Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org

Search the Community

Showing results for tags 'covid-19'.



More search options

  • Search By Tags

    Type tags separated by commas.
  • Search By Author

Content Type


Forums

  • 99nicu
    • Partners and Sponsors
    • Feedback and support
  • GENERAL NEONATAL CARE
    • prenatal care and fetal growth
    • resuscitation
    • fluid and electrolyte balance
    • nutrition
    • drug treatment and analgesia
    • nursing the neonate
    • family support
    • practical procedures
    • technical equipment
  • NEONATAL MORBIDITY
    • pulmonary disorders
    • cardiovascular problems
    • neurology
    • infections
    • gastroenterology
    • hematology
    • metabolic disorders
    • disorders of the genitourinary tract
    • ophtalmology
    • orthopedic problems
    • dermatology
    • neonatal malignancies
  • ORGANISATION OF NEONATAL CARE
    • education, organisation and evaluation
    • ethical and legal aspects
  • MESSAGE BOARD
    • Job Board
    • Reviews
    • Congresses and courses
    • Other notes

Blogs

  • Department of Brilliant Ideas
  • My blog, Gaza, Palestine
  • Blog selvanr4
  • Blog ali
  • Neonatology Research Blog
  • Blog JACK
  • Blog MARPSIE
  • Blog Christina Arent
  • Blog docspaleh
  • HIE and brain death
  • emad shatla's Blog
  • Medhaw
  • DR.MAULIK SHAH
  • keith barrington's neonatalresearch.org
  • sridharred15's Blog
  • Petra's Blog
  • Abel
  • All Things Neonatal
  • Dr Alok Sharma
  • Simulation and Technology Enhanced Learning as a Tool to Improve Neonatal Outcomes
  • Hesham Tawakol
  • spotted: NICU
  • Bubbly Girl in NICU
  • Narongsak Nakwan
  • Dr. Rajeev Malhotra
  • Smells like DR spirit
  • Ravi Agarwal
  • Traumatic LP

Collections

  • 99nicu
  • How everything works
  • Terms and conditions

Categories

  • Pharmacopedia

Categories

  • Gastrointestinal Quizzes
  • Neurology Quizzes
  • Pulmonary Quizzes

Find results in...

Find results that contain...


Date Created

  • Start

    End


Last Updated

  • Start

    End


Filter by number of...

Joined

  • Start

    End


Group


First name


Last name


Occupation


Affiliation


Location


Interests


Twitter


Facebook


LinkedIn


Skype

Found 23 results

  1. Newborns of covid-19 positive mothers - outcomes of co-location and breastfeeding: I have posted a link to a new article by Patil et al on this topic on www.perinatalcovid19.org, a free website with resources to help you deal with the covid-19 pandemic. Please look under 'Important Publications', 'Treatment and Management'.
  2. I recently had the honour of being asked to present grand rounds at the University of Manitoba. My former Department Head during the question period stumped me when he asked me what role angiotensin converting enzyme 2 receptor (ACE2) has in pediatric COVID19. Like all great teachers, after I floundered and had to confess that while I was aware there is a role in COVID19 I wasn’t sure of the answer, he sent me a paper on the subject. The reality is that a very small percentage of COVID19 illness is found in children. Some estimates have it at 2%. Why might that be? It’s what’s in the nose that matters What has been known for some time know is that the point of entry for SARS-CoV-2 is the nasal epithelium. What is also known is that the receptor that the virus binds to in order to gain access to the host. Such binding and what happens after the virus gains entry to the body is shown in this figure depicting the life cycle of SARS-CoV-2. In a research letter by Bunyavanich et al Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults looked at 305 patients from ages 4-60 years to examine biomarkers of asthma. In the course of looking at the nasal epithelium of these patients, they found age related differences in the expression of ACE2 receptors as shown in the following figure. I think the results somewhat speak for themselves. The younger you are the less receptors you have. If you have less receptors maybe you are less likely to contract the virus! What we don’t know This research leads to some interesting questions. Drugs such as losartan and valsartan already exist and function by blocking he ACE2 receptor. Could blockade help to limit the spread of infection? I am not aware of any such trials going on at the moment but something worth looking at. The other point that needs to be raised is that the most vulnerable group of ages >60 were not looked at in this study. The trend would certainly indicate that with age we would expect the receptor numbers to increase but since we don’t actually have the data in the older groups we don’t know if receptor numbers start to fall again with age. Similarly we don’t know below the age of 4 what receptor numbers are like. In examining risk of vertical transmission it is worth noting that the recent placental positive RT-PCRs as in Detection of SARS-COV-2 in Placental and Fetal Membrane Samples. In that study while 3 of 11 placental membranes tested positive, none of the newborns were infected. Could it be the fetus and newborn is protected by having very little density of ACE2 receptors? Something to look at and will be no doubt. Regardless, in the fight against COVID19 maybe one direction for therapeutic targeting should be addressing this receptor and seeing if there is something we can’t do to make it less susceptible to binding.
  3. Just a few days ago, Professor de Luca in Paris showed a paper with a scientific evidence of vertical transmission of Sars-Cov-2. An excellent (although sad) news by an excellent professor. Coincidentally, yesterday the National Perinatal Institute, in Mexico made a webinar about this topic. In this slide, what you can see, they are showing in the left, that 17 of 86 placenta tested positive to Covid PCR; that 11 of 22 amniotic fluids tested positive and that 6 of 17 human milk the same. All in mothers positive to Covid-19. Hope this will be of interest for you all.
  4. Dear Friends, Please visit www.perinatalcovid19.org , a free website that has many resources to help you deal with the covid-19 pandemic. New research on covid-19 is posted here regularly. Hope you find it useful. Please send me information and suggestions that will help serve your needs. Dr. Gautham, Houston, Texas, USA
  5. Good morning or evening everyone! As we move thorough these turbulent times everyone has questions about how this story will end. My experience with social media has been one that has been evolving for some time. Recently with so many questions about COVID19 I opted for setting up Facebook Live video sessions and although they aren't a visual question and answer session they do allow for people who are watching to make comments. One of my favourite sessions so far has been with Stefan from 99nicu as shown here! https://www.youtube.com/watch?v=AwNGxiYvgLg&list=PLHmYb5bfg4U3RuEO7Jf9mC4rF_0CAHiIZ&index=10&t=33s As the number of discussions builds you will be able to find them posted all in this one playlist that I hope you will find helpful. It is so important to remember that while all we seem to hear about these days is COVID19 the reality is that we are still in the infancy of our understanding of this disease. When you think of the 250 or so reported cases of neonatal outcomes remember that many conditions have thousands upon thousands or millions of cases to help our understanding of the disease. In the case of COVID19 we are in a period where I fear there will be much back and forth or whipsawing as small but important reports have the chance of moving the needle substantially. If you find all of this confusing don't worry you are not alone. It is my hope though to help you with your jouney along the way. As mentioned here is the link to the playlists for all COVID19 related videos including several simulations for resuscitation which perhaps your centre will find useful for planning in the event you do find yourself faced with such a delivery. https://www.youtube.com/playlist?list=PLHmYb5bfg4U3RuEO7Jf9mC4rF_0CAHiIZ
  6. After several reports providing reassurance to breastfeeding mothers, two very recent reports are giving me reason to pause. The Canadian Pediatric Society has been recommending breastfeeding if a mother has COVID19 with precautions in place; Breastfeeding when mothers have suspected or proven COVID-19. It would be heresy to suggest that a mother not be permitted to breastfeed her infant but what follows are two reports that at the very least may need to enter the discussion when a COVID19 positive mother gives birth and is deciding about route of feeding. Toronto Case Report The first report was notable not so much for breastmilk but rather that a mother with a chronic immunodeficiency and pneumonia from COVID19 had placental surfaces that tested positive on PCR for COVID19. This was the main focus of the paper Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection. In the same paper though, testing of breastmilk in this mother demonstrated a positive PCR with a semi-quantitative cycle time result (there are 40 cycles of amplification of RNA in PCR testing- the further away from 40 cycles the more likely it is a true positive). The results above were positive at 2 days and negative at 7 days. One could possibly excuse this case as an anomaly since the mother in this case not only was sick but also has chronic neutropenia but then along comes another report. Second Research Report This week a second report emerged that adds to the uncertainty around breastmilk. Detection of SARS-CoV-2 in human breastmilk looks at two mothers one of whom was negative on testing of breastmilk but the other unfortunately tested positive. The authors included the following timeline which is very informative. From the timeline above you will note that in the second case the mother becomes positive at 11 days of age and the infant tests positive around the same time the milk comes back positive. The infant in this case also develops RSV which likely explains the symptoms they developed later in the course. What is concerning to me though is that in this case while the mother was COVID19 positive, she was not acutely ill. When thinking of vertical transmission this has been something that has been postulated in suspecting that those with more severe illness have higher viral loads and therefore may be capable of vertical transmission. Not the case here if the results are to be believed. Adding to the strength of the result are Ct values for SARS­CoV­2 N peaked at 29∙8 and 30∙4 in whole milk and skimmed milk respectively so this seems real. How does this differ than past testing? What intrigues me about this study in particular is that past research on transmission into breastmilk has failed to detect the virus. It could be that previous testing close to delivery was negative and that with time might the virus enter breastmilk? At eleven days I think this may be the latest testing done. In virtually all cases reported about COVID19 positives in newborns the authors have always explained the painstaking steps they took to prevent postnatal infection. I do wonder now if some of these cases may be related to a small percentage of women carrying the virus in their breastmilk. This leaves us in a tough spot. What do we tell women who are thinking of breastfeeding and have COVID19? There will need to be discussion on this but one option is to proceed with feeding accepting there may be a small risk of transmission. A second option would be to test milk but if the transmission occurs late you may miss it in hospital on initial sampling Finally it may be worth pumping and discarding milk until mothers test negative and using donor breastmilk in the meantime (or formula for those who don’t have DBM). Regardless I think this information coming out will need to be digested and centres think about how they will approach this issue. My guess is these will not be the last reports on this.
  7. During Covid-19, I have spent more time researching Adult pulmonary critical care than Neonatal pulmonary critical care. Based on this blog: https://emcrit.org/category/pulmcrit/ I am both fascinated and disgusted by the approach to respiratory support for Covid-19 patients. For those that have been following adult pulmonary critical care: 1. Are you appalled by the PEEP and PiPs? 2. Are you appalled by the FiO2s? 3. Do you feel like this is Neonatology circa 1990? 4. Do you think HFOV and/or NBCPAP are tools that should be applied earlier, not later for Covid-19 patients? 5. Do you have a hypothesis as to why neonates, who are inherently immunocompromised, are not more severely affected? Thank you
  8. Unicef: 6,000 children could die every day due to impact of coronavirus Disruption of essential maternity and health services is the biggest crisis faced by under fives since the second world war, reports The Guardian. The UN warns that up to 6,000 children could die every day from preventable causes over the next six months due to the impact of coronavirus.
  9. 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.
  10. In preparation form potential Covid+ or PUI in the delivery and NICU setting, viral filters are suggested while using self inflated resuscitators, NIV (high flow cannula, NIPPV, bubble CPAP, SiPAP, CPAP), and ventilators. Pediatric Viral filters are on back order and we have only adult viral filters of various specs depending on manufacturer (min 200 ml VT or > 125 ml VT for others). The representatives for Drager have stated that many are using their ventilators at the expiratory limb at the exhalation valve which we can do in the Bunnel Jet ventilator. We are awaiting feedback from Sensormedics for Oscillator. We are going to like going to a tent set up if patient is on High flow, bCPAP and SiPAP unless can of the distinguished colleagues can help in determining if there is another work around or experience with using adult viral filter for the NIV. We are planning on placing respiratory supported patient in negative pressure room with full PPE but if there is limitations in space and if overwhelmed will need to place in regular patient room in isolette (single bed rooms unless overwhelmed will cluster.) The second issue is adaption of neonatal self inflator bags or T-piece resuscitator for adult viral filter and is there any experience adapting this. Thanks for any assistance. Edward Lee, MD Winchester Medical Center, NICU Winchester, VA, USA
  11. Knowing that asymptomatic carriers can spread coronavirus, I have been petitioning our hospital administration for the past 3 weeks that masks be mandatory for caregivers in the NICU anytime they are within 6 feet of a patient, family, or other staff member. Last week they said masks are optional and each staff member would be issued one mask per shift. I strongly recommended that our caregivers wear masks anytime they were within 6 feet of other staff, patients, or their families. 2 days ago I was reprimanded by our administration for strongly recommending masks while at work. My reasoning for wearing masks is primarily to protect staff, patients, and families from asymptomatic carriers. References: https://www.ncbi.nlm.nih.gov/pubmed/7670241 https://www.ncbi.nlm.nih.gov/pubmed/18335238 https://www.ncbi.nlm.nih.gov/pubmed/12009822 How many of your NICUs have implemented mandatory masks when unable to maintain social distancing?
  12. hi.i live in iran,i have two neonate that mothers are suspected covid -19,what s advice for breastfeeding and vaccination?!
  13. Dear all As all of us are preparing ourselves to form potential strategies to mitigate and manage SARS CoV2 positive neonates, we come across various challenges. Our NICU has Sophie ventilators which do not have a expiratory filter. So the potentially infectious aerosols would be released in the NICU environment. We have not been able to devise a way to circumvent that yet. Though thankfully there have been no suspect cases so far in Delhi. But in order to prepare for a possible surge it is essential to look at such issues. Please suggest what is being followed in other units who are currently managing such neonates and suggest the possible solution to the issue that our unit is facing Thank you
  14. Hi all I am looking for protocols for the care of asymptomatic newborns born to mothers with suspected Covid. One question that has come up in my unit is whether an isolette 6 feet away ( that is turned off to avoid air circulation) should be used as an ideal physical barrier to protect the baby from the mother and other caregivers. I did see this recommendation briefly at some site online but unable to find it now! Thanks for your help Mike Mike Sukumar MD Rockville MD USA
  15. I had the pleasure of being asked to speak to a Canadian audience of people working with newborns yesterday about the new CPS practice points for managing deliveries and newborns with suspected or proven COVID-19. Something fascinating happened over the course of the discussion and that was that we are a country divided. It didn’t help that the week prior to the CPS releasing their practice points the American Academy of Pediatrics released the following position: “Precautions for birth attendants: Staff attending a birth when the mother has COVID-19 should use gown and gloves, with either an N95 respiratory mask and eye protection goggles or with an air-purifying respirator that provides eye protection. The protection is needed due to the likelihood of maternal virus aerosols and the potential need to perform newborn resuscitation that can generate aerosols.” I don’t know how the Americans are going to deliver on bringing N95 masks to all deliveries and even acknowledge in their statement that this recommendation essentially holds as long as there are supplies. There are a lot of deliveries in the US and if every one requires all team members to have an N95 respirator (two nurses, RRT, MD) that will burn through supplies quickly! The driver of this division in the country and the AAP I believe is fear butI am not in any way judging anyone for having it in these trying times. I think it is worth looking at what is being proposed for care of the newborn by the CPS and what may be motivating this fear. Who knows it may help someone work through their own feelings on this. What has been recommended? What the CPS recommendations boil down to is this. For attendance at a delivery in which the mother is not intubated or expected to be, providers of care for the newborn should use droplet precautions. Specifically, whether the infant is going to receive PPV, CPAP or be intubated the evidence strongly suggests the newborn is delivered uninfected so an N95 is not needed to protect health care providers. Even if the baby is born vaginally and is exposed to blood and stool, the viral load in the distal tracheobronchial tree will be low to non-existent so aerosolization would not be a concern. If the mother is going to be intubated then an N95 mask should be worn instead of a surgical mask. Outside of the delivery room in the NICU one should use an N95 mask for providing care to any newborns on CPAP or other non-invasive support as well as those who are intubated. It is the last statement that I know has caused some confusion. Why is it that Dr. Narvey is suggesting that in the first 30 minutes of resuscitation we don’t need an N95 but then after the baby is moved to NICU we do? The issue is a pragmatic one. The earliest known case of a positive nasopharyngeal swab is 36 hours. This doesn’t mean of course that the earliest one can get horizontal transmission is 36 hours as this is when the health care providers decided to test. Presumably they were not lucky and timed it right so we have to expect at some point maybe hours or more earlier the baby became infected. As we get busier with more and more COVID suspect mothers there is a risk of people not “watching the clock” and therefore if we had said once 12 hours or 24 hours have elapsed use N95 masks for those on respiratory support we run the risk of someone losing track of time. There are a lot of babies who need PPV at birth though but not all eventually need CPAP so eliminating the need to use N95 masks when the evidence doesn’t support their use is a responsible way of preserving masks that are in short supply for those who truly need them based on true proven risk such as with adults with COVID pneumonia being intubated. Why is there so much fear? I blame the media to a great extent. They latch on to stories such as this one that made its way around twitter and facebook and yet there are no publications of this infant. Likely a positive infant no doubt but I suspect it was not detected minutes after birth. Then there is the case series in Jama Pediatrics that turned the world upside down a few weeks ago. I don’t know about you but my inbox was peppered with this paper from all over Canada and beyond. Looking at the paper in detail including the images is informative as what was initially touted as evidence of vertical transmission on closer inspection I think is far from it. Three out of thirty three infants tested positive on an NPA at 48 hours of age with a claim that all three had pneumonia. The authors included two x-rays for the two 40 week infants and a CT scan of the chest for the 31 week infant. Take a look at these films. I am not a radiologist but I suspect we would have reported these films as normal. The CT scan of the chest is in a 31 week infant who had RDS and enterobacter sepsis. How would one differentiate RDS, enterobacter pneumonia or COVID19? It may be possible these three babies indeed were inoculated in the first day or two with COVID19 but I am not so sure they really had disease. If you agree with my argument here then we have multiple case series demonstrating no vertical transmission and this one case series indicating possible horizontal transmission. Why then are we hearing about care providers bring N95 masks to deliveries just in case CPAP is needed? Fear is a great motivator It likely comes down to the “what if” argument. What if everyone is wrong and babies can be born with COVID19? If we had an unlimited supply of N95 masks then my answer to everyone would be “if it makes you feel better then go for it and use away”. My argument for not using them at birth is twofold. Firstly, the evidence so far is that this is not a risk and secondly we don’t have an unlimited supply of N95 masks. This creates an issue for society as a whole that if we are guided by our fear we may deprive those who truly need this resource for evidence supported high risk procedures. I believe we all have a duty to provide the best care possible and working within a system with a finite amount of resources we need to really consider what happens if we let fear override what we know from evidence. Having said all that (and this is not a cop out but reality), we are all fatigued and probably not at our best at the moment. We are fearful for our own heath and not just physicial but mental as well. I read this morning that suicide rates in the US are up 35% this year and extrapolating I would imagine that rates of depression and anxiety have gone up with it. These infants we care for deserve us to be at our very best. If fear of contracting COVID19 has reached a level for an individual that it may interfere with their ability to provide the proper steps of NRP if not wearing their “armor” in the form of an N95 mask this needs to be considered. I am not a psychiatrist nor am I pretending to be one but our mental state has a great impact on performance. I am not endorsing the use of N95 masks for everyone but I am suggesting that during this time we all take a moment and do a check in with yourself. Are you focused, are you able to think with a clear head when needed? We need to be at our best and for me I am confident that I can care for a newborn with a regular mask but I ask you since you know yourself to be truthful with yourself so we can provide the best care possible. Please everyone stay safe!
  16. I just got this email from Dr's Meg Kirkley, Clyde Wright and @GauthamSuresh in the US - they are aggregating Neonatal Covid-19 literature to a spreadsheet. A fantastic initiative! Find the continuously updated spreadsheet here: https://docs.google.com/spreadsheets/d/1L9tsrLn9a7LMql_nnUfMA3uS1SSurrj4XUh2yT2bEUc/edit#gid=1867332198 Please find the full email below. Big thanks to Meg, Clyde and @GauthamSuresh for this iniative! _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ We have a resource to share!!! Meg Kirkley (Assistant Professor here in Colorado) and I have been developing a platform to help our Section stay familiar with the rapidly emerging evidence surrounding COVID-19 With that in mind, we created NeoCLEAR: Neonatal COVID-19 Literature Evaluated and Aggregated in Real-time Topic champions within the section are committing to staying abreast in the following areas, to serve as a resource for you: Transmission (with a focus on vertical / perinatal / neonatal transmission): Rob Dietz and Susan Niermeyer Clinical Features of Neonatal Infection: Clyde Wright & Meg Kirkley Diagnosis and Treatment: Laurie Sherlock & Steph Bourque NICU-specific practices and policies: Steph Chassen & Sadie Houin Consensus Statements (reviews & guidelines from medical governing bodies): Erica Mandell & Susan Hwang The Topic Champions are continually updating this spreadsheet which can be sorted by topic, publication date, and publication type. Hyperlinks are provided and the workgroup has provided a brief “key points” column. Gautham has worked hard to include the NeoCLEAR spreadsheet on the perinatalcovid19.org site and it can be found here: https://perinatalcovid19.org/neoclear/ We will do our best to keep it updated and our searches robust! Thank you - Meg and Clyde and Gautham
  17. This document has been drafted by Dr Riccardo Davanzo, Chair of the Technical Panel on Breastfeeding (TAS) of the Ministry of Health (MOH), and Prof. Fabio Mosca, President of the Italian Society of Neonatology (SIN), with the collaboration of Dr Guido Moro, President of AIBLUD (Human Milk Banking Association of Italy), Dr Fabrizio Sandri, Secretary of SIN and Prof. Massimo Agosti, President of the SIN Breastfeeding Commission. https://www.uenps.eu/2020/03/16/sars-cov-2-infection-sin-recommendations-endorsed-by-uenps/?utm_source=Social&utm_medium=Post&utm_campaign=UENPS_Congress_Awareness&fbclid=IwAR125OOwyNmMpZjY30YXo23GEISvYUFoTu6RMlWYBhjDcISIWRo3EoBMTUU 14marzo.SIN_UENPS0.pdf
  18. Quick question- what are the rules right now in your NICU? Are the parents (asymptomatic) still allowed to visit/stay with their baby during the hospitalization in the unit? Share your thoughts and practices!
  19. Dear all, I want to share a website that I have created - www.perinatalcovid19.org Please share widely. It has resources to help all of us manage the covid-19 situation we are all facing. I am open to suggestions on how to make it more useful. K.S. Gautham, MD, DM, MS, FAAP Professor of Pediatrics, Baylor College of Medicine Section Head and Service Chief of Neonatology Texas Children's Hospital 6621 Fannin, Suite W6104 Houston, TX 77030
  20. As the world deals with the Covid-19 pandemic, clinicians caring for newborn babies are all scrambling to come up with guidelines to handle babies who are at risk of or confirmed to have Covid-19 infection. We are also trying to personally stay healthy and avoid catching the infection. By sharing our resources and ideas we can make more progress than working individually. This free repository of information is offered as a resource for you and your clinical team. Please share any useful documents you might have.
  21. 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
  22. This week on social media this seemed to be a hot topic. What should we do to protect ourselves as we start to see more mothers infected or at least suspected of having COVID-19 presenting in labour. Should we be assuming all of these infants are infected and if so should we all don personal protective equipment (PPE) including the N95 mask? Let’s see what we know so far. The Media The big concern with this began after a report of a 36 hour old newborn in China contracting the virus. This was published in Clinical Infectious Diseases in the paper A case report of neonatal COVID-19 infection in China. As the authors point out in this paper it is difficult to determine if the baby was born with the infection or was seeded with virus at birth and then tested positive at that point. This story made the news and sparked a lot of questions about whether newborns could be infected. The latest story to hit the news though is more worrisome as it leaves little to the question of when the infant was infected. Newborn baby tests positive for coronavirus in London from the Guardian as well as other sources publicized that a newborn who was swabbed within minutes of birth tested positive. This is enough to strike fear in just about everyone but there are questions that need to be answered before panic can set in. There really are little if any details about this patient. Were they symptomatic or was a nasopharyngeal swab positive for the virus alone? While it is tempting to link the infected newborn with transmission from amniotic fluid, there are other sources of virus such as blood and stool that can be present at delivery from the mother than could have yielded the positive result. What does the evidence say about amniotic fluid Bear in mind the data is sparse but here is what we know about amniotic fluid thus far. In a recent paper in the Lancet entitled Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. some good information was found. It is important to note that all of the infants were born via c-section so the issue of potential contamination by stool or blood was greatly reduced. All of these women had their amniotic fluid sampled and all nine tested negative for the virus. Yes I realize nine samples does not totally guarantee that virus cannot be transmitted into amniotic fluid but it is certainly reassuring as they were pure samples. Also notable was that none of the babies in the study presented with any symptoms of respiratory distress. Additionally another recent paper Infants Born to Mothers With a New Coronavirus (COVID-19) in Frontiers of Pediatrics demonstrated no neonatal infections in the three infants whose parents consented to testing for COVID-19. Presumably their amniotic fluid was free of virus as well. If you look at the total number of known cases to this point in the world summarized below we know there have been now 30 infants tested in total aside from the two cases above that have been negative. Things for the most part are looking good on the neonatal front (at least at delivery) Planning for deliveries In the twitter world this week there was much discussion about this issue. To use PPE including an N95 mask or not. I would love to tell you what you should do but that is up to your own institutions and their risk tolerance. While the media can certainly sensationalize things (and these two cases above haven’t helped stop that), the evidence would suggest at this time that these newborns are not born infected for the most part. One of the issues though is sample size for sure. How many pregnant women with COVID-19 have there been to this point? Hard to say especially since not every person can be tested. For the time being though my bet is that these babies are not born viremic but may be contaminated at birth. How long the virus takes to grab hold of the newborn and possibly cause disease is a different story altogether. Once a baby is in an NICU and develops symptoms our approach must be more cautious. We will have to see where this all goes but be careful out there.
×
×
  • Create New...