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Smith LK, van Blankenstein E, Fox G, Seaton SE, Martínez-Jiménez M, Petrou S, Battersby C. Effect of national guidance on survival for babies born at 22 weeks' gestation in England and Wales: population based cohort study. BMJ MEDICINE 2023; 2:e000579. [PMID: 38027415 PMCID: PMC10649719 DOI: 10.1136/bmjmed-2023-000579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023]
Abstract
Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks' gestation in England and Wales. Design Population based cohort study. Setting England and Wales, comprising routine data for births and hospital records. Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021. Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21. Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at <500g weight; 19% to 31% at 22 weeks+0 days to 22 weeks+3 days). Conclusions A change in national guidance to recommend a risk based approach was associated with a threefold increase in 22 weeks' gestation babies receiving survival focused care. The number of babies being admitted to neonatal units and those surviving to discharge increased.
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Affiliation(s)
- Lucy K Smith
- Population Health Sciences, University of Leicester, Leicester, UK
| | - Emily van Blankenstein
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Grenville Fox
- Neonatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sarah E Seaton
- Population Health Sciences, University of Leicester, Leicester, UK
| | - Mario Martínez-Jiménez
- Department of Economics and Public Policy, Centre for Health Economics & Policy Innovation, Imperial College Business School, London, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care and Health Science, Oxford University, Oxford, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Thirugnanasundralingam K, Davies-Tuck M, Rolnik DL, Reddy M, Mol BW, Hodges R, Palmer KR. Effect of telehealth-integrated antenatal care on pregnancy outcomes in Australia: an interrupted time-series analysis. Lancet Digit Health 2023; 5:e798-e811. [PMID: 37890903 DOI: 10.1016/s2589-7500(23)00151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, rapid integration of telehealth into antenatal care occurred to support ongoing maternity care. A programme of this scale had not been previously implemented. We evaluated whether telehealth-integrated antenatal care in an Australian public health system could achieve pregnancy outcomes comparable to those of conventional care to assess its safety and efficacy. METHODS Routinely collected data for individuals who gave birth at Monash Health (Melbourne, VIC, Australia) during a conventional care period (Jan 1, 2018, to March 22, 2020) and telehealth-integrated period (April 20, 2020, to April 25, 2021) were analysed. We included all births that occurred at 20 weeks' gestation or later or with a birthweight of at least 400 g (if duration of gestation was unknown). We excluded multiple births, births for which private antenatal care was received, and births to individuals transferred from other hospitals or who had no antenatal care. Baseline demographics, telehealth uptake, and pregnancy complications (related to pre-eclampsia, fetal growth restriction [FGR], gestational diabetes, stillbirth, neonatal intensive care [NICU] admission, and preterm birth [<37 weeks' gestation]) were compared using comparative statistics and an interrupted time-series analysis. Results were stratified by care stream, with high-risk models consisting of obstetric specialist-led care, and all other streams categorised as low-risk models. The impact of the integrated period on outcomes was also assessed with stratification by parity. FINDINGS 17 873 births occurred in the conventional period and 8131 in the integrated period. Compared with the conventional period, women giving birth during the integrated period were slightly older (30·63 years vs 30·88 years) and had slightly higher BMI (25·52 kg/m2vs 26·14 kg/m2), and more Australian-born women gave birth during the integrated period (37·37% vs 39·79%). There were no significant differences in smoking status or parity between the two groups. 107 (0·08%) of 129 514 antenatal consultations in the conventional period and 34 444 (45·94%) of 74 982 in the integrated period were delivered by telehealth. No significant differences between the conventional and integrated periods were seen in median gestational age at pre-eclampsia diagnosis (low-risk models 37·4 weeks in the conventional period vs 37·1 weeks in the integrated period, difference -0·3 weeks [-0·7 to 0·1]; high-risk models 35·5 weeks vs 36·3 weeks, difference 0·3 weeks [-0·3 to 1·1]), incidence of FGR below the 3rd birthweight percentile (low-risk models 1·62% vs 1·74%, difference 0·12 percentage points [-0·26 to 0·50]; high-risk 4·04% vs 4·13%, difference 0·089 percentage points [-1·08 to 1·26]), and incidence of preterm birth (low-risk models 4·99% vs 5·01%, difference 0·02% [-0·62 to 0·66]; high-risk models 15·76% vs 14·43%, difference -1·33% [-3·42 to 0·77]). Parity did not affect these findings. Interrupted time-series analysis showed a significant reduction in induction of labour for singletons with suspected FGR among women in low-risk models during the integrated period (-0·04% change per week [95% CI -0·07 to -0·01], p=0·0040), and NICU admission declined after telehealth integration (low-risk models -0·02% change per week [-0·03 to -0·003], p=0·018; high-risk models -0·10% change per week, -0·19 to -0·001; p=0·047). No significant differences in stillbirth rates were observed. The proportion of women diagnosed with gestational diabetes was significantly higher in the integrated period compared with the conventional period for both low-risk care models (22·28% vs 25·13%, difference 2·85 percentage points [1·60 to 4·11]) and high-risk care models (28·70% vs 34·02%, difference 5·32 percentage points [2·57 to 8·07]). However overall, when compared with the conventional period, there was no significant difference in proportion of women with gestational diabetes requiring insulin therapy (low-risk models 8·08% vs 7·73%, difference -0·35 percentage points [-1·13 vs 0·44]; high-risk models 14·81% vs 15·71%, difference 0·89 percentage points [-1·23 to 3·02]), or proportion of women with gestational diabetes who gave birth to a baby with macrosomia in the integrated period (low-risk models 3·16% vs 2·33%, difference -0·83 percentage points [-1·77 to 0·12]; high-risk models 5·58% vs 4·81%, difference -0·77 percentage points [-3·06 to 1·52]). INTERPRETATION Telehealth-integrated antenatal care replaced around 46% of in-person consultations without compromising pregnancy outcomes. It might be associated with a reduction in labour induction for suspected FGR, particularly for women in low-risk models, without compromising FGR detection or perinatal morbidity. These findings support the ongoing use of telehealth in providing flexible antenatal care. FUNDING None.
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Affiliation(s)
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Ryan Hodges
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia.
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Quigley MA, Harrison S, Levene I, McLeish J, Buchanan P, Alderdice F. Breastfeeding rates in England during the Covid-19 pandemic and the previous decade: Analysis of national surveys and routine data. PLoS One 2023; 18:e0291907. [PMID: 37819882 PMCID: PMC10566678 DOI: 10.1371/journal.pone.0291907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Few studies have compared breastfeeding rates before and during the pandemic using comparable data across time. We used data from two national maternity surveys (NMS) to compare breastfeeding rates in England before and during the pandemic. METHODS Analysis was conducted using the NMS from 2018 (pre-pandemic; n = 4,509) and 2020 (during the pandemic; n = 4,611). The prevalence of breastfeeding initiation, and 'any' breastfeeding and exclusive breastfeeding (EBF) at 6 weeks and 6 months were compared between these surveys. Data were interpreted in the context of underlying trends in these prevalences from previous NMS (from 2010 and 2014), and annual routine data for England (from 2009-10 to 2020-21). Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the effect of birth during the pandemic (2020 versus 2018) on breastfeeding, with adjustment for sociodemographic and birth-related factors. RESULTS Breastfeeding initiation and any breastfeeding at 6 weeks remained relatively constant in the NMS and the routine data. Birth during the pandemic was associated with a 3 percentage point decrease in EBF at 6 weeks in the NMS (aRR 0.92, 95%CI: 0.87, 0.98 for pandemic versus pre-pandemic), but a smaller decrease in the routine data. Birth during the pandemic was associated with a 3 percentage point increase in any breastfeeding at 6 months in the NMS (aRR 1.05, 95%CI: 1.00, 1.10). Breastfeeding varied across different groups of women in the NMS (i.e. marked inequalities), but the small changes observed between the pandemic and pre-pandemic NMS were broadly similar across the sociodemographic and birth-related factors examined (i.e. no change in inequalities). CONCLUSION Breastfeeding initiation and any breastfeeding at 6 weeks in England were unaffected by the pandemic, and the persistent inequalities in breastfeeding did not widen. Services should aim to reduce these inequalities in breastfeeding which have been documented since the 1970s.
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Affiliation(s)
- Maria A. Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sian Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jenny McLeish
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Phyll Buchanan
- Breastfeeding Supporter, The Breastfeeding Network, Paisley, United Kingdom
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Lau M, Kraus V, Schulze AF, Rausch TK, Krüger M, Göpel W. Observational study on the neonatal outcome during the COVID-19 pandemic in Germany. Acta Paediatr 2023; 112:1892-1897. [PMID: 37306278 DOI: 10.1111/apa.16873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/13/2023]
Abstract
AIM We aimed to determine stillbirth, preterm birth, perinatal complications, and the developmental outcome of children born preterm during the COVID-19 pandemic in Germany. METHODS National data from the perinatal survey of preterm and term infants born in 2017-2020 between 22 March and 31 December were evaluated. Neurodevelopment of preterm infants at 2 years corrected age was tested with the Parent Report of Children's Abilities-Revised questionnaire and by clinical testing with Bayley scales, either before or during the COVID-19 pandemic. Statistical significance was calculated using a Pearson's chi-square-independence test and a linear regression model. RESULTS In 2020, there was an increase of stillbirths of 0.02% (p = 0.01) and a decrease in preterm births by 0.38% (p < 0.001). No changes were found in a representative subgroup of infants with regard to neurodevelopmental scores (mental developmental index and psychomotor developmental index) or in parent survey data (non-verbal cognition scale and language development scale). CONCLUSION Increasing rates of stillbirths and decreasing preterm births in Germany were observed. Existing networks might stabilise neurodevelopment of preterm infants during the COVID-19 pandemic.
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Affiliation(s)
- M Lau
- Department of Paediatrics, University Hospital of Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - V Kraus
- Chair of Social Paediatrics, School of Medicine of the Technical University of Munich, Munich, Germany
- Pediatric Neurology, School of Medicine and Munich Municipal Hospital Group, Technical University of Munich, Munich, Germany
| | | | - T K Rausch
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - M Krüger
- Neonatology, Munich Municipal Hospital Group, Munich, Germany
| | - W Göpel
- Department of Paediatrics, University Hospital of Schleswig-Holstein, University of Lübeck, Lübeck, Germany
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Jegatheesan P, Narasimhan SR, Huang A, Nudelman M, Song D. Higher NICU admissions in infants born at ≥35 weeks gestational age during the COVID-19 pandemic. Front Pediatr 2023; 11:1206036. [PMID: 37484778 PMCID: PMC10360125 DOI: 10.3389/fped.2023.1206036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background Increasing evidence has shown that the COVID-19 pandemic has had a profound negative impact on vulnerable populations and a significant effect on maternal and neonatal health. We observed an increase in the percentage of infants admitted to NICU from 8% to 10% in the first year of the pandemic. This study aimed to compare the delivery room outcomes, NICU admissions and interventions, and neonatal outcomes two years before and during the pandemic. Methods This was a retrospective study in a public hospital between pre-COVID-19 (April 2018-December 2019) and COVID-19 (April 2020-December 2021). Data were obtained from all live births at ≥35 weeks gestation (GA). Maternal and neonatal demographics, delivery room (DR), and NICU neonatal outcomes were compared between the study periods using simple bivariable generalized estimating equations (GEE) regression. Multivariable GEE logistic regression analysis was performed to adjust for the effects of baseline differences in demographics on the outcomes. Results A total of 9,632 infants were born ≥35 weeks gestation during the study period (pre-COVID-19 n = 4,967, COVID-19 n = 4,665). During the COVID-19 period, there was a small but significant decrease in birth weight (33 g); increases in maternal diabetes (3.3%), hypertension (4.1%), and Hispanic ethnicity (4.7%). There was a decrease in infants who received three minutes (78.1% vs. 70.3%, p < 0.001) of delayed cord clamping and increases in the exclusive breastfeeding rate (65.9% vs. 70.1%, p < 0.001), metabolic acidosis (0.7% vs. 1.2%, p = 0.02), NICU admission (5.1% vs. 6.4%, p = 0.009), antibiotic (0.7% vs. 1.7%, p < 0.001), and nasal CPAP (1.2% vs. 1.8%, p = 0.02) use. NICU admissions and nasal CPAP were not significantly increased after adjusting for GA, maternal diabetes, and hypertension; however, other differences remained significant. Maternal hypertension was an independent risk factor for all these outcomes. Conclusion During the COVID-19 pandemic period, we observed a significant increase in maternal morbidities, exclusive breastfeeding, and NICU admissions in infants born at ≥35 weeks gestation. The increase in NICU admission during the COVID-19 pandemic was explained by maternal hypertension, but other adverse neonatal outcomes were only partly explained by maternal hypertension. Socio-economic factors and other social determinants of health need to be further explored to understand the full impact on neonatal outcomes.
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Affiliation(s)
- Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Matthew Nudelman
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States
| | - Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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Goulding A, McQuaid F, Lindsay L, Agrawal U, Auyeung B, Calvert C, Carruthers J, Denny C, Donaghy J, Hillman S, Hopcroft L, Hopkins L, McCowan C, McLaughlin T, Moore E, Ritchie L, Simpson CR, Taylor B, Fenton L, Pollock L, Gale C, Kurinczuk JJ, Robertson C, Sheikh A, Stock S, Wood R. Confirmed SARS-CoV-2 infection in Scottish neonates 2020-2022: a national, population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 108:367-372. [PMID: 36609412 PMCID: PMC10313998 DOI: 10.1136/archdischild-2022-324713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To examine neonates in Scotland aged 0-27 days with SARS-CoV-2 infection confirmed by viral testing; the risk of confirmed neonatal infection by maternal and infant characteristics; and hospital admissions associated with confirmed neonatal infections. DESIGN Population-based cohort study. SETTING AND POPULATION All live births in Scotland, 1 March 2020-31 January 2022. RESULTS There were 141 neonates with confirmed SARS-CoV-2 infection over the study period, giving an overall infection rate of 153 per 100 000 live births (141/92 009, 0.15%). Among infants born to women with confirmed infection around the time of birth, the confirmed neonatal infection rate was 1812 per 100 000 live births (15/828, 1.8%). Two-thirds (92/141, 65.2%) of neonates with confirmed infection had an associated admission to neonatal or (more commonly) paediatric care. Six of these babies (6/92, 6.5%) were admitted to neonatal and/or paediatric intensive care; however, none of these six had COVID-19 recorded as their main diagnosis. There were no neonatal deaths among babies with confirmed infection. IMPLICATIONS AND RELEVANCE Confirmed neonatal SARS-CoV-2 infection was uncommon over the first 23 months of the pandemic in Scotland. Secular trends in the neonatal confirmed infection rate broadly followed those seen in the general population, although at a lower level. Maternal confirmed infection at birth was associated with an increased risk of neonatal confirmed infection. Two-thirds of neonates with confirmed infection had an associated admission to hospital, with resulting implications for the baby, family and services, although their outcomes were generally good. Ascertainment of confirmed infection depends on the extent of testing, and this is likely to have varied over time and between groups: the extent of unconfirmed infection is inevitably unknown.
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Affiliation(s)
| | - Fiona McQuaid
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | | | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Bonnie Auyeung
- School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Sam Hillman
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Hopcroft
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | | | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | | | - Louisa Pollock
- Child Health, University of Glasgow, Glasgow, UK
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
| | | | - Chris Robertson
- Public Health Scotland, Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Stock
- Public Health Scotland, Edinburgh, UK
- Obstetrics and Gynaecology, MRC Centre for Reproductive Health University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Koç E, Dilli D. How does COVID-19 affect maternal and neonatal outcomes? J Perinat Med 2023; 51:277-283. [PMID: 36580338 DOI: 10.1515/jpm-2022-0509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES In this article, we aimed to evaluate the most recent information on the impact of the COVID-19 pandemic on the health of mothers and their babies. METHODS We conducted a literature search by utilizing online sources. Scientific papers that were written in English on the effects of COVID-19 on both mother and their newborn were assessed. RESULTS COVID-19 can be fatal, especially in pregnant women with accompanying chronic diseases. The timing and mode of delivery should be decided by the status of the mother and fetus instead of SARS-CoV-2 positivity in pregnant women. At the nursery, routine separation of SARS-CoV-2 positive mothers and their infants is not recommended. However, it is important to take preventive measures to reduce the risk of transmission. The advantages of breastfeeding seem to outweigh the potential dangers of viral transmission. Neonatal COVID-19 infections may cause different clinical pictures from asymptomatic infections to life-threatening diseases. International health authorities specifically recommend that pregnant and lactating women get vaccinated to diminish the risk of transmission of the virus to the mother and fetus, not giving preference to a certain vaccine. It is prudent to apply universal screening only in populations with a high prevalence of COVID-19. CONCLUSIONS Healthcare professionals should carefully manage the perinatal period during the COVID-19 outbreak, using the most up-to-date information to protect and promote maternal and newborn health. Further scientific studies are needed to clarify the early and long-term effects of the COVID-19 pandemic on maternal-neonatal morbidity and mortality.
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Affiliation(s)
- Esin Koç
- Department of Neonatology, Chief of Neonatology Division, Gazi University, Gazi School of Medicine, Chief of Turkish Neonatal Society, Ankara, Türkiye
| | - Dilek Dilli
- Department of Neonatology, Dr Sami Ulus Maternity and Children Research and Training Hospital, University of Health Sciences of Türkiye, Ankara, Türkiye
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Maalouf FI, Saad T, Zakhour R, Yunis K. Successful establishment and five-year sustainability of a neonatal-specific antimicrobial stewardship program in a low middle-income country. Front Pharmacol 2023; 13:1076392. [PMID: 36686698 PMCID: PMC9848584 DOI: 10.3389/fphar.2022.1076392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction: Antibiotic use varies substantially among neonatal intensive care units (NICUs) without any appreciable impact on outcomes. An increased use of antimicrobials has been reported in low-middle income countries. This raises the concern for potential overuse of antibiotics in a fragile patient population, thus increasing the rates of multidrug resistant organisms and affecting the developing microbiome. The presence of a neonatal-specific antimicrobial stewardship program can aid with the judicious use of antibiotics in the neonatal population and thus decrease the overuse of such medications. Methods: In this quality improvement project, we established and implemented a neonatal-specific antimicrobial stewardship program with the aim of reducing antimicrobial use in the neonatal intensive care units within a year of starting. Several interventions using a multidisciplinary approach included implementing standard algorithms, direct audit and feedback, and automated hard stops. Results: These series of interventions led to a 35% decrease in antimicrobial usage in the first 3 months and further decrease was seen with a median of 63% decline for a total of 5 years after project implementation. The use of the most commonly prescribed antibiotics, ampicillin and gentamicin, decreased by 63% and 79%, respectively. There was no evidence that this change in practice affected or jeopardized patient outcomes. Additionally, it showed sustainability and resilience despite the many challenges such as COVID-19 pandemic, political and financial unrest, and healthcare sector collapse. Discussion: This model-based and multidisciplinary low-cost approach can lead to marked improvement affecting neonatal outcomes and can be replicated in other similar centers.
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Affiliation(s)
- Faouzi I. Maalouf
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Therese Saad
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramia Zakhour
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khalid Yunis
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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The Association of Patent Ductus Arteriosus with Inflammation: A Narrative Review of the Role of Inflammatory Biomarkers and Treatment Strategy in Premature Infants. Int J Mol Sci 2022; 23:ijms232213877. [PMID: 36430355 PMCID: PMC9699120 DOI: 10.3390/ijms232213877] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Patent ductus arteriosus (PDA) is a common cardiovascular complication that complicates clinical care in the intensive care of premature infants. Prenatal and postnatal infections and the inflammation process can contribute to PDA, and intrauterine inflammation is a known risk factor of PDA. A variety of inflammatory biomarkers have been reported to be associated with PDA. Chorioamnionitis induces the fetal inflammatory process via several cytokines that have been reported to be associated with the presence of PDA and may have a role in the vascular remodeling process or vessel dilation of the ductus. On the other hand, anti-inflammatory agents, such as antenatal steroids, decrease PDA incidence and severity in patients born to those with chorioamnionitis. Proinflammatory cytokines, which are expressed more significantly in preterm neonates and chorioamnionitis, are associated with the presence of PDA. In this review, we focus on the pathogenesis of PDA in preterm infants and the role of biomarkers associated with the perinatal inflammatory process.
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Yang J, D'Souza R, Kharrat A, Fell DB, Snelgrove JW, Shah PS. COVID-19 pandemic and population-level pregnancy and neonatal outcomes in general population: A living systematic review and meta-analysis (Update#2: November 20, 2021). Acta Obstet Gynecol Scand 2022; 101:273-292. [PMID: 35088409 DOI: 10.1111/aogs.14318] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 12/30/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Conflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the coronavirus disease 2019 (COVID-19) pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta-analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre-pandemic periods. MATERIAL AND METHODS We searched the PubMed and Embase databases and reference lists of articles published up until November 20, 2021, and included English language studies that compared outcomes between the COVID-19 pandemic time period with pre-pandemic time periods. Risk of bias was assessed using the Newcastle-Ottawa scale. We conducted random-effects meta-analysis using the inverse variance method. RESULTS Fifty-two studies with low-to-moderate risk of bias, reporting on 2 372 521 pregnancies during the pandemic period and 28 518 300 pregnancies during the pre-pandemic period, were included. There was significant reduction in unadjusted estimates of PTB (43 studies, unadjusted odds ratio [uaOR] 0.95, 95% CI 0.93-0.98), but not in adjusted estimates (five studies, adjusted OR [aOR] 0.94, 95% CI 0.74-1.19). This reduction was noted in studies from single centers/health areas (29 studies, uaOR 0.90, 95% CI 0.85-0.94) but not in regional/national studies (14 studies, uaOR 0.99, 95% CI 0.99-1.01). There was reduction in spontaneous PTB (nine studies, uaOR 0.91, 95% CI 0.88-0.94) but not in induced PTB (eight studies, uaOR 0.90, 95% CI 0.79-1.01). There was no difference in the odds of stillbirth between the pandemic and pre-pandemic time periods (32 studies, uaOR 1.07, 95% CI 0.97-1.18 and three studies, aOR 1.18, 95% CI 0.86-1.63). There was an increase in mean birthweight during the pandemic period compared with the pre-pandemic period (nine studies, mean difference 21 g, 95% CI 13-30 g). The odds of maternal mortality were increased (five studies, uaOR 1.15, 95% CI 1.05-1.26); however, only unadjusted estimates were available, and the result was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB. CONCLUSIONS The COVID-19 pandemic may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no statistically significant difference in stillbirths between pandemic and pre-pandemic periods.
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Affiliation(s)
- Jie Yang
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynaecology and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ashraf Kharrat
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - John W Snelgrove
- Department of Obstetrics and Gynaecology and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Gurol-Urganci I, Waite L, Webster K, Jardine J, Carroll F, Dunn G, Frémeaux A, Harris T, Hawdon J, Muller P, van der Meulen J, Khalil A. Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study. PLoS Med 2022; 19:e1003884. [PMID: 35007282 PMCID: PMC8803187 DOI: 10.1371/journal.pmed.1003884] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 01/31/2022] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. This national study aimed to compare obstetric intervention and pregnancy outcome rates in England during the pandemic and corresponding pre-pandemic calendar periods, and to assess whether differences in these rates varied according to ethnic and socioeconomic background. METHODS AND FINDINGS We conducted a national study of singleton births in English National Health Service hospitals. We compared births during the COVID-19 pandemic period (23 March 2020 to 22 February 2021) with births during the corresponding calendar period 1 year earlier. The Hospital Episode Statistics database provided administrative hospital data about maternal characteristics, obstetric inventions (induction of labour, elective or emergency cesarean section, and instrumental birth), and outcomes (stillbirth, preterm birth, small for gestational age [SGA; birthweight < 10th centile], prolonged maternal length of stay (≥3 days), and maternal 42-day readmission). Multi-level logistic regression models were used to compare intervention and outcome rates between the corresponding pre-pandemic and pandemic calendar periods and to test for interactions between pandemic period and ethnic and socioeconomic background. All models were adjusted for maternal characteristics including age, obstetric history, comorbidities, and COVID-19 status at birth. The study included 948,020 singleton births (maternal characteristics: median age 30 years, 41.6% primiparous, 8.3% with gestational diabetes, 2.4% with preeclampsia, and 1.6% with pre-existing diabetes or hypertension); 451,727 births occurred during the defined pandemic period. Maternal characteristics were similar in the pre-pandemic and pandemic periods. Compared to the pre-pandemic period, stillbirth rates remained similar (0.36% pandemic versus 0.37% pre-pandemic, p = 0.16). Preterm birth and SGA birth rates were slightly lower during the pandemic (6.0% versus 6.1% for preterm births, adjusted odds ratio [aOR] 0.96, 95% CI 0.94-0.97; 5.6% versus 5.8% for SGA births, aOR 0.95, 95% CI 0.93-0.96; both p < 0.001). Slightly higher rates of obstetric intervention were observed during the pandemic (40.4% versus 39.1% for induction of labour, aOR 1.04, 95% CI 1.03-1.05; 13.9% versus 12.9% for elective cesarean section, aOR 1.13, 95% CI 1.11-1.14; 18.4% versus 17.0% for emergency cesarean section, aOR 1.07, 95% CI 1.06-1.08; all p < 0.001). Lower rates of prolonged maternal length of stay (16.7% versus 20.2%, aOR 0.77, 95% CI 0.76-0.78, p < 0.001) and maternal readmission (3.0% versus 3.3%, aOR 0.88, 95% CI 0.86-0.90, p < 0.001) were observed during the pandemic period. There was some evidence that differences in the rates of preterm birth, emergency cesarean section, and unassisted vaginal birth varied according to the mother's ethnic background but not according to her socioeconomic background. A key limitation is that multiple comparisons were made, increasing the chance of false-positive results. CONCLUSIONS In this study, we found very small decreases in preterm birth and SGA birth rates and very small increases in induction of labour and elective and emergency cesarean section during the COVID-19 pandemic, with some evidence of a slightly different pattern of results in women from ethnic minority backgrounds. These changes in obstetric intervention rates and pregnancy outcomes may be linked to women's behaviour, environmental exposure, changes in maternity practice, or reduced staffing levels.
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Affiliation(s)
- Ipek Gurol-Urganci
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Lara Waite
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Kirstin Webster
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Jennifer Jardine
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Fran Carroll
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - George Dunn
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Alissa Frémeaux
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Tina Harris
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Jane Hawdon
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Patrick Muller
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, London, United Kingdom.,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom.,Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, United Kingdom
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