Clinical Characteristics of Mother–Infant Dyad and Placental Pathology in COVID-19 Cases in Predominantly African American Population

Objective In this currently evolving coronavirus disease 2019 (COVID-19) pandemic, the evidence is scarce about the impact of COVID-19 infection on women in labor and neonates in an inner city African-Americans (AA) population. The objective of this study was to evaluate the clinical outcomes and placental pathology in mother–infant dyads in COVID-19 cases. Study Design Retrospective chart review was conducted on 34 COVID-19 positive mother–infant dyads to study their baseline characteristics and outcomes. Placental pathology was reviewed by two perinatal pathologists. Results COVID-19 was noted in 3% of pregnant women who delivered in our institution. The majority (82%) of them were asymptomatic. Out of the four mothers who were symptomatic, only three (9%) required supplemental oxygen. None of them required invasive ventilation. All the neonates tested negative for COVID-19 at 24 hours of age. There were no gross or microscopic pathological abnormalities detected that could be definitely associated with any COVID-19 related complications during pregnancy in any of the 34 placentas. Conclusion COVID-19 does not appear to increase morbidity and mortality among pregnant women and their neonates in a predominantly AA population. Our study did not find any evidence of vertical transmission of COVID-19 infection nor any specific findings on placental pathology. Key Points

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Severe and critical COVID-19 in pregnancy: A case series from Montreal

Obstetric Medicine ◽

10.1177/1753495x21990213 ◽

2021 ◽

pp. 1753495X2199021

Author(s):

Marie-Julie Trahan ◽

Isabelle Malhamé ◽

Cristina Mitric ◽

Camille Simard ◽

Jed Lipes ◽

...

Keyword(s):

Pregnant Women ◽

Chart Review ◽

Case Series ◽

Retrospective Chart Review ◽

Supplemental Oxygen ◽

Careful Consideration ◽

Non Invasive ◽

Individualized Approach ◽

Obstetric Management ◽

Supplemental Oxygen Therapy

Background Optimal obstetric management for women with coronavirus disease (COVID-19) is not known. We describe the management of six pregnant women requiring in-hospital care for severe COVID-19. Methods A retrospective chart review was conducted to identify pregnant women who tested positive for Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) between 15 March and 30 June 2020. A subset of women meeting criteria for severe COVID-19 was included. Results Four women required non-invasive supplemental oxygen therapy and two required mechanical ventilation. Four women were discharged from hospital undelivered and two required preterm delivery. One woman had a pulmonary embolism, and two required re-admission for worsening symptoms. Conclusion Management of pregnant women with severe COVID-19 is complex and should involve multidisciplinary expertise. Avoiding early delivery may be a safe option. We recommend an individualized approach to care, including careful consideration of the expected risks and benefits of expectant obstetric management versus delivery.

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The risk of clinical complications and death among pregnant women with COVID-19 in the Cerner COVID-19 cohort: a retrospective analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03772-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fares Qeadan ◽

Nana A. Mensah ◽

Benjamin Tingey ◽

Joseph B. Stanford

Keyword(s):

Pregnant Women ◽

Disease Outbreaks ◽

Hospital Length ◽

Morbidity And Mortality ◽

Hospital Length Of Stay ◽

High Risk Population ◽

Invasive Ventilation ◽

Female Patients ◽

Race Ethnicity ◽

The Impact

Abstract Background Pregnant women are potentially a high-risk population during infectious disease outbreaks such as COVID-19, because of physiologic immune suppression in pregnancy. However, data on the morbidity and mortality of COVID-19 among pregnant women, compared to nonpregnant women, are sparse and inconclusive. We sought to assess the impact of pregnancy on COVID-19 associated morbidity and mortality, with particular attention to the impact of pre-existing comorbidity. Methods We used retrospective data from January through June 2020 on female patients aged 18–44 years old utilizing the Cerner COVID-19 de-identified cohort. We used mixed-effects logistic and exponential regression models to evaluate the risk of hospitalization, maximum hospital length of stay (LOS), moderate ventilation, invasive ventilation, and death for pregnant women while adjusting for age, race/ethnicity, insurance, Elixhauser AHRQ weighted Comorbidity Index, diabetes history, medication, and accounting for clustering of results in similar zip-code regions. Results Out of 22,493 female patients with associated COVID-19, 7.2% (n = 1609) were pregnant. Crude results indicate that pregnant women, compared to non-pregnant women, had higher rates of hospitalization (60.5% vs. 17.0%, P < 0.001), higher mean maximum LOS (0.15 day vs. 0.08 day, P < 0.001) among those who stayed < 1 day, lower mean maximum LOS (2.55 days vs. 3.32 days, P < 0.001) among those who stayed ≥1 day, and higher moderate ventilation use (1.7% vs. 0.7%, P < 0.001) but showed no significant differences in rates of invasive ventilation or death. After adjusting for potentially confounding variables, pregnant women, compared to non-pregnant women, saw higher odds in hospitalization (aOR: 12.26; 95% CI (10.69, 14.06)), moderate ventilation (aOR: 2.35; 95% CI (1.48, 3.74)), higher maximum LOS among those who stayed < 1 day, and lower maximum LOS among those who stayed ≥1 day. No significant associations were found with invasive ventilation or death. For moderate ventilation, differences were seen among age and race/ethnicity groups. Conclusions Among women with COVID-19 disease, pregnancy confers substantial additional risk of morbidity, but no difference in mortality. Knowing these variabilities in the risk is essential to inform decision-makers and guide clinical recommendations for the management of COVID-19 in pregnant women.

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Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽

10.1161/str.52.suppl_1.p305 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Emma M Loebel ◽

Mary Rojas ◽

Connor Mensching ◽

Danielle Wheelwright ◽

Laura K Stein

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Mount Sinai Hospital ◽

Index Admission ◽

Negative Consequences ◽

Medical Comorbidities ◽

Post Stroke ◽

Increased Risk ◽

Adjusted Model ◽

The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

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The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

Australasian Journal of Paramedicine ◽

10.33151/ajp.12.1.8 ◽

2015 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Aaron Burnett ◽

Dolly Panchal ◽

Bjorn Peterson ◽

Eric Ernest ◽

Kent Griffith ◽

...

Keyword(s):

Emergency Medical Services ◽

Chart Review ◽

Retrospective Chart Review ◽

T Test ◽

Medical Services ◽

Demographic Differences ◽

Chemical Restraint ◽

Emergency Medical ◽

Clinically Significant ◽

The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints. Haloperidol is employed for chemical restraint in many EMS services. Recently, ketamine has been introduced as an alternate option for prehospital sedation. On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review. On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups. On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.

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Low-Dose Aminophylline for the Treatment of Neonatal Non-Oliguric Renal Failure—Case Series and Review of the Literature

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-13.2.80 ◽

2008 ◽

Vol 13 (2) ◽

pp. 80-87

Author(s):

Bethany A. Lynch ◽

Peter Gal ◽

J. Laurence Ransom ◽

Rita Q. Carlos ◽

Mary Ann V.T. Dimaguila ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Chart Review ◽

Low Dose ◽

Case Series ◽

Retrospective Chart Review ◽

Review Of The Literature ◽

Oliguric Renal Failure ◽

The Impact

OBJECTIVE Aminophylline is a methylxanthine with multiple physiologic actions. At low doses, aminophylline can antagonize adenosine and improve renal function via increased glomerular filtration rate. Despite its clinical use, little data exists in neonates for this indication. Therefore, the objective of this report is to describe the impact of aminophylline on renal function indices in a series of neonates with acute renal failure. MATERIALS AND METHODS This was a retrospective chart review of 13 neonates with acute renal failure who received aminophylline during a 15-month study period. Aminophylline was administered at 1 mg/kg intravenously or orally every twelve hours. Forty-six percent (n = 6) of the patients received a 5 mg/kg loading dose before initiation of maintenance therapy. Most patients had already received other treatments for renal failure, including diuretics and dopamine. RESULTS Resolution of acute renal failure (with normalization of serum creatinine and blood urea nitrogen) was documented in 10 patients (77%). Four of the thirteen patients died from complications due to their prematurity. Failure of low-dose aminophylline was observed in 3 of the 4 patients who died. CONCLUSIONS Low-dose aminophylline in neonates with acute renal failure is associated with an improvement in renal function indices.

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Retrospective Chart Review of Cryopreserved Amniotic Membrane for Knee Pain

Journal of Regenerative Biology and Medicine ◽

10.37191/mapsci-2582-385x-2(6)-047 ◽

2020 ◽

Author(s):

Ruben Berrocal Timmons

Keyword(s):

Quality Of Life ◽

Adverse Events ◽

Amniotic Membrane ◽

Chart Review ◽

Retrospective Chart Review ◽

Final Analysis ◽

Mean Values ◽

Number Of Patients ◽

The Impact

Objective: Treatment of joint pain with an injection of the amniotic membrane has not been adequately studied. This study retrospectively reviewed Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analgesic usage data from patients treated with the injection of cryopreserved amniotic membrane (CAM) in their knees to determine the impact of treatment on patients’ pain, quality of life, and analgesic usage. Methods: Chart review was conducted on 40 patients. Institutional Review Board (IRB) approval was obtained prior to initiation of the project. The membrane was utilized as per the FDA guidance of 21CFR1271. Retrospective data, including demographics, medical history, pain score, quality of life score, analgesic usage and adverse events, were collected from their medical records for each consenting patient through 6 months after CAM injection. Results: A total of 40 patients were considered in the final analysis. Mean VAS for pain level improved from 7.0 to 2.6 (p<0.001). WOMAC daily activity function score improved from a mean score of 52 to 28 (p<0.001). Opioid and non-steroidal anti-inflammatory drug (NSAID) usage decreased from 97% to 25% (p<0.001). No adverse events were reported. Conclusion: Mean values for VAS and WOMAC scores significantly improved at all time points and the number of patients who used analgesics decreased as compared to baseline. CAM injection into painful knee joints decreases pain, improves physical function, and decreases the use of analgesics in the absence of adverse events.

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Antibody Testing of Infants Born to Asymptomatic COVID-19 Positive Mothers

Neonatology Today ◽

10.51362/neonatology.today/202110161037 ◽

2021 ◽

Vol 16 (10) ◽

pp. 3-7

Author(s):

Tonya Robinson ◽

Nicole Pozzi ◽

Saeed Jortani

Keyword(s):

Pregnant Women ◽

Chart Review ◽

Retrospective Chart Review ◽

Igg Antibodies ◽

Rt Pcr ◽

Antibody Testing ◽

University Of Louisville ◽

Specific Igg ◽

Negative Conclusion ◽

Future Management

Awareness of SARS-COV-2 IgG may contribute to the management of asymptomatic RT PCR COVID-19 positive pregnant women, their newborns, and future vaccination practices. Objective: Characterize COVID testing results of asymptomatic COVID-19 positive pregnant women and their infants. Our assumption/hypothesis maintained that all infants born to asymptomatic COVID-19 positive mothers would have detectable SARS-CoV-2 specific IgG. Study Design: Retrospective chart review. Clinical demographics/COVID-19 testing of maternal/infant dyads were reviewed/collected for reporting purposes. Setting: Center for Women and Infants (CWI), University of Louisville Hospital, Louisville, KY Participants: Asymptomatic COVID-19 positive pregnant women/infant dyads admitted to the CWI between June 2020 to February 2021. Results: 36 COVID-19 positive asymptomatic mother/37 infant dyads (one set of twins) reviewed. 38% of the mother/infant dyads were positive for SARS-CoV-2 IgG, while 27% of mother/infant dyads were negative for IgG. A COVID-19 positive mother of twins was IgG negative, but both twins were positive. Two mothers in this study group had developed significant COVID-19 disease at 28w4d gestation and 34w0d gestation. Both required intensive care but recovered, and their pregnancies were maintained until 37w4d and 39w3d gestation, respectively. By the time of delivery, both mothers had negative COVID-19 RT PCR testing, but both infants were positive for SARS-CoV-2 IgG antibodies. COVID-19 RT PCR testing on both of these infants at 24 and 48 hours of age was negative. Conclusion: SARS-CoV-2 IgG is passively transferred to the infant during pregnancy of asymptomatic positive COVID-19 mothers however appears variable and/or possibly based on the ability of IgG detection with current testing. Further investigation of the immune system’s response to the SARS-CoV-2 virus during pregnancy can direct future management/treatment during pregnancy, especially in the wake of vaccination for the virus during pregnancy and emerging variants.

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Abstract WMP89: Stroke Code De-escalation: Safety and Outcomes

Stroke ◽

10.1161/str.48.suppl_1.wmp89 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jessica Jarnot ◽

Christopher Streib ◽

Angela Heyer ◽

Amy Reichert ◽

David Anderson ◽

...

Keyword(s):

Chart Review ◽

Healthcare Providers ◽

Retrospective Chart Review ◽

Before And After ◽

Chi Squared ◽

Cost Implications ◽

The Impact ◽

Timely Treatment ◽

Iv Tpa ◽

Missed Opportunity

Introduction: “Stroke codes” (SCs) facilitate the timely treatment of acute ischemic stroke (AIS) with IV tPA or intra-arterial thrombectomy (IAT), but are inherently resource-intensive and can expose patients to unnecessary and potentially harmful interventions. While all healthcare providers are encouraged to activate SCs, this might lead to low SC-to-treatment-ratios (SCTR). We examined the impact of de-escalation of stroke codes (DSCs) on SCTR. Methods: DSCs were initiated in our institution in January 2015. All DSCs were reviewed for the patient’s eligibility for IV tPA or IAT, and reason for de-escalation. We reviewed all stroke codes 12 months before and after the initiation of this process and compared the SCTR by chi-squared testing. Results: In 2014, prior to DSCs, 253 SCs resulted in 22 AIS interventions (22 IV tPA) for a SCTR of 8.7%. In 2015, 348 SCs were activated with 64 subsequent DSCs (18.4%) and 45 AIS interventions (38 IV tPA, 7 IAT, 7 both), for a SCTR of 15.8%. The improvement in SCTR after introducing DSCs was statistically significant (p=0.012). When restricting the analysis to IV tPA interventions alone, there remained a trend (p=0.068) towards improvement in SCTR. Retrospective chart review did not reveal any DSC cases that resulted in missed opportunity for IV TPA or IAT treatment. No DSCs were due to an acute ICH. Justifications for de-escalations are summarized in figure 1. Conclusions: The introduction of DSCs resulted in a statistically significant absolute improvement in SCTR of 7.1%. Importantly, DSCs did not result in any eligible AIS patient forgoing IV tPA or IAT, nor missed ICH. More research is needed to increase the yield of stroke codes, refine the criteria for both activating and de-escalating them, and quantify the resource and cost implications of such de-escalations.

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2532. Identifying Educational Needs and Improving Provider Knowledge Regarding the Management of Febrile Neutropenia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2210 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S880-S880

Author(s):

Amy Chang ◽

Stan Deresinski ◽

Aruna Subramanian ◽

Bruno Medeiros ◽

Emily Mui, PharmD ◽

...

Keyword(s):

Medical Students ◽

Febrile Neutropenia ◽

Chart Review ◽

Retrospective Chart Review ◽

Empiric Therapy ◽

Myelogenous Leukemia ◽

Front Line ◽

National Guidelines ◽

Gram Positive ◽

The Impact

Abstract Background In a retrospective chart review of 211 first episodes of febrile neutropenia (FN) in in-patients with acute myelogenous leukemia evaluating rates of appropriate vs. inappropriate management, we identified frequent noncompliance with national guidelines for the management of FN. We utilized these data to develop an educational intervention targeting front-line providers. Methods Based on findings from our chart review, we developed and implemented an interactive, case-based didactic session for advanced practice providers (APPs) and medical students/residents rotating on hematology, targeting inappropriate antibiotic use. Pretest questions were embedded into the lecture, preceding content related to each learning objective. Lecture material included content from national guidelines, literature addressing misconceptions (e.g., vancomycin usage for persistent fever), and data from our institutional antibiogram (Figure 1). A post-test was given directly after the lecture to evaluate knowledge gained. Results Five inappropriate behaviors were identified (Figure 2): (1) changing empiric therapy despite clinical stability, (2) misunderstanding piperacillin/tazobactam’s spectrum of activity, (3) inappropriate initiation of antibiotics active against resistant Gram-positive organisms; (4) failure to de-escalate therapy at 72 hours and (5) failure to add Gram-positive coverage when using aztreonam. Lectures were provided to 13 APPs and 17 medical students/residents over 6 sessions. An improvement in knowledge was noted for most learning objectives except for the third, for which misconceptions remained, especially regarding need for vancomycin in the setting of mucositis (Figures 3 and 4). Higher baseline knowledge was noted for medical students/residents than APPs. 93% of learners rated the lecture very/extremely helpful. Learners recommended future content focus on antifungal therapy. Conclusion We utilized local practice data to develop educational content for front-line providers. We will convert this lecture into a video-format to be incorporated into hematology rotations to reinforce key concepts. A prospective cohort study to evaluate the impact on prescribing behavior is underway. Disclosures All authors: No reported disclosures.

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Delivering Telerehabilitation to COVID-19 Inpatients:A Retrospective Chart Review Suggests It Is a Viable Option

HSS Journal ® ◽

10.1007/s11420-020-09774-4 ◽

2020 ◽

Vol 16 (S1) ◽

pp. 64-70

Author(s):

Kelsey Rosen ◽

Monika Patel ◽

Cecelia Lawrence ◽

Brianne Mooney

Keyword(s):

Physical Therapy ◽

Chart Review ◽

Vital Signs ◽

Retrospective Chart Review ◽

Inpatient Rehabilitation ◽

Supplemental Oxygen ◽

Hospitalized Patients ◽

Home Exercise ◽

Viable Option ◽

Therapeutic Exercises

Abstract Background Guidelines for physical therapy management of patients hospitalized with COVID-19 recommend limiting physical therapists’ contact with patients when possible. Telehealth has been viewed as “electronic personal protective equipment” during the COVID-19 pandemic; although telerehabilitation has been shown to be effective with outpatients, it is unknown whether it is a viable option for hospitalized patients. Purpose Our facility developed an algorithm for the use of a physical therapy telerehabilitation program for inpatients with COVID-19. We sought to investigate the safety and viability of the program. Methods We conducted a retrospective chart review of patients admitted with a diagnosis of COVID-19 who received either telerehabilitation only or a combination of telerehabilitation and in-person rehabilitation. Based on the algorithm, COVID-19 inpatients were selected to receive telerehabilitation if they could ambulate independently, could use technology, had stable vital signs, required minimal supplemental oxygen, and were cognitively intact. We analyzed data of inpatients who received telerehabilitation only, which included patient education, therapeutic exercises, and breathing techniques. Results Of 33 COVID-19 inpatients who received telerehabilitation, in-person rehabilitation, or a combination of the two, 12 patients received telerehabilitation only (age range, 33 to 65 years; all but one male). They demonstrated independence with their individualized home exercise programs in one to two sessions, did not require an in-person rehabilitation consultation, did not require increased oxygen, experienced no exacerbation of symptoms, and were discharged home. Conclusions Inpatient telerehabilitation appears to be a viable option for selected hospitalized patients with COVID-19 and may be a safe way of delivering inpatient rehabilitation to isolated or at-risk populations. At our hospital, the use of inpatient telerehabilitation reduced staff exposure while providing important education and services to patients. To our knowledge, no studies have investigated the use of telerehabilitation for hospitalized patients, including those with COVID-19. Our findings suggest that this innovative approach warrants further study.

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