Quality of Care at childbirth during the COVID-19 pandemic: findings of the IMAgiNE EURO study in Belgium (preprint)

Objectives To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time. Design A cross-sectional observational study. Setting Data of the IMAgiNE EURO study in Belgium. Participants Women giving birth in a Belgian facility from March 1, 2020, to May 1, 2023, responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources, and organizational changes related to COVID 19. Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann Kendall test. Results 897 women were included in the analysis, 67%(n=601) with spontaneous vaginal birth, 13.3%(n=119) with instrumental vaginal birth and 19.7%(n=177) with cesarean section. We found high QMNC scores but also specific gaps in all domains of QMNC. On provision of care, 21.0%(n=166) of women who experienced labor and 14.7%(n=26) of women with a cesarean reported inadequate pain relief; 64.7%(n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1%(n=279) reported unclear communication, 32.9%(n=295) reported that they were not involved in choices,11.5%(n=104) stated not being treated with dignity and 8.1%(n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). The multivariable analyses showed significantly lower QMNC scores for women with an instrumental vaginal birth. Over time there was a significant increase in QMNC score for experience of care and key organizational changes due to COVID-19. Conclusions and relevance Although overall QMNC scores were high, findings also suggest gaps in QMNC. Underlying causes of these gaps should be explored to design appropriate interventions and policies.

"She helped from the first minute to the last" - experiences of respectful maternal and newborn care during the COVID-19 pandemic in Nampula Province, Mozambique (preprint)

Pandemic-related health service adaptations raised concerns about provision of quality, respectful maternity care globally. Despite this, little research has focused on the experiences of those using intrapartum care during this time. This study aimed to elevate the voices and document the experiences of birthing people in Nampula Province, Mozambique during the COVID-19 pandemic. We conducted a longitudinal qualitative study from March-August 2021 and present an analysis of the 17 follow-up in-depth interviews conducted with participants who had a vaginal live birth. Interviews explored participants experience of labor and delivery care. They were conducted in Makua and Portuguese, audio-recorded, transcribed and translated. We applied thematic content analysis. Overall, participants did not express major concerns about COVID-19 or related service adaptations when describing their experiences of intrapartum care. Some noted its negative effects on elements of respectful care such as restricting birth companions. Overcrowding became more concerning due to the threat of infection. While unclear if affected by the pandemic, all participants who gave birth at a health facility reported experiencing at least one form of mistreatment, some recounting threats of cesarean delivery. Most explained that they and their newborns received care without their consent, especially regarding enemas and episiotomies. At the same time, respondents described a range of intrapartum experiences that included both respectful and disrespectful care. Most recalled positive verbal communication with their providers and many described receiving continuous attentive care. Participants explained that their satisfaction with childbirth services was tied to their birth outcome and their experience of respectful care. The findings indicate that steadfast commitments to quality care are critical to ensure families benefit from high-quality, respectful care at all times. The ramifications of the COVID-19 pandemic were limited but nonetheless signal a need for tighter connections between maternal health and emergency preparedness stakeholders.

Functional ANOVA approaches for detecting changes in air pollution during the COVID-19 pandemic (preprint)

Faced with novel coronavirus outbreak, the most hard-hit countries adopted a lockdown strategy to contrast the spread of virus. Many studies have already documented that the COVID-19 control actions have resulted in improved air quality locally and around the world. Following these lines of research, we focus on air quality changes in the urban territory of Chieti-Pescara (Central Italy), identified as an area of criticality in terms of air pollution. Concentrations of NO2, PM10, PM2.5 and benzene are used to evaluate air pollution changes in this Region. Data were measured by several monitoring stations over two specific periods: from 1st February to 10 th March 2020 (before lockdown period) and from 11st March 2020 to 18 th April 2020 (during lockdown period). The impact of lockdown on air quality is assessed through functional data analysis. Our work makes an important contribution to the analysis of variance for functional data (FANOVA). Specifically, a novel approach based on multivariate functional principal component analysis is introduced to tackle the multivariate FANOVA problem for independent measures, which is reduced to test multivariate homogeneity on the vectors of the most explicative principal components scores. Results of the present study suggest that the level of each pollutant changed during the confinement. Additionally, the differences in the mean functions of all pollutants according to the location and type of monitoring stations (background vs traffic), are ascribable to the PM10 and benzene concentrations for pre-lockdown and during-lockdown tenure, respectively. FANOVA has proven to be beneficial to monitoring the evolution of air quality in both periods of time. This can help environmental protection agencies in drawing a more holistic picture of air quality status in the area of interest.

Evaluation of safety concerns for COVID-19 immunization of pregnant women: A systematic review of emerging evidence (preprint)

Background: There is an urgent need to review the status of COVID-19 vaccine immunization in pregnant women globally so that the adverse outcomes may be prevented. Objective: To evaluate the probable outcome of COVID-19 vaccination in pregnant women. Search strategy: An electronic search was conducted over the period of 3 months (June 15-August 15, 2021). Selection criteria: The original studies evaluating safety concerns in pregnant women for COVID-19 vaccination were included. Data collection and analysis: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were used for the collection of the data and reporting of the findings. The inclusion and exclusion criteria for the studies were determined based on ‘PICO principle’ (Population, Intervention, Comparator, and Outcome, Study design. Risk of bias assessment was done using National Institute of Health (NIH) tool for systematic reviews. Main results: COVID-19 vaccination in pregnant women was not associated with increased adverse effects or complications to the mother as well as developing fetus or newborn compared to non-vaccinated pregnant women. Vaccinated pregnant women showed a robust immune response against COVID-19 infection. Conclusions: COVID-19 vaccination during pregnancy causes no significant health risks for the mother or developing fetus or newborn.

Lung ultrasound an alternative to computed tomography and chest X-ray in the diagnosis of children infected with SARS-CoV-2: a systematic review of literature (preprint)

Abstract Background: Lung ultrasound (LUS) has become an important tool in diagnosing and following an adult patient with COVID-19; however, the literature for the pediatric age group is limited. Herein, we reviewed the up-to-date literatures on ultrasound use for COVID-19 pediatric patients for better management of COVID-19 in children. Methods and Objectives: The search terms “COVID-19,” “SARS-CoV2,” “coronavirus,” “2019-nCoV,” “lung ultrasound,” “sonography,” “adolescents” “children,” “childhood” and “newborn” were searched on the online databases PubMed, Embase and Medline. Articles meeting the inclusion criteria were included in the analysis and review. Results: We identified only fifteen studies to date using LUS to diagnose SARS-CoV-2 infection in children. These studies involved a total of 334 newborns, children and adolescents. Regarding the use of chest X-ray (CXR) and LUS in pediatric patients with COVID-19, we identified six studies with a total of 162 participants, with the following results: 33patients(14.11%) with lung abnormalities on lung US had a normal CXR; however, no patients with normal lung US had abnormalities on the CXR. In addition, regarding the use of computed tomography (CT) and LUS in pediatric patients with COVID-19 infection, we identified five studies with a total of 50 participants and 3 patients(6%) with lung abnormalities on chest LUS had a normal CT. Conclusion: Our findings suggest that LUS is a useful tool in the diagnosis of children and reduction in chest CT assessments may be possible when LUS is used in early diagnosis and follow-up monitoring of COVID-19 pneumonia in the children.

UPTAKE OF REPRODUCTIVE, MATERNAL AND NEWBORN HEALTH IN THE CONTEXT OF COVID-19 PANDEMIC IN KENYA (preprint)

BackgroundThe outbreak of COVID 19 in 2019 lead to destabilization of all sectors globally including access to health care. The strain on the health care system as a result of the disease outbreak led to a shift in operations in the health care system. Maternal and neonatal care was affected as women and their families could not freely access health care owing to the restrictions to curb the spread of COVID 19. This led to a risk of a reversal in the gains made in maternal and neonatal health, prompting the need to strengthen community midwifery. AimThe aim of this study was to strengthen community reproductive, maternal and newborn health in the context of COVID-19 pandemic in Kenya. Materials and methodsThis is part of an interventional study that sought to strengthen community maternal and neonatal health services. A baseline survey was conducted to assess the uptake of reproductive, maternal and neonatal care services in one sub-county in Kilifi and Kitui, where five wards in each sub-county were selected. An interviewer administered questionnaire was used to collect data. The sample size for the two Counties was 414. ResultsThere was a total of 378 respondents mostly comprising a rural population 75.7% (n=286). Outpatient and COVID 19 services (tests and vaccine) were most sought 37.5% (n= 137) and 29.9% (n=109) respectively. Antenatal care services were sought by 26% (n=95) of the respondents, postnatal care 9% (n=33) and skilled birth attendance 8.8% (n=32). ConclusionThe most utilized health facility services were outpatient and COVID 19 services. Antenatal care was also sought, however skilled birth attendance and postnatal care services were least sought.

Epcoritamab Compared to Observation for Treating B-cell Lymphoma Patients Not in Complete Remission After CD19-directed CAR-T Therapy

Project VerioVue Enhancements - Neonate Study

Trends and factors associated with neonatal mortality among Neonates hospitalized at the Women and Newborn Hospital in Lusaka Zambia in the pre-covid 19 period (preprint)

BackgroundNeonatal mortality is a global problem especially in resource-poor settings such as sub-Saharan African Countries. Trends and factors associated with neonatal mortality vary in different settings. This cross-sectional study investigated trends and factors that are associated with increased neonatal mortality among hospitalised neonates with a view of identifying pointers that can be modified to help improve neonatal survival. MethodsMedical records for all neonates admitted to the NICU in 2018 and 2019 were reviewed for the study. The Mortality rates were calculated using WHO standard and Microsoft excel 2010 used to construct monthly trends analysis using monthly totals. Univariate and multivariate logistic regression analysis to determine the factors associated with neonatal deaths at the tertiary facility using Stata version 14.2. Model fit was evaluated using Hosmer and Lemeshow test (chi2=13.90, P =0.0845), implies the models estimates fit the data at an acceptable level. ResultsA total of 7,581 admissions were seen and 2340 files were extracted for analysis, of which 940 (40.2%) died. The overall Neonatal mortality percentage during the study period was 31.8%. Relatively similar trends were observed during the study period with differences in case fatality rates. Factors associated with an increased odds of dying were not attending antenatal care (AOR=2.09, 95% CI [1.46 - 2.99] p <0.0001), parity (AOR=1.09, 95% CI [1.02 - 1.16] p=0.0013) and age of the neonate in days (AOR=0.92, 95% CI [0.91- 0.94] p <0.0001). ConclusionNeonatal mortality is high among hospitalized neonates at the Women and New-born Hospital in Zambia. Associated Factors included no antenatal attendance, increased parity, and early age of the neonate. This has detrimental effects; hence emphasis is on early Antenatal Care for easy monitoring of mother and neonates for fast actions in case of complications

COVID-19 Infection during Pregnancy: Disruptions in Lipid Metabolism and Implications for Newborn Health (preprint)

The COVID-19 pandemic has raised questions about indirect impact in pregnant women on the development of their future children. Investigating the characteristics of lipid metabolism in the "mother-placenta-fetus" system can give information about the pathophysiology of COVID-19 infection during pregnancy. 234 women were included in study. Maternal plasma, cord blood, amniotic fluid lipidome were analyzed using HPLC-MS/MS. Differences in lipid profile were searched by Manna-Whitney and Kruskall-Wallis test, diagnostic model based on logistic regres-sion were bilt by AIC. Elevation levels of lysophospholipids, triglycerides, sphingomyelins, and oxidized lipids was registered in patients’ after COVID-19 maternal and cord plasma. An increase in maternal plasma sphingomyelins and oxidized lipids was observed in cases of infection during the second trimester. In amniotic fluid, compared to the control group, nine lipids are reduced, six lipids are elevated. Levels of phosphoglycerides, lysophosphoglycerides, and phosphatidylinosi-tols decreased during infection in the second and third trimesters of pregnancy. Newborn’s health diagnostic model based on maternal plasma were developed for each group and exhibit good di-agnostic value (AUC> 0.85). Maternal and cord plasma’s lipidome changes during delivery, asso-ciated with Covid-19 infection during pregnancy, are synergistic. The most significant disturbances occur with infections in the second trimester of pregnancy.

Efficacy and Safety of Orally Administered Engineered Probiotics (CBT102-A) for the Treatment of Children With Phenylketonuria

COVID-19 during the Third Semester of Pregnancy: Maternal Characteristic, Possibility of Intrauterine Transmission and Neonatal Outcome in Aceh, Indonesia

BACKGROUND: Pregnant women are vulnerable against COVID-19 infection due to physiological and immunological changes. COVID-19 in pregnancy affects fetal well-being with a potential for vertical infection. AIM: This study aims to determine the incidence of vertical infection and anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in infants born to mothers with positive COVID-19 infection. MATERIALS AND METHODS: Amniotic fluid, swabs of the newborn's nasopharynx and oropharynx, and swabs of the placenta were examined using reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2. Serological examination was performed by Electro-Chemiluminescence Immunoassay on infant's blood. RESULT(S): Four of 33 pregnant women gave birth to infants positive SARS-CoV-2 infection. RT-PCR examination of all amniotic fluid and placental swabs was negative for SARS-CoV-2. Four of 33 infants (12.1%) showed negative polymerase chain reaction (PCR) results but positive SARS-CoV-2 antibodies, another 4 newborns (12.1%) showed positive PCR results, but no SARS-CoV-2 antibodies detected. The remaining 25 babies (75.8%) showed both negative PCR and serologic results. CONCLUSION(S): No evidence of vertical transmission found in this study.Copyright © 2023 Cut Meurah Yeni, Zinatul Hayati, Sarjani M. Ali, Hasanuddin Hasanuddin, Rusnaidi Rusnaidi, Cut Rika Maharani.

Findings from the ECHO Cohorts Regarding the Effects of the COVID-19 Pandemic

Background: Studies suggest perinatal infection with SARSCoV- 2 can induce adverse birth outcomes, but studies published to date have substantial limitations. Most have identified cases based upon their presentation for clinical care, and very few have examined pandemic-related stress which may also impact adverse birth outcomes. Objective(s): To evaluate the relationships between SARSCoV- 2 infection in pregnancy and pandemic-related stress with birth outcomes. Study Design: We conducted an observational study of 211 mother-newborn dyads in three urban cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program. Serology for SARS-CoV-2 was assessed in a convenience sample of prenatal maternal, cord serum or dried blood spots from births occurring between January 2020-September 2021. Specimens were assessed for IgG, IgM, and IgA antibodies to nucleocapsid, S1 spike, S2 spike, and receptor-binding domain. A Pandemic-related Traumatic Stress (PTS) scale was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Acute Stress Disorder criteria. Result(s): 36% were positive for at least one antibody type, chiefly IgG. Self-report of infection was not significantly correlated with combined serology. There were no differences in gestational age (GA), birth weight, preterm birth (PTB), or low birth weight (LBW) among seropositive mothers. However, IgM seropositive mothers had children with lower BW (434g, 95% CI: 116- 752), BW Z score-for-GA (0.73 SD, 95% CI 0.10-1.36) and were more likely to deliver preterm (OR 8.75, 95% CI 1.22-62.4). Associations with LBW sustained in sensitivity analyses limited to pre-vaccine samples, and PTS symptoms were not associated with birth outcomes. The addition of PTS did not substantially change associations with BW, although associations with PTB attenuated to near-significance. Conclusion(s): We identified decreased birth weight and increased prematurity in mothers IgM seropositive to SARS-CoV-2, independent of PTS. Though there are limits to interpretation, the data support efforts to prevent SARS-CoV-2 infections in pregnancy.

What about the baby? Infancy and parenting in the COVID-19 pandemic

This article reviews the evolution of a newborn through the first year of life and the potential impacts of COVID-19 on the infant, parent, and the parent-infant relationship. Babies grow in the context of relationships, and the quality of those relationships affects the physiological and psychological organization of the baby. Precisely because each baby is a being with unique biology, temperament, and ways of experiencing, feeling, and learning, much is to be discovered and understood about them. The baby's wordless communications require their parents to intuit, infer, hypothesize, and experiment as parents come to know the needs of their baby. As we walk alongside parents who struggle to come to know their infant-even as the infant is coming to know them-we are required to have conceptual knowledge of how a newborn becomes a fully awakened infant. Under typical conditions, the birth of a firstborn baby presents a caregiving challenge and developmental opportunity for the emerging parent. Environmental context can serve to support or interfere in the success of the adjustment. This paper will explore some theoretical underpinnings that contribute to infant and parent well-being and the possible impact of being born during the COVID-19 pandemic. Also considered will be the undue burden of families bearing the weight of economic inequities, oppression, and structurally supported racism. This article will explore the influence of parental perception, the development of attachment relationships, and how that is influenced by and influences infant communication. Finally, it will suggest ways that psychotherapists seeing individuals who are parents can hold the infant in mind as they work to understand and respond to their adult clients navigating the impacts of this pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Newborn-onset chronic urticaria as the first manifestation of NLRP3 mosaicism

Objectives: A 7-month-old boy presented with generalized urticaria since the first week of life, without any other clinical manifestation. Cow's milk allergy was ruled out. His development was normal for his age. Maternal history was significant for COVID-19 infection in the third trimester of pregnancy with mild symptoms. Family history was significant for dermatographism in a maternal uncle. Hives were migratory with no single lesion persisting more than 24 h. There were no recognizable triggers and only relieved for 1-2 days after each vaccination. Patient was treated with optimal doses of antihistamines without improvement. Method(s): Laboratory tests and further studies were performed Results: Laboratory tests were normal including complete blood testing, circulating autoantibodies and infectious studies. C-reactive protein level and erythrocyte sedimentation rate were elevated. Due to chronic urticaria of newborn onset unresponsive to antihistamines a monogenic autoinflammatory disease was suspected. A targeted gene panel covering causative genes revealed the unreported p.Gly307Ala variant in the NLRP3 gene with a variant allele frequency (VAF) of 3% compatible with gene mosaicism. NLRP3 variant was classified as "likely pathogenic" based on its location, where a different variant has been reported as causing a severe form of cryopyrin-associated periodic syndromes (CAPS), and bioinformatic analyses. As expected, the variant was absent in patient's parents supporting for its de novo nature. Vision and hearing exams were normal. Treatment with canakinumab will start soon. Discussion(s): CAPS are dominantly-inherited autoinflammatory diseases caused by gain-of-function NLRP3 variants. These variants are often germline, but in some reported cases the variants are postzygotic causing gene mosaicism as in the patient here described. We believe that the mild presentation in our patient, despite having a likely pathogenic variant, may be explained by the low VAF. The genetic diagnosis in our patient allowed early initiation of anti-IL-1 treatment, which probably will prevent the development of other CAPS manifestations.

SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.Copyright © 2023. Thieme. All rights reserved.

Impact of SARS-CoV-2 infection in pregnancy on fetal immune state

SARS-CoV-2 infection during pregnancy is associated with increased risk of adverse maternal and pregnancy outcomes. Maternal COVID- 19 is associated with immune activation and inflammatory response in the pregnant individual and an altered immune repertoire in the placenta. Mother-to-child transmission of infection is reported but uncommon. Still, the potential impact of maternal SARS-CoV-2 infection on the immunologic and inflammatory state of the infant is of interest, both for the acute health of the newborn and longer-term outcomes. In this talk, we will discuss the mixed data from cord blood and infant studies of cytokine profiles, transcriptomics, immunophenotyping, and functional studies. We will address the timing and severity of maternal infection as we explore the potential immunological consequences of in utero exposure to maternal SARS-CoV-2 infection.

Introduction

Two hundred seventy-four million people-one in thirty people on the planet-are in humanitarian need as of September 2022.1 More than one hundred million of these individuals are displaced, usually as a result of crisis: conflict, political upheaval, economic meltdown, or climate shocks.2 In a humanitarian crisis, health is the most urgent and paramount need. But today the system for preventing and addressing humanitarian crisis is failing, and with it, the health needs of millions of vulnerable people are under threat. From treating childhood acute malnutrition to delivering COVID-19 vaccines to ensuring access to sexual, reproductive, maternal, and newborn health, health care in humanitarian contexts requires a dramatic rethink amid growing challenges to access and service delivery.

COVID-19 mimicked fetal hemolytic disease: a case report

The pandemic of COVID-19 changed the traditional approaches to the management of gestational complications. Today there is still a lack of information about the impact of COVID-19 on the pregnancy course, in particular, about its role in relation to Rh-conflict during pregnancy. The paper focused on a rare presentation of Rh-conflict pregnancy and COVID-19. 32 years old G3 P2 pregnant women with Rh-negative had a third pregnancy. The injection of anti-D immunoglobulin after the first abortion was not performed. The second pregnancy finished with a term delivery and the birth of a fetus with hemolytic disease. During the third pregnancy, the woman fell ill with COVID-19 in the 26th week. The bilateral pneumonia was diagnosed. The treatment included antibiotics, antiviral, antithrombotic, and anti-inflammatory drugs. No signs of fetal hemolytic disease were found via ultrasonography. But the abnormal level of anti-D antibodies – 1:1024 was detected. From the 28th weeks of pregnancy till the delivery the test for anti-D antibodies was constant – 1:4. The variables of utero-placental, fetal (blood flow velocity in a middle cerebral artery), and umbilical hemodynamics were normal during the third trimester. But fetal moderate hepato-and splenomegaly were found at 36 weeks of gestation. The patient delivered at 38 weeks of gestation a female newborn 3100 g, 52 cm with a 7→8 Apgar score. The laboratory investigation detected a hemoglobin value of 202.6 mg/dL in a child. The blood analysis showed total bilirubin of 44.2 mg/dL, direct bilirubin of 1.0 mg/dL, and a negative result on the direct Coombs test. The baby received phototherapy for 3 days. Total bilirubin was decreased (15.2 mg/dL). The newborn was discharged from a hospital with the mother on the fifth day. COVID-19 could change the placental permeability and increase the titer of anti-D antibodies. But it did not contribute to fetal and newborn hemolytic disease. © The Author(s) 2023.