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  • Blog Entries

    • By AllThingsNeonatal in All Things Neonatal
      This is another hot topic out there as centers around the world struggle to determine how best to manage the mother who has contracted COVID-19 in pregnancy. There are resources out there already such as the CDC which states the following.
      The World Health Organization also has this to say as of yesterday.
      The question though is where do these recommendations come from? How strong is the evidence?
      Let’s begin with another Coronavirus
      Do you remember SARS? This was another coronavirus.
      Wong SF et al published Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome in 2004 in which they described the outcomes of 12 women infected with the coronavirus causing SARS. In this study they sampled Evidence of perinatal transmission of virus was assessed by SARS-associated coronavirus reverse-transcriptase polymerase chain reaction (SARS-CoV RT-PCR) and viral culture on cord blood, placenta tissue, and amniotic fluid at or after delivery. None of the tested infants were found to have infection nor were any of the tissues or fluids positive. They did not test breast milk specifically but as none of the infants developed SARS one could infer that if the other samples were negative so were the breastmilk samples. The conclusion after the SARS epidemic is that vertical transmission does not occur.
      Moving on to COVID-19
      It may surprise you but there is very little out there on breastmilk and COVID-19. Having said that, there is very little data on pregnancy and COVID-19 so the question then is how strong is the evidence for lack of transmission in breastmilk?
      There is really one study by Chen H et al Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The authors looked at 9 women presenting in the third trimester and examined outcomes from pregnancy. All of the infants were delivered via c-section and in 6 of the 9 samples of breastmilk were obtained and sampled for COVID-19. The good news was that none of the samples tested positive for the virus.
      I suppose the result shouldn’t be that surprising as the virus causing SARS is similar and also has not been demonstrated to lead to neonatal infection. The question then is whether one should freely breastfeed their newborn if they are known to be positive for COVID-19.
      Getting back to the earlier recommendations from the CDC, they read as pretty firm. Looking at the sum total of evidence I think it is safe to say we don’t have a lot of data to go by. What we have though in this situation is to look at risk/benefit. To the best of our knowledge, the COVID-19 is not transmitted into the fetus and after birth does not get into breastmilk. Both of these things appear to be quite good but as the virus spreads and more pregnant women contract the virus we may see as we get a larger sample that it is possible but I suspect this is a virus that simply doesn’t transmit to breastmilk. What if we banned breastfeeding in suspect or confirmed patients? The potential loss of immunoglobulins against COVID-19 is a real risk for the infant as they continue to live in the same home as the mother. How do we know that such antibodies exist? As for as I know for COVID-19 this hasn’t been proven yet but in the SARS epidemic a case report demonstrated that antibodies against this virus were indeed in breastmilk; SARS and pregnancy: a case report. Given that the viruses are part of the same class I would imagine the same would hold true with the new coronavirus. They may not be born with the virus but if they are receiving passive immunity from the mother that needs to be considered given that we have nothing effective (at the moment) to treat anyone. An alternative is to use donor breast milk but if we go down that road, our supplies will be exhausted before long. Weighing everything and using the best data we have at the moment my bias would be continue breastfeeding albeit with the recommendations for droplet precautions and hand hygiene as the CDC suggests.
      Stay safe out there everyone.
    • By Stefan Johansson in Department of Brilliant Ideas
      I am guided by the vision that every infant should have access to evidence-based interventions. The principal idea to practice EBM in the NICU has been central for me to pursue many projects, also the initiative in 2016 that led to Neobiomics, a “neonatal startup” now under the wings of the Innovation Incubator at Karolinska Institutet in Stockholm.
      The vision that all infants have access to evidence-based interventions also guided Neobiomics to develop ProPrems®, a high-quality probiotics product tailor-made for preterm infants. I am particularly glad that ESPGHAN recently acknowledged the combination of strains in ProPrems® (Bb-02, Bb-12 and Th-4) and that the high-end manufacturing complies to listed safety conditions. In brief, we drew the same conclusions as ESPGHAN in our review of the literature a few years back.
      Due to obvious reasons during the current Covid-19 pandemic, more long-term development of neonatal care is put on hold. We have therefore decided to provide ProPrems® free of charge to NICUs with implementation plans now postponed due to time constraint and shift in focus. We aim to provide a sufficient number of ProPrems® doses for use until May 31. The same offer is given to hospitals already using ProPrems®. Please note that ProPrems® is only available in Europe.
      Visit this URL to fill in the request form and I will connect back within 48 hours to discuss practical aspects further: https://proprems.eu/proprems-delivery/
    • By Stefan Johansson in Department of Brilliant Ideas
      The professional communication during the Covid-19 pandemic really shows the potential to share expertise and experience through web-based channels.
      Journals, societies, regular news media, social media platforms etc-etc play an important role for us to keep updated, and many web sites have also opened up their content free of charge.
      We will learn many things from facing and tackling this pandemic, but one major change will certainly be our communication channels. Many are discovering the web-based possibilities to learn and discuss.
      We will do our best to facilitate professional communication within the neonatal community.
      And, finally it seems that the company providing our software (IPB) will finally roll out a smartphone app. Which means that 99nicu will literally become available in your pocket through a "99nicu App".
      The screen shots below comes from the beta-version of the app now used by the company providing our software.
      And yes, there will be light-mode and dark-mode  
      Stay tuned!
    • By AllThingsNeonatal in All Things Neonatal
      We are living in challenging times but, as a community caring for neonates and their families, we will get through this together.  Canadians and others around the world are digesting a great deal of information in order to come up with a best approach to caring for mothers and infants with either suspected or confirmed COVID-19 infections.  It is an imperfect science for sure as we have scarce information to go on but you may find it helpful to look at what centres are doing in terms of their approaches to delivery and care in the NICU. Please note that these are being posted in an attempt to share our collective efforts but that referral to your local health authority protocols is recommended. 
      Protocols and other relevant information including sim/ education and processes can be shared  from sites across Canada and  accessed through the COVID-19 menu at the top of the site.
      There will no doubt be geographic differences which may be due to unit layout (single/double rooms, open bay concept, negative pressures rooms), local IPC and health authority protocols.  Hopefully, though, our community can share useful resources, algorithms, videos, etc that can serve as a framework for others to use or modify to suit their needs.  
      Thanks to all of you for your dedication, your hard work and for your caring. Please stay safe and stay healthy – we will get through this – together.
      Useful Links
      Provincial Approaches to Newborn Care
      COVID19 Provincial Approaches
      Literature Review
      COVID19 Literature
      Additional Organizational Information
      Ontario “Provincial Council for Maternal and Child Health – Covid 19 Practice Support Tools
      Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings
  • Upcoming Events

    • 01 April 2020 04:00 AM Until 30 April 2020 04:00 PM
      April is HIE Awareness Month
      Hope for HIE is once again coordinating global awareness for HIE. This year, the theme is CHOOSE HOPE. We hope we can count on our 99NICU colleagues to help us spread the word. 
      Our awareness month website is being built and should be available in the next week or two with a variety of tools to help spread awareness including social media graphics, press releases and talking points, downloadable patient referral and educational materials, and more. 
      Over 2 million impressions were generated in 2019, and Hope for HIE now serves over 5,000 families worldwide.
      Questions? Reach out to Annie Goeller, Public Relations & Marketing.
    • 25 June 2020 Until 26 June 2020
      Visit Conference website: http://www.lutonneocon.co.uk
    • 03 October 2020 Until 05 October 2020
      First announcement of 
      Recent advances in neonatal medicine
      IXth International symposium honoring prof. Richard B. Johnston, MD, Denver, US
      26-28 April 2020, in Würzburg, Germany
      Find more information in the attached folder.
    • 17 November 2020
      The 17th of November each year is the World Prematurity Day. Originally started by parent organisations in Europe in 2008, the World Prematurity Day is an international event aiming at high-lighting the ~15 million infants born preterm each year.
      Read more about this day on the March of Dimes web site, and on Facebook.
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