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2.
PLoS One ; 16(12): e0260006, 2021.
Article in English | MEDLINE | ID: covidwho-1581786

ABSTRACT

BACKGROUND: During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. METHODS: We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April-September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. FINDINGS: The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. INTERPRETATION: Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.


Subject(s)
COVID-19/epidemiology , Hospitals, Rural/statistics & numerical data , Infant Mortality , Adult , Continuous Positive Airway Pressure/methods , Female , Hospitals, Rural/organization & administration , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal/organization & administration , Intensive Care Units, Neonatal/statistics & numerical data , Maternal Age , Patient Admission/statistics & numerical data , Pregnancy , Retrospective Studies , Rural Health/statistics & numerical data , Uganda/epidemiology , Young Adult
6.
J Perinatol ; 40(Suppl 1): 36-46, 2020 09.
Article in English | MEDLINE | ID: covidwho-1023856

ABSTRACT

OBJECTIVES: To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes. STUDY DESIGN: A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability. RESULTS: Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybrid-design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support. CONCLUSIONS: Hospital restrictions have significantly limited parental presence for NICU admitted infants, although single-family room design may attenuate this effect.


Subject(s)
Betacoronavirus , Coronavirus Infections , Hospital Administration , Intensive Care Units, Neonatal/organization & administration , Pandemics , Parents , Pneumonia, Viral , Visitors to Patients/statistics & numerical data , COVID-19 , Cross-Sectional Studies , Hospital Design and Construction , Humans , Infant, Newborn , Organizational Policy , Patients' Rooms , SARS-CoV-2 , United States
8.
Arch Dis Child Fetal Neonatal Ed ; 106(2): 172-177, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-767783

ABSTRACT

OBJECTIVE: To evaluate the parent and staff experience of a secure video messaging service as a component of neonatal care. DESIGN: Multicentre evaluation incorporating quantitative and qualitative items. SETTING: Level II and level III UK neonatal units. POPULATION: Families of neonatal inpatients and neonatal staff. INTERVENTION: Use of a secure, cloud-based asynchronous video messaging service to send short messages from neonatal staff to families. Evaluation undertaken July-November 2019. MAIN OUTCOME MEASURES: Parental experience, including anxiety, involvement in care, relationships between parents and staff, and breastmilk expression. RESULTS: In pre-implementation surveys (n=41), families reported high levels of stress and anxiety and were receptive to use of the service. In post-implementation surveys (n=42), 88% perceived a benefit of the service on their neonatal experience. Families rated a positive impact of the service on anxiety, sleep, family involvement and relationships with staff. Qualitative responses indicated enhanced emotional closeness, increased involvement in care and a positive effect on breastmilk expression. Seventy-seven post-implementation staff surveys were also collected. Staff rated the service as easy to use, with minimal impact on workload. Seventy-one percent (n=55) felt the service had a positive impact on relationships with families. Staff identified the need to manage parental expectations in relation to the number of videos that could be sent. CONCLUSIONS: Asynchronous video messaging improves parental experience, emotional closeness to their baby and builds supportive relationships between families and staff. Asynchronous video supports models of family integrated care and can mitigate family separation, which could be particularly relevant during the COVID-19 pandemic.


Subject(s)
COVID-19/psychology , Intensive Care, Neonatal/psychology , Parents/psychology , Text Messaging/statistics & numerical data , Video Recording/statistics & numerical data , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal/organization & administration , Male
9.
J Perinatol ; 40(10): 1576-1581, 2020 10.
Article in English | MEDLINE | ID: covidwho-706423

ABSTRACT

Although the COVID-19 pandemic has largely not clinically affected infants in neonatal intensive care units around the globe, it has affected how care is provided. Most hospitals, including their NICUs, have significantly reduced parental and family visitation privileges. From an ethical perspective, this restriction of parental visitation in settings where infectious risk is difficult to understand. No matter what the right thing to do is, NICUs are currently having to support families of their patients via different mechanisms. In this perspective, we discuss ways NICUs can support parents and families when they are home and when they are in the NICU as well as provide infants the support needed when family members are not able to visit.


Subject(s)
Coronavirus Infections , Infection Control/methods , Intensive Care Units, Neonatal/organization & administration , Intensive Care, Neonatal , Pandemics , Pneumonia, Viral , Psychosocial Support Systems , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Family/psychology , Humans , Infant, Newborn , Infant, Premature , Intensive Care, Neonatal/organization & administration , Intensive Care, Neonatal/psychology , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2
10.
J Perinatol ; 40(9): 1283-1285, 2020 09.
Article in English | MEDLINE | ID: covidwho-680375

ABSTRACT

Parents of NICU infants are a vulnerable population from a psychological perspective, and often experience high levels of acute stress, depression, anxiety, and post-traumatic stress. The added burden of the current SARS CoV-2 disease (COVID-19) pandemic is likely to exacerbate these issues, with potential implications for the wellbeing of infants and families in the short- and long-term. In this paper, we propose utilizing the stress contagion framework and consider how psychosocial stress can "spill over" into the parent-infant relationship domain, which can impact child development and family wellbeing longer term. As the effects of the pandemic will likely persist well beyond the acute stage, we offer advocacy points and general guidelines for healthcare professionals to consider in their quest to mitigate stress and build resilience in NICU families.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Family/psychology , Intensive Care Units, Neonatal/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Psychosocial Support Systems , Adult , COVID-19 , Family Relations/psychology , Female , Humans , Infant, Newborn , Infection Control/organization & administration , Infectious Disease Transmission, Vertical/prevention & control , Male , Needs Assessment , Pandemics/statistics & numerical data , Parents/psychology , Risk Assessment , United States , Vulnerable Populations/psychology
12.
Curr Probl Pediatr Adolesc Health Care ; 50(4): 100795, 2020 04.
Article in English | MEDLINE | ID: covidwho-260604

ABSTRACT

In January 2020, China reported a cluster of cases of pneumonia associated with a novel pathogenic coronavirus provisionally named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). Since then, Coronavirus Disease 2019 (COVID-19) has been reported in more than 180 countries with approximately 6.5 million known infections and more than 380,000 deaths attributed to this disease as of June 3rd , 2020 (Johns Hopkins University COVID map; https://coronavirus.jhu.edu/map.html) The majority of confirmed COVID-19 cases have been reported in adults, especially older individuals with co-morbidities. Children have had a relatively lower rate and a less serious course of infection as reported in the literature to date. One of the most vulnerable pediatric patient populations is cared for in the neonatal intensive care unit. There is limited data on the effect of COVID-19 in fetal life, and among neonates after birth. Therefore there is an urgent need for proactive preparation, and planning to combat COVID-19, as well as to safeguard patients, their families, and healthcare personnel. This review article is based on the Centers for Disease Control and Prevention's (CDC) current recommendations for COVID-19 and its adaptation to our local resources. The aim of this article is to provide basic consolidated guidance and checklists to clinicians in the neonatal intensive care units in key aspects of preparation needed to counter exposure or infection with COVID-19. We anticipate that CDC will continue to update their guidelines regarding COVID-19 as the situation evolves, and we recommend monitoring CDC's updates for the most current information.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Guideline Adherence , Infection Control/organization & administration , Intensive Care Units, Neonatal/organization & administration , Maternal-Child Health Services , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Pregnancy Complications, Infectious/virology , Adult , Breast Feeding , Breast Milk Expression , COVID-19 , Civil Defense , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Delivery Rooms , Female , Hand Hygiene/standards , Health Knowledge, Attitudes, Practice , Hospitals, Urban , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Interdisciplinary Communication , Maternal-Child Health Services/organization & administration , New York City/epidemiology , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , SARS-CoV-2 , Visitors to Patients
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