Management of the newborn baby of a mother with suspected or confirmed Covid-19 positivity

The Sars-CoV-2 pandemic has created concern and uncertainty about the management of the newborn and breastfeeding, particularly if the mother has suspected or known coronavirus positivity. In our neonatology department, a second-level center, separate pathways were defined for Covid-positive (or suspected) and Covid-free patients at the beginning of March 2020; isolation rooms were identified, and indications were given regarding the management of the newborn in the delivery room and within the Neonatal Pathology department, with the aim of preventing the spread of the SARS-Cov-2 infection and encouraging breastfeeding.

Resuscitation of the newborn occurs according to the recommended guidelines, taking care to quickly clean the newborn of the mother's blood and fluids. At the end of the stabilization of the newborn, four scenarios can occur:

Newborn who does not require intensive care, born of a mother in good condition and with a positive SARS-CoV-2 swab; follows the mother as she is transferred to the maternal ward of the Covid Hospital (superHub Padova).

Newborn born to a suspected mother, who does not require intensive or semi-intensive assistance; can be managed by favoring rooming-in, compatibly with the mother's conditions.

Newborn who needs intensive or semi-intensive care for neonatal reasons, born from a suspected or SARS-CoV2-positive mother; requires STEN - Neonatal Emergency Transport Service, according to the procedure and dedicated routes.

Newborn born to a positive or suspected mother, who has severe symptoms of respiratory infection or general state impairment; will be separated from the mother and placed in semi-intensive isolation in a dedicated incubator in the neonatal ward.

This paper provides a proposal for the management of the newborn born to a suspected or coronavirus-positive mother, and was formulated to avoid the spread of the infection and to implement neonatal care.

Failure of hearing screening in high-risk neonates does not increase parental anxiety

OBJECTIVE

The aim of this study was to determine whether a failure of neonatal hearing screening affected the anxiety level of parents of high-risk infants.

METHODS

Two hundred and eighty-eight parents of infants included in the neonatal hearing screening protocol of our Institution were tested with the Spielberger State-Trait Anxiety Inventory and with an open-question questionnaire investigating parents' attitude to hearing problems in their child, done at the time of audiological follow-up. 105 were parents of high-risk infants who had been discharged from neonatal intensive care unit (NICU) and 183 of low-risk infants discharged from well-baby nursery.

RESULTS

No differences in anxiety levels were seen between parents of high-risk infants passing and failing neonatal hearing screening using homogeneous case-control pairs. Additionally, no differences in the level of anxiety were found between parents of high- and low-risk infants failing neonatal auditory screening.

CONCLUSIONS

Failure of neonatal auditory screening does not affect the anxiety levels of parents of high-risk infants at post discharge from NICU. This finding is a key factor to be considered when evaluating the costs and benefits of tests for universal neonatal hearing screening.

D-dimer evaluation of hemorrhagic orbital lymphangioma

An 8-year-old boy with recurrent acute bleeding of lymphangioma of the left orbit is described. D-dimer levels increased as the size of the mass became stable, showing the effect of fibrinolysis within the hemorrhagic mass after clotting. D-dimer levels confirmed the possible use of conservative management of this lymphangioma.

Paternal uniparental isodisomy of chromosome 6 causing a complex syndrome including complete IFN-gamma receptor 1 deficiency

Mendelian susceptibility to mycobacterial disease (MSMD) is a rare primary immunodeficiency associated with clinical disease caused by weakly virulent mycobacterial species. Interferon gamma receptor 1 (IFN-gammaR1) deficiency is a genetic etiology of MSMD. We describe the clinical and genetic features of a 7-year-old Italian boy suffering from MSMD associated with a complex phenotype, including neonatal hyperglycemia, neuromuscular disease, and dysmorphic features. The child also developed necrotizing pneumonia caused by Rhodococcus equi. The child is homozygous for a nonsense mutation in exon 3 of IFNGR1 as a result of paternal uniparental disomy (UPD) of the entire chromosome 6. This is the first reported case of uniparental disomy resulting in a complex phenotype including MSMD.

Reliability of hearing screening in high-risk neonates: Comparative study of otoacoustic emission, automated and conventional auditory brainstem response

OBJECTIVE

To compare the diagnostic reliability of automated transient evoked otoacoustic emissions (a-TEOAE), automated auditory brainstem response (a-ABR) and conventional brainstem auditory evoked potential (BAEP/ABR) for identification of hearing loss in high-risk neonates.

METHODS

Two hundred and six neonatal intensive care unit (NICU) admitted neonates were tested pre-discharge. Follow-up included a-TEOAE in all children, repetition of a-ABR or BAEP if failed in NICU. Sensitivity and specificity were compared and correlated with auditory risk factors.

RESULTS

BAEP had the highest sensitivity (100%) and specificity (90.8%), a-ABR the lowest (88.9% and 70.6%). A statistically significant difference in risk factors for temporary hearing loss was observed between normal and false positive a-TEOAE and BAEP, but not a-ABR outcome. Differences in specificity between a-ABR and a-TEOAE explain the pattern of "absent a-ABR/present a-TEOAE" in 13.8% of ears.

CONCLUSIONS

The BAEP appears the more reliable test for hearing screening of high-risk neonates because of highest sensitivity and specificity and should be used to confirm the diagnosis of "auditory neuropathy" in high-risk neonates. The reliability of a-ABR devices in critically ill neonates needs further investigation.

SIGNIFICANCE

This is, to our knowledge, the first attempt to compare the diagnostic reliability of a-TEOAE, a-ABR and BAEP in high-risk neonates.