Clinical characteristics of confirmed COVID-19 in newborns: a systematic review.

OBJECTIVE: Aim of this systematic review is to investigate the available evidence describing neonatal outcomes in newborns who have SARS-CoV-2 infection in order to guide prevention of COVID-19 in newborns. METHODS: This is the study protocol for a systematic review. MEDLINE, Web of Science, PubMed, Science Direct, CINAHL, Scopus, Cochrane, TUBITAK databases, and key words of "Newborn" (neonatal OR clinical characteristics newborn OR infants less than 1 month OR infants less than 28 weeks OR Neonate) AND "clinical presentation" (epidemiology OR symptoms OR clinical course OR features) AND "COVID-19" (Coronavirus OR COVID-19 OR Sars-Cov2 OR coronavirus disease 2019 OR Novel Coronavirus OR 2019-nCoV) were searched for this systematic review. Randomized controlled trial, cross-sectional, case-control, and case reports, case reports examining neonatal outcomes in newborns who have SARS-CoV-2 infection were included. Studies were selected according to criteria around the population, intervention, comparator, outcome(s) of interest, and study design (PICOS framework). All citations and full-text articles were searched by independent five authors. The population that newborns with COVID-19 that confirmed within 28 d of birth are included. The interventions included in COVID-19 infection diagnosed via reverse transcription-polymerase chain reaction (RT-PCR) or serological. The primary outcomes were Neonatal clinical outcomes. The methodological quality of the studies was appraised using appropriate tools. Strength of the body of evidence was assessed according to the quality assessment tool for quantitative studies (QATQS). RESULTS: The electronic search identified 1051 records that were examined, after evaluating 35 of them were included in the study. Seven studies were research articles and twenty-eight were case reports. Methodological quality was medium. Most of the clinical characteristics of newborns were respiratory difficulty and secondly fever. Some newborns gastrointestinal (GIS) symptoms in the form of diarrhea and feeding intolerance and abdominal distension were present in 50%. The fatality case did not exist in any newborn due to COVID-19. Death occurred in one case due to prematurity. CONCLUSIONS: The most common symptoms in patients with COVID-19 infection in the neonatal period are respiratory tract symptoms and fever. It has been observed that the COVID-19 infection detected in the neonatal period is not fatal. However, data including more cases are needed.

Effect of camera monitoring and feedback along with training on hospital infection rate in a neonatal intensive care unit.

BACKGROUND: In terms of pediatric healthcare-associated infections (HAI), neonatal intensive care units (NICU) constitute the greatest risk. Contacting a health care personnel, either directly or indirectly, elevates NICU occurrence rate and risks other infants in the same unit. In this study, it is aimed to retrospectively analyze the effect of the training along with camera monitoring and feedback (CMAF) to control the infection following a small outbreak. METHODS: ESBL producing Klebsiella pneumoniae was detected on three infants in May 2014 at the isolation room of Sakarya University Hospital NICU. Precautions were taken to prevent further spread of the infection. The infected infants were isolated and the decolonization process was initiated. For this aspect, health care workers (HCWs) in NICU were trained for infection control measures. An infection control committee has monitored the HCWs. Before monitoring, an approval was obtained from the hospital management and HCWs were informed about the CMAF, who were then periodically updated. On a weekly basis, NICU workers were provided with the feedbacks. Epidemic period and post-epidemic control period (June-July-August 2014) were evaluated and p value < 0.05 was considered statistically significant. RESULTS: Healthcare-associated infection (HAI) density was 9.59% before the onset of the CMAF, whereas it was detected as 2.24% during the CMAF period (p < 0.05). Following the precautions, HAI and HAI density rates have reduced to 76.6% and 74.85%, respectively. Moreover, hand hygiene compliance of health care workers was found 49.0% before the outbreak, whereas this rate has elevated to 62.7% after CMAF. CONCLUSIONS: Healthcare workers should be monitored in order to increase their compliance for infection control measures. Here, we emphasized that that CMAF of health workers may contribute reducing the HAI rate in the NICU.

The value of fingertip blood impregnated paper in hepatitis B surface antigen screening.

Hepatitis B surface antigen (HBsAg) screening is an important procedure to determine the prevalence of hepatitis B (HBV) in a community. However, it is difficult, time consuming and expensive. In this study we aim to investigate the efficacy and usefulness of fingerprint blood impregnated paper in HBsAg screening. To our knowledge, blood impregnated paper is a practical, useful method for HBsAg screening in the community.

Frequency of nasal Helicobacter pylori carriage among cooks.

OBJECTIVE: To investigate the frequency of nasal Helicobacter pylori carriage among cooks living in Bolu, Ardahan and Sakarya province of Turkey. METHODS: A total of 54 cooks (10 from Bolu, 29 from Ardahan and 15 from Sakarya) were enrolled. Nasal Helicobacter was tested using polymerase chain reaction. RESULTS: Helicobacter pylori was detected in only one cook. CONCLUSION: Nasal Helicobacter pylori colonisation ratio in cooks in Turkey was found to be very low. Presumably hand hygiene compliance lowered the frequency.

Assessment of magnesium status in newly diagnosed diabetic children: measurement of erythrocyte magnesium level and magnesium tolerance testing.

The aim of this study was to investigate the relationship between serum, erythrocyte and urine magnesium levels and retained magnesium percentage in newly diagnosed diabetic children. In a cross-sectional study, 34 children with insulin dependent diabetes mellitus (IDDM) and 21 healthy age- and sex-matched control subjects were screened for their serum, erythrocyte, and urine magnesium levels. Magnesium tolerance test was performed on diabetic and control subjects. Serum and erythrocyte magnesium levels in diabetic children were significantly lower than in healthy controls (plasma magnesium, p<0.05; erythrocyte magnesium, p<0.001); however, serum magnesium level was in normal range in diabetics and controls. Erythrocyte magnesium levels in diabetic children showed an inverse correlation with percentage of retained magnesium load (r=-0.44, p<0.01). Urine magnesium excretion in diabetic children (7.12 +/- 2.18 mmol/g creatinine/24-hr) was significantly higher than in healthy controls (4.0 +/- 1.35 mmol/g creatinine/24-hr) (p<0.001). There was a negative correlation between erythrocyte magnesium (2.07 +/- 0.62 mmol/L) and urine magnesium (7.12 +/- 2.18 mmol/g creatinine/24-hr) (r=-0.68 p<0.01) in diabetic children. Magnesium tolerance test showed that percentage of retained magnesium in diabetic children (66 +/- 26%) was significantly higher than in controls (16 +/- 7%) (p<0.001). This study is the first study to simultaneously investigate serum, erythrocyte and urine magnesium levels and magnesium tolerance test in newly diagnosed diabetic children. In conclusion, erythrocyte magnesium levels decrease earlier than serum magnesium in diabetic children. The follow-up parameters in diabetics may include the policy of monitoring magnesium status. Erythrocyte magnesium measurement is preferred to serum magnesium. Magnesium tolerance test is a reliable and sensitive method, which may be used as an alternative to erythrocyte magnesium measurement or in combination with it in hospitalized diabetic children.

Congenital hypothyroidism and iodine status in Turkey: a comparison between the data obtained from an epidemiological study in school-aged children and neonatal screening for congenital hypothyroidism in Turkey.

BACKGROUND: Congenital hypothyroidism and endemic iodine deficiency are the most common cause of mental retardation. However in both cases retardation is of nonpreventable nature. OBJECTIVE: The aim of the study was to investigate whether epidemiological study in school-aged children or neonatal screening of congenital hypothyroidism (CH) was useful to assess iodine status and monitor the preventive measures of iodine deficiency disorders (IDD). SUBJECTS: To study the epidemiology, 1046 school children, aged 8 to 12 years from 23 primary schools in rural and urban areas from three cities in Turkey were included. Neonatal screening for congenital hypothyroidism (CH) was carried in. METHODS: Goiter and thyroid volume were assessed by palpation and ultrasound, respectively. Thyroid stimulating hormone (TSH), total thyroxine (T4), and urinary iodine excretion (UIE) were measured. Neonatal screening for CH was adjusted according to the guidelines of Pediatric Endocrinology of the European Society for Pediatric Endocrinology. RESULTS: There was no significant difference between the median TSH in school-aged children and the cities of Bolu and Duzce (p>0.05). Median TSH of Zonguldak was significantly different from the median TSH of Bolu (p=0.046) and Düzce (p=0.028). There was no significant difference between the median T4 levels of Bolu and Duzce (p>0.05). The median T4 of Zonguldak showed a significant difference from the median T4 value of Bolu (p=0.018), but an insignificant difference from the median T4 of Duzce (p>0.05). The overall goiter prevalence in 1046 children was 52%. In two years, 18606 newborns were screened. With a cut-off point at TSH >20 microm U/ml, the recall rate was 1.6% and the incidence of CH 1/2326. There was 26.7% children with TSH >5 microm U/ml. Both data of the epidemiological study in school-aged children and neonatal screening for CH indicated that the West Black Sea Region is affected by mild to moderate iodine deficiency. CONCLUSION: the implementation of neonatal screening for congenital hypothyroidism using TSH measurement has many advantages. It can detect congenital hypothyroidism and transient primary hypothyroidism, and can also be used for monitoring tools of preventive measures of IDD. Countries, such as Turkey, which has not begun national screening for CH yet, should make implementation of neonatal screening for CH using primary TSH measurement a political priority.