Research
15.
Pan Afr Med J ; 41: 191, 2022.
Article in English | MEDLINE | ID: covidwho-1847714

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) has exposed vulnerable populations, including pregnant women, to an unprecedented public health crisis. According to recent data, pregnancy in COVID-19 patients is associated with increased hospitalization, admission to the intensive care unit (ICU) and intubation. It has been suggested that pregnancy induced immune responses and cardiorespiratory changes can exaggerate the course of the COVID-19. The present is a case of a pregnant woman who presented with critical respiratory failure secondary to COVID-19 resulted in her admission to the ICU and mechanical ventilator support. After childbirth, maternal outcomes were marked by disseminated intravascular coagulopathy and cardiopulmonary arrest on day thirty-four of admission. As to the neonatal outcome, a preterm female baby was transferred to the neonatal intensive care unit (NICU) and intubated immediately due to progressive respiratory distress. She was diagnosed with bacterial pneumonia with no evidence of COVID-19 and recovered after twenty-one days after NICU stay. This case showed that the maternal COVID-19 may lead to acute respiratory distress syndrome, coagulation dysfunction and preterm delivery. The risk of vertical transmission by SARS-CoV-2 is probably very low.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Respiratory Distress Syndrome , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Family , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Intensive Care Units, Neonatal , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome , SARS-CoV-2
16.
BJOG ; 129(2): 282-290, 2022 01.
Article in English | MEDLINE | ID: covidwho-1831885

ABSTRACT

OBJECTIVE: To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes considering testing policy and test-positivity-to-delivery interval. DESIGN: Nationwide cohort study. SETTING: Sweden. POPULATION: From the Pregnancy-Register we identified 88 593 singleton births, 11 March 2020-31 January 2021, linked to data on SARS-CoV-2-positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing-policy and test-positivity-to-delivery interval. MAIN OUTCOME MEASURES: Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth. RESULTS: During pregnancy, SARS-CoV-2 test-positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non-universal testing. There were generally lower risks associated with SARS-CoV-2 under universal than non-universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62-3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5-minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24-1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10-5.20). Compared with term births (2.1%), test-positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60-4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62-2.02). CONCLUSIONS: Testing policy and timing of test-positivity impact associations between SARS-CoV-2-positivity and pregnancy outcomes. Under non-universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. TWEETABLE ABSTRACT: Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.


Subject(s)
COVID-19 Testing , COVID-19 , Intensive Care Units, Neonatal/statistics & numerical data , Pregnancy Complications, Infectious , Pregnancy Outcome/epidemiology , SARS-CoV-2/isolation & purification , Apgar Score , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cohort Studies , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Premature Birth/epidemiology , Prenatal Care/methods , Prenatal Care/standards , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Stillbirth/epidemiology , Sweden/epidemiology
17.
Nat Commun ; 13(1): 2414, 2022 05 10.
Article in English | MEDLINE | ID: covidwho-1830053

ABSTRACT

Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 COVID-19 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the effectiveness of mRNA vaccination against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89·5% (95% CI 69·0-96·4%, 18,828 vaccinated pregnant people, I2 = 73·9%). The risk of stillbirth was significantly lower in the vaccinated cohort by 15% (pooled OR 0·85; 95% CI 0·73-0·99, 66,067 vaccinated vs. 424,624 unvaccinated, I2 = 93·9%). There was no evidence of a higher risk of adverse outcomes including miscarriage, earlier gestation at birth, placental abruption, pulmonary embolism, postpartum haemorrhage, maternal death, intensive care unit admission, lower birthweight Z-score, or neonatal intensive care unit admission (p > 0.05 for all). COVID-19 mRNA vaccination in pregnancy appears to be safe and is associated with a reduction in stillbirth.


Subject(s)
COVID-19 , Premature Birth , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Placenta , Pregnancy , Premature Birth/epidemiology , RNA, Messenger , SARS-CoV-2 , Stillbirth/epidemiology , Vaccination
18.
N Engl J Med ; 386(17): 1627-1637, 2022 04 28.
Article in English | MEDLINE | ID: covidwho-1815679

ABSTRACT

BACKGROUND: Neonatal endotracheal intubation often involves more than one attempt, and oxygen desaturation is common. It is unclear whether nasal high-flow therapy, which extends the time to desaturation during elective intubation in children and adults receiving general anesthesia, can improve the likelihood of successful neonatal intubation on the first attempt. METHODS: We performed a randomized, controlled trial to compare nasal high-flow therapy with standard care (no nasal high-flow therapy or supplemental oxygen) in neonates undergoing oral endotracheal intubation at two Australian tertiary neonatal intensive care units. Randomization of intubations to the high-flow group or the standard-care group was stratified according to trial center, the use of premedication for intubation (yes or no), and postmenstrual age of the infant (≤28 or >28 weeks). The primary outcome was successful intubation on the first attempt without physiological instability (defined as an absolute decrease in the peripheral oxygen saturation of >20% from the preintubation baseline level or bradycardia with a heart rate of <100 beats per minute) in the infant. RESULTS: The primary intention-to-treat analysis included the outcomes of 251 intubations in 202 infants; 124 intubations were assigned to the high-flow group and 127 to the standard-care group. The infants had a median postmenstrual age of 27.9 weeks and a median weight of 920 g at the time of intubation. A successful intubation on the first attempt without physiological instability was achieved in 62 of 124 intubations (50.0%) in the high-flow group and in 40 of 127 intubations (31.5%) in the standard-care group (adjusted risk difference, 17.6 percentage points; 95% confidence interval [CI], 6.0 to 29.2), for a number needed to treat of 6 (95% CI, 4 to 17) for 1 infant to benefit. Successful intubation on the first attempt regardless of physiological stability was accomplished in 68.5% of the intubations in the high-flow group and in 54.3% of the intubations in the standard-care group (adjusted risk difference, 15.8 percentage points; 95% CI, 4.3 to 27.3). CONCLUSIONS: Among infants undergoing endotracheal intubation at two Australian tertiary neonatal intensive care units, nasal high-flow therapy during the procedure improved the likelihood of successful intubation on the first attempt without physiological instability in the infant. (Funded by the National Health and Medical Research Council; Australian New Zealand Clinical Trials Registry number, ACTRN12618001498280.).


Subject(s)
Intubation, Intratracheal , Oxygen Inhalation Therapy , Australia , Elective Surgical Procedures , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Intubation, Intratracheal/methods , Oxygen/analysis , Oxygen Inhalation Therapy/methods
19.
Clin Lab ; 68(5)2022 May 01.
Article in English | MEDLINE | ID: covidwho-1798753

ABSTRACT

BACKGROUND: There is a sudden rise in infectious diseases, with special concern to the most recent SARS-CoV 2 outbreak. A retrospective study was conducted to study the effect of this outbreak on neonatal sepsis as a global issue that poses a challenge for pediatric management and to identify its risk factors, microbial profile, and mortality rate at King Faisal Medical Complex, Taif, KSA, a COVID-19-tertiary care segregation hospital. METHODS: This research included 111 neonates with a culture-proven diagnosis of neonatal sepsis (4 and 62 cases during 2019 and 2020, respectively). RESULTS: During 2019 early onset sepsis (EOS) occurred in 6/49 (12.2%) while in 2020 22/62 (35.5%), and during 2019 late onset sepsis (LOS) occurred in 43/49 (87.7%) while in 2020 40/62 (64.5%). Premature rupture of membrane was the major neonatal risk factor for EOS during 2019 and 2020 with proportions of 4 (66.7%), 20 (90.9%); respectively. As regards LOS, the peripherally inserted central catheters and peripheral lines were the top neonatal risk factors. In the two-year outbreak, the most prevalent causative organism for EOS neonates was Escherichia coli and for LOS neonates it was Klebsiella. There was non-significant change in the mortality rate of neonatal sepsis between 2019 and 2020. However, the mortality rate was higher in EOS 9/22 (40.9%) in 2020 in comparison to 2/6 (33.3%) in 2019. CONCLUSIONS: Neonatal sepsis remains a major health problem causing serious morbidity and mortality, and health care policy makers have to implement EOS preventive measures.


Subject(s)
COVID-19 , Neonatal Sepsis , Sepsis , COVID-19/epidemiology , Child , Escherichia coli , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Neonatal Sepsis/diagnosis , Neonatal Sepsis/epidemiology , Pandemics , Retrospective Studies , Sepsis/diagnosis , Sepsis/epidemiology
20.
BMJ Open ; 12(4): e056856, 2022 04 07.
Article in English | MEDLINE | ID: covidwho-1784823

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has disrupted healthcare systems, challenging neonatal care provision globally. Curtailed visitation policies are known to negatively affect the medical and emotional care of sick, preterm and low birth weight infants, compromising the achievement of the 2030 Development Agenda. Focusing on infant and family-centred developmental care (IFCDC), we explored parents' experiences of the disruptions affecting newborns in need of special or intensive care during the first year of the pandemic. DESIGN: Cross-sectional study using an electronic, web-based questionnaire. SETTING: Multicountry online-survey. METHODS: Data were collected between August and November 2020 using a pretested online, multilingual questionnaire. The target group consisted of parents of preterm, sick or low birth weight infants born during the first year of the COVID-19 pandemic and who received special/intensive care. The analysis followed a descriptive quantitative approach. RESULTS: In total, 1148 participants from 12 countries (Australia, Brazil, Canada, China, France, Italy, Mexico, New Zealand, Poland, Sweden, Turkey and Ukraine) were eligible for analysis. We identified significant country-specific differences, showing that the application of IFCDC is less prone to disruptions in some countries than in others. For example, parental presence was affected: 27% of the total respondents indicated that no one was allowed to be present with the infant receiving special/intensive care. In Australia, Canada, France, New Zealand and Sweden, both the mother and the father (in more than 90% of cases) were allowed access to the newborn, whereas participants indicated that no one was allowed to be present in China (52%), Poland (39%), Turkey (49%) and Ukraine (32%). CONCLUSIONS: The application of IFCDC during the COVID-19 pandemic differs between countries. There is an urgent need to reconsider separation policies and to strengthen the IFCDC approach worldwide to ensure that the 2030 Development Agenda is achieved.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Parents/psychology , Surveys and Questionnaires
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