Francesco Cardona

Thanks, we hope we can start something new with the webinars.

https://mhnpjournal.biomedcentral.com/articles/10.1186/s40748-018-0093-1

This is the protocol of a recently finished trial that has not been published to by knowledge.

I like this as a starting point https://ep.bmj.com/content/104/1/43.long

Maybe this is too basic though?

great series, thanks!

I find these posters very helpful as well. We will all have to look after eachother in the upcoming crisis.

https://www.ics.ac.uk/ICS/Education/Wellbeing/ICS/Wellbeing.aspx?hkey=92348f51-a875-4d87-8ae4-245707878a5c

#staffwellbeing

The CDC has come out with recommendations:

It is unknown whether newborns with COVID-19 are at increased risk for severe complications. Transmission after birth via contact with infectious respiratory secretions is a concern. To reduce the risk of  transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued, as described in the Interim Considerations for Disposition of Hospitalized Patients with COVID-19. See the considerations below for temporary separation:

• The risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team.
• A separate isolation room should be available for the infant while they remain a PUI. Healthcare facilities should consider limiting visitors, with the exception of a healthy parent or caregiver. Visitors should be instructed to wear appropriate PPE, including gown, gloves, face mask, and eye protection. If another healthy family or staff member is present to provide care (e.g., diapering, bathing) and feeding for the newborn, they should use appropriate PPE. For healthy family members, appropriate PPE includes gown, gloves, face mask, and eye protection. For healthcare personnel, recommendations for appropriate PPE are outlined in the Infection Prevention and Control Recommendations.
• The decision to discontinue temporary separation of the mother from her baby should be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. The decision should take into account disease severity, illness signs and symptoms, and results of laboratory testing for the virus that causes COVID-19, SARS-CoV-2. Considerations to discontinue temporary separation are the same as those to discontinue transmission-based precautions for hospitalized patients with COVID-19. Please see Interim Considerations for Disposition of Hospitalized Patients with COVID-19.
• If colocation (sometimes referred to as “rooming in”) of the newborn with his/her ill mother in the same hospital room occurs in accordance with the mother’s wishes or is unavoidable due to facility limitations, facilities should consider implementing measures to reduce exposure of the newborn to the virus that causes COVID-19.
  • Consider using engineering controls like physical barriers (e.g., a curtain between the mother and newborn) and keeping the newborn ≥6 feet away from the ill mother.
  • If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed COVID-19 or is a PUI should put on a facemask and practice hand hygiene¹ before each feeding or other close contact with her newborn. The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on transmission-based precautions in a healthcare facility.

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnant-women-and-children.html

Breast feeding

Breast milk provides protection against many illnesses. There are rare exceptions when breastfeeding or  feeding expressed breast milk is not recommended. CDC has no specific guidance for breastfeeding during infection with similar viruses like SARS-CoV or Middle Eastern Respiratory Syndrome (MERS-CoV).

Outside of the immediate postpartum setting, CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant.

Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers.  A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast.  If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.

UK is not that drastic in isolating neonate from mom https://www.rcog.org.uk/en/news/national-guidance-on-managing-coronavirus-infection-in-pregnancy-published/

https://wwwnc.cdc.gov/eid/article/26/6/20-0287_article?deliveryName=USCDC_333-DM21761

Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China

I wonder what the ideal management of newborns born to COVID19+ mothers is. I hope there will be more information coming.

The recommendation from the Austrian/German Society for neonatology is as follows: mother COVID-19 positive: isolation of mother and child and no breastfeeding until mother is COVID-19 negative.

https://www.sciencedirect.com/science/article/abs/pii/S1553725008340197?via%3Dihub

http://rc.rcjournal.com/content/58/7/1237

Please help researchers from Germany with their study: https://www.umfrageonline.com/s/175a5bb

Quote

 

We would like to determine a status quo concerning the standard of care of premature infants during their “second hour of life”.
The latter we define as the period after completion of initial treatment in the delivery room up to the time when the infant is in the NICU allowed to rest for a longer period for the first time.

https://www.umfrageonline.com/s/175a5bb

The questionnaire includes 22 questions. Please reply only once per NICU.

We thank you very much for your support.

If you have any comments, you will have the opportunity to write them down at the end of the questionnaire.

 

One of the oldest forums for neonatal staff has to close because yahoo is discontinuing the groups feature.

Would be nice to welcome some of the people from that group in our forum! I am sure they would settle in quickly and would love joining our discussions.

https://groups.yahoo.com/neo/groups/nicu-net/conversations/messages

On 9/19/2019 at 2:28 AM, richmaus said:

Sorry, no answers but thought I would share that!

 

Thanks for sharing, looking forward to the results!

On 8/3/2019 at 7:27 AM, bimalc said:

Given that ELBWs get comprehensive follow-up (at least in most settings I know where you could even contemplate routine MRI at discharge), what possible value could MRI provide which would change care or outcomes? 

As I understand it, MRI is better at detecting who will NOT develop severe developmental abnormalities, so that might be of comfort to parents. But as so often - very few things are black and white...

Interesting subject.

In Vienna, we prime insulin infusion systems before use. The insulin is prepared as ordered, we start off with 0.05-0.1 IE/kg/h. After 30min, the insulin in the infusion system is discarded and the same amount/dilution prepared with the same system before use.

Let me know if you need more information @ChantalNICU

You might want to share this link with parents on your NICU: https://parenting.nytimes.com/health/nicu-care

A question reaches us via Twitter by Susanna Fustolo-Gunnink:

Are there neonatal intensive care units in which hyperconcentrated platelet transfusions are administered? @EBNEO @ccroehr @DrCGale @NeonatalResearc @cwsbattersby @RizKhanahmed @TimWatts1964 @BSantamaria8 @drpaulclarke @Colin37377735

We used Protovit for some months when Soluvit wasnt available for us.

26 minutes ago, Stefan Johansson said:

Let's hope he can come next year

He's on the wishlist 😉

Start reading here maybe: https://www.nature.com/articles/nrdp201637

Hi,

In the hospitals I worked in Austria, the rule was to increase by 10-20ml/kg/d and start on first day. If Colostrum is available this is fed as well. We start with enteral feeds right away on the first day. We give 2-3 hourly feeds.

@Vicky Payne who is high/medium/low risk according to your tool?

@bimalc do you have some literature sources you can point to? would love to read up.

We perform LISA routinely on all preterms < 28 wks right after birth. We do not use any premedication or analgesia. We use a gastric tube and Magill forceps for application of surfactant intratracheally. We follow a slightly modified version of the original protocol from Cologne (as published here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60986-0/fulltext).

You can find our publication on our experience with LISA here: https://www.ncbi.nlm.nih.gov/pubmed/23446061

Let me know if you need any more information.

Most studies I know use "bundles" - so insertion with maximum sterile precautions were used in most settings, but I have not seen any study that only looks at using  cap/face-mask in incubators. I would say the possible research question is also one about equipoise.. how much hassle is it to put on cap and mask for a potential higher risk of infection that can have quite deleterious effects. Is sterile material also handled outside of the incubator (i.e. unpacking the catheter etc.)? Then it probably still might make sense.

On 9/18/2018 at 1:24 AM, p_schmidt_nicu said:

The air-Qsp LMA from Cookgas is available in size 0.5. The packaging says for use <4kg. It is obviously smaller than the size 1 and certainly works when used on the prem sim babies.

Thank you for this comment! I was not aware of the 0.5