Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals

2021 ◽  
Author(s):  
Jayme L. Congdon ◽  
Laura R. Kair ◽  
Valerie J. Flaherman ◽  
Kelly E. Wood ◽  
Mary Ann LoFrumento ◽  
...  
Keyword(s):  
Clinical Management ◽  
Neonatal Intensive Care ◽  
Clinical Care ◽  
Case Series ◽  
Neonatal Outcomes ◽  
Term Neonates ◽  
Key Points ◽  
Inpatient Management ◽  
Novel Coronavirus

Objective There is a paucity of evidence to guide the clinical care of late preterm and term neonates born to women with perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The objective of this case series is to describe early neonatal outcomes and inpatient management in U.S. hospitals. Study Design We solicited cases of mother–infant dyads affected by novel coronavirus disease 2019 (COVID-19) from the Better Outcomes through Research for Newborns (BORN) Network members. Using a structured case template, participating sites contributed deidentified, retrospective birth hospitalization data for neonates ≥35 weeks of gestation at birth with mothers who tested positive for SARS-CoV-2 before delivery. We describe demographic and clinical characteristics, clinical management, and neonatal outcomes. Results Sixteen U.S. hospitals contributed 70 cases. Birth hospitalizations were uncomplicated for 66 (94%) neonates in which 4 (6%) required admission to a neonatal intensive care unit. None required evaluation or treatment for infection, and all who were tested for SARS-CoV-2 were negative (n = 57). Half of the dyads were colocated (n = 34) and 40% directly breastfed (n = 28). Outpatient follow-up data were available for 13 neonates, all of whom remained asymptomatic. Conclusion In this multisite case series of 70 neonates born to women with SARS-CoV-2 infection, clinical outcomes were overall good, and there were no documented neonatal SARS-CoV-2 infections. Clinical management was largely inconsistent with contemporaneous U.S. COVID-19 guidelines for nursery care, suggesting concerns about the acceptability and feasibility of those recommendations. Longitudinal studies are urgently needed to assess the benefits and harms of current practices to inform evidence-based clinical care and aid shared decision-making. Key Points

scholarly journals Overgrowth syndrome in neonates: a rare case series with a review of the literature

2019 ◽  
Vol 12 (1) ◽  
pp. e225640
Author(s):  
Aakash Pandita ◽  
Astha Panghal ◽  
Girish Gupta ◽  
Kirti M Naranje
Keyword(s):  
Lower Limb ◽  
Rare Case ◽  
Case Series ◽  
Port Wine Stain ◽  
Port Wine ◽  
Review Of The Literature ◽  
Term Neonates ◽  
Overgrowth Syndrome ◽  
Klippel Trenaunay Syndrome

We present here two-term neonates presenting with right lower limb hypertrophy, a port-wine stain, acral abnormalities and clubfeet. These neonates had overlapping features of Klippel Trenaunay syndrome and congenital lipomatous overgrowth, vascular malformation, epidermal nevi and scoliosis/skeletal abnormalities. Such overgrowth syndrome has not been previously described in the literature. Both the neonates are doing well and are under regular follow-up.

Thromboelastographic profiles of healthy very low birthweight infants serially during their first month

2019 ◽  
Vol 105 (4) ◽  
pp. 412-418 ◽  
Author(s):  
Genny Raffaeli ◽  
Armando Tripodi ◽  
Giacomo Cavallaro ◽  
Valeria Cortesi ◽  
Erica Scalambrino ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Maximum Amplitude ◽  
Very Low Birthweight ◽  
Term Infants ◽  
Term Neonates ◽  
Outcomes Measures ◽  
Very Low Birthweight Infants ◽  
Α Angle

ObjectiveWe determined thromboelastographic (TEG) profiles of healthy very low birthweight infants (VLBWIs) of the day of birth and at set intervals during their first month.DesignProspective observational study with blinded clinical and laboratory follow-up.SettingLevel III neonatal intensive care unit (June 2015 to June 2018).PatientsConsecutive qualifying VLBWIs were enrolled at birth and followed up for 30 days.Interventions and main outcomes measuresLaboratory (citrated-native TEG, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, blood count) and clinical variables were retrieved at birth, 3rd–5th, 10th and 30th day of life. Blood samples temporally related to events with a potential hemostatic impact (sepsis, bleeding, platelets/plasma transfusions, ibuprofen/indomethacin administration) were excluded from analysis.ResultsWe enrolled 201 VLBWIs and 72 full-term neonates. Sixty-seven of the healthy VLBWIs completed the 30-day follow-up. 541 TEG traces were analysed.On day 1, the median (minimum–maximum) TEG values were as follows: reaction time (R), 8.2 min (1–21.8); kinetics (K), 2.8 min (0.8–16); α angle, 51° (14.2–80.6); maximum amplitude (MA), 54.9 mm (23.9–76.8). PT and APTT were 15.9 s (11.7–51.2) and 59 s (37.8–97.5), respectively. The above parameters suggest minor hypocoagulability compared with term infants. On day 30, the median (minimum–maximum) R was 5 (1–16.9), K 1 (0.8–4.1), α 74.7 (41.1–86.7) and MA 70.2 (35.8–79.7). PT and APTT were 12.1 (10.4–16.6) and 38.8 (29.6–51.4), respectively. Those parameters are consistent with a relatively hypercoagulable phenotype, compared with term infants.ConclusionsHealthy VLBWIs have a prolonged PT and APTT, but their TEG profiles suggest a relatively balanced hemostatic system, with slight hypocoagulability initially (compared with term neonates), gradually evolving to a somewhat more procoagulant phenotype over the first month.

scholarly journals Lessons from the "non-critical" patient during a pandemic: developmental-behavioural pediatric populations & COVID-19

2022 ◽  
Vol 9 (1) ◽  
pp. 23-24
Author(s):  
Shuvo Ghosh ◽  
Andreea Gorgos
Keyword(s):  
Clinical Care ◽  
Acute Health Care ◽  
Life Threatening ◽  
Pediatric Populations ◽  
One Year ◽  
Novel Coronavirus ◽  
The Waves ◽  
Short Narrative ◽  
Acute Crisis

Seemingly overnight, in March 2020, the world was turned upside down by the global SARS-CoV 2 (novel coronavirus) pandemic. As COVID-19 affected all aspects of clinical care, Canadian ambulatory clinics for any service deemed "non-urgent" or "non-critical," were suspended for several months. When outpatient care slowly resumed during the summer and fall of 2020, the backlog of patients in these areas and subsequent requests for follow-up significantly outpaced the number of available appointments. In fact, it became apparent that certain patients' needs had grown in unprecedented ways during the pandemic, even though their issues had previously been given low priority during the acute crisis period. Among these groups were youth with underlying mental health conditions, those with chronic but non-life-threatening illnesses, and the subgroups seen in Developmental-Behavioural Pediatrics. In Montréal, they were among the least likely to have their needs met as the waves of COVID-19 moved through the community, and many still struggle to find relevancy in the discussions about the hidden impacts of the coronavirus pandemic, even one year later. What can the experiences of these marginalised youth teach us about what our system labels less relevant care in the context of an acute health care crisis? A short narrative presentation will demonstrate insights gleaned from 2020 & early 2021 to underscore the often unrecognised challenges faced by these populations and their families.

Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus

2021 ◽  
Author(s):  
Susan Cohen ◽  
Ulrike Mietzsch ◽  
Carl Coghill ◽  
Narendra Dereddy ◽  
Katerina Ducis ◽  
...  
Keyword(s):  
At Risk ◽  
Neonatal Intensive Care ◽  
Clinical Care ◽  
Practice Variation ◽  
Neonatal Intensive Care Units ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Posthemorrhagic Hydrocephalus ◽  
Standard Guideline ◽  
Key Points

Objective This study aimed to determine clinical care practices for infants at risk for posthemorrhagic hydrocephalus (PHH) across level IV neonatal intensive care units (NICUs). Study Design Cross-sectional survey that addressed center-specific surveillance, neurosurgical intervention, and follow-up practices within the Children's Hospitals Neonatal Consortium. Results We had a 59% (20/34 sites) response rate, with 10 sites having at least two participants. Respondents included neonatologists (53%) and neurosurgeons (35%). Most participants stated having a standard guideline for PHH (79%). Despite this, 42% of respondents perceive inconsistencies in management. Eight same-center pairs of neonatologists and neurosurgeons were used to determine response agreement. Half of these pairs disagreed on nearly all aspects of care. The greatest agreement pertained to a willingness to adopt a consensus-based protocol. Conclusion Practice variation in the management of infants at risk of PHH in level IV NICUs exists despite the perception that a common practice is available and used. Key Points

Immediate Postnatal Microbial Colonization in Sick Term Neonates Admitted to NICU: Prevalence, Microbiota, and Associated Characteristics

2021 ◽  
Author(s):  
Rita P. Verma ◽  
Archana Kota ◽  
Joshua Fogel
Keyword(s):  
Neonatal Intensive Care ◽  
Group B Streptococcus ◽  
Microbial Colonization ◽  
Respiratory Support ◽  
Term Infants ◽  
Term Neonates ◽  
E Coli ◽  
Single Center Study ◽  
Key Points ◽  
Group B

Objective The immediate postnatal rectal (RC) and nasopharyngeal colonization (NPC), their prevalence, taxa, and associated characteristics were investigated in sick term infants admitted to the neonatal intensive care unit. Study Design In a retrospective cohort single center study, nasopharyngeal (NPCx) and rectal (RCx) microbial cultures were obtained within 20 minutes of birth in mild-to- moderate sick term infants. Associations between the colonization and maternal–neonatal variables, including early neonatal course, were analyzed via logistic regression analysis. Results A total of 154 term infants were admitted for respiratory distress, hypoglycemia, maternal chorioamnionitis (CHO), and suspected neonatal sepsis; out of which, 80 (52%) were NPCx-positive (+) infants. The duration of rupture of membrane (ROM) was higher (15.5 ± 10.0 vs. 11.3 ± 11.0 hours, p = 0.02), while the respiratory support requirement (16.3 vs. 29.7%, p = 0.04) and occurrence of maternal group B Streptococcus (GBS) colonization lower (15.0 vs. 35.1%, p = 0.01) in NPCx+ infants. ROM increased (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01–1.07), and maternal GBS colonization decreased the odds of positive nasopharyngeal cultures (OR: 0.31, 95% CI: 0.14–0.72). The major microorganisms isolated were Staphylococcus epidermidis (41%), α hemolytic Streptococcus (AHS; 16%), Escherichia coli (13%), and GBS (1.06%). Among the enrolled infants, 44 (28.5%) were RCx positive. The need for (11.4 vs. 27.3%, p = 0.03) and days on respiratory support (0.2 ± 0.6 vs. 0.8 ± 2.5, p = 0.03) were lower and the occurrence of CHO higher (41.0 vs. 23.2%, p = 0.04) in the RCx positive infants. Cesarean section (CS) was performed less frequently (18.2 vs. 55.5%, p = 0.001) and decreased the odds of having positive rectal cultures (OR: 0.21, 95% CI: 0.08–0.51). In total, 80% of the RCx positive infants isolated E. coli, and 6.8% Klebsiella. Conclusion In sick term neonates, early NPC is dominated by SE and RC by E. coli. NPC is supported by ROM and declines by maternal GBS colonization, whereas RC decreases with CS. NPC is more common than RC in this population. Key Points

scholarly journals Pediatric Ulcerative Colitis in Kazakhstan: First Case Series from Central Asia and Current Clinical Management

2020 ◽  
Vol 11 (2) ◽  
pp. 27-35
Author(s):  
Dimitri Poddighe ◽  
Aigerim Telman ◽  
Ernas Tuleutayev ◽  
Aigul Ibrayeva
Keyword(s):  
Ulcerative Colitis ◽  
Central Asia ◽  
Clinical Studies ◽  
Clinical Management ◽  
Pediatric Patients ◽  
Clinical Laboratory ◽  
Case Series ◽  
Developed Countries ◽  
One Year

The diagnoses of ulcerative colitis have increased in pediatric patients in the last two decades. Whereas there are several reports from most areas of the world, no clinical studies describing the clinical management of pediatric ulcerative colitis are currently available from Central Asia. In this article, we first describe a case series of pediatric patients affected with ulcerative colitis in Kazakhstan. This is a retrospective study including 25 consecutive pediatric patients diagnosed with ulcerative colitis in a tertiary pediatric hospital. The available demographic, clinical, hematological and inflammatory parameters at diagnosis and at the first one-year follow-up have been provided and analyzed. Most pediatric patients diagnosed with ulcerative colitis were older than 12 years, with prevalence of male gender. The analysis of clinical, laboratory, endoscopic parameters at the diagnosis suggested a significant diagnostic delay compared to developed countries; however, most of them showed clinical, laboratory and endoscopic improvements at the one-year follow-up. Even though the therapeutic approach and outcomes resulted to be consistent with other clinical studies from developed countries, several aspects of the medical follow-up should be improved, especially in pediatric patients with extensive disease.

Clinical management of coronavirus disease 2019 (COVID-19) in pregnancy: recommendations of WAPM-World Association of Perinatal Medicine

2020 ◽  
Vol 48 (9) ◽  
pp. 857-866
Author(s):  
Oluş Api ◽  
Cihat Sen ◽  
Marzena Debska ◽  
Gabriele Saccone ◽  
Francesco D’Antonio ◽  
...  
Keyword(s):  
Clinical Management ◽  
Clinical Care ◽  
Review Literature ◽  
Perinatal Medicine ◽  
World Association ◽  
The World ◽  
New Evidence ◽  
Quality Evidence ◽  
In Pregnancy

AbstractThese guidelines follow the mission of the World Association of Perinatal Medicine, which brings together groups and individuals throughout the world with the goal of improving outcomes of maternal, fetal and neonatal (perinatal) patients. Guidelines for auditing, evaluation, and clinical care in perinatal medicine enable physicians diagnose, treat and follow-up of COVID-19-exposed pregnant women. These guidelines are based on quality evidence in the peer review literature as well as the experience of perinatal expert throughout the world. Physicians are advised to apply these guidelines to the local realities which they face. We plan to update these guidelines as new evidence become available.

scholarly journals COVID-19 in Neonates, A Case Series Study From Tertiary Neonatal Centers in Iran

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Sedigheh Rafiei Tabatabaei ◽  
Minoo Fallahi ◽  
Abbas Boskabadi ◽  
Naeeme Taslimi Taleghani ◽  
Fatemeh Pajouhandeh ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Neonatal Intensive Care ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Clinical Manifestations ◽  
Case Series ◽  
Reactive Protein ◽  
Radiologic Findings ◽  
Case Series Study ◽  
Novel Coronavirus

Introduction: The Novel coronavirus, sars-cov-2, is responsible for the recent pandemic. Although it mostly affects adults, children of all ages, including neonates, can become ill with Covid-19, as well. The real prevalence rate of coronavirus disease 2019 (COVID-19) in children is unknown. However, the severity of symptoms in children and neonates is less than in adults. Regarding the new presentation of this disease, the current study has reported a case series of COVID-19 in neonates. Case Presentation: In this article, 10 neonates with COVID- 19 admitted to our neonatal intensive care units are reported. All reported neonates had general suspicious symptoms of COVID- 19 with positive results for SARS-CoV-2 assessed by polymerase chain reaction (PCR) from the nasopharynx area or nose of the patients. All neonates, except for two of them, were term neonates. One case had open-heart surgery for congenital heart disease (transposition of the great arteries (TGA)). The patients aged 22 days on admission. The most frequent symptom was fever. Severe respiratory symptoms were reported in two cases. Also, abnormal radiologic findings in the chest x-ray were detected in two cases. Regarding the lack of significant respiratory symptoms in most of the patients, the lung computed tomography (CT) scan was taken just from one neonate. Leukopenia (WBC < 5000/mm3) was detected in one case, with no lymphopenia in all neonates. The positive C-reactive protein test was not found in all cases. No patient was treated by special anti-viral agents for COVID-19, and usual antibiotic treatment for neonatal sepsis was administered for all cases. All patients, except for one, survived with no significant sequela of the disease. Conclusions: This study demonstrated that clinical manifestations, as well as laboratory and radiologic findings of COVID-19, are milder in neonates than in the older ages. Hence, it can be argued that the prognosis of COVID-19 in the neonatal period is generally good.

scholarly journals Clinical findings and long-term managements of patients with amelogenesis imperfecta

2014 ◽  
Vol 08 (04) ◽  
pp. 546-552 ◽  
Author(s):  
Mine Koruyucu ◽  
Merve Bayram ◽  
Elif Bahar Tuna ◽  
Koray Gencay ◽  
Figen Seymen
Keyword(s):  
Primary Teeth ◽  
Treatment Plan ◽  
Clinical Care ◽  
Young Patients ◽  
Case Series ◽  
Amelogenesis Imperfecta ◽  
Permanent Teeth ◽  
Radiographic Evaluation ◽  
Prevalence Index

ABSTRACTThe aim of this clinical case series is to present a diagnosis and different treatment methods of patients in different ages with amelogenesis imperfecta (AI) as well as further treatments during a 3-6 years follow-up period. A number of 31 patients (16 female, 15 male with a mean age of 10.77 ± 2.65 years) with AI have been examined for the study group between 2007 and 2010 years. A detailed anamnesis was recorded, followed by a clinical and radiological assessment of oral health. The types of AI classified for each patient according to clinical and radiographic evaluation. The main complaints of patients, presence of dental caries and dental anomalies were noted. Necessary treatments had been planned for the individual cases of AI. A number of 19 patients had hypoplastic (HP) form, and 10 patients showed hypomaturation (HM) form of AI, while one patient showed hypocalcified form of AI and one patient had HM-HP form with taurodontism. Main complaints were chiefly related to dissatisfactory esthetics and dental sensitivity. Caries prevalence index was 93.5%. Mean decayed, missing, filling permanent teeth (DMF) and DMF surface (DMFS) were found as 2.74 ± 1.71 and 6.23 ± 3.99; df (decayed, filling primary teeth) and dfs (decayed, filling primary teeth surface) were found as 3.12 ± 2.85 and 5.24 ± 4.97, respectively. All patients received individual clinical care, including preventive, restorative, and prosthetic treatments. Patients have scheduled for regular follow-up in every 3 months. Composite restorations were used as the most common treatment (25 patients, 80.6%). The treatment plan should be based on patient's age, type of defects and individual needs of the patients. Necessary treatment plan is essential, not only due to functional and aesthetic reasons, but also for the positive psychological impact on young patients.

scholarly journals Pleural complications in patients with coronavirus disease 2019 (COVID-19): how to safely apply and follow-up with a chest tube during the pandemic?

2020 ◽  
Vol 58 (6) ◽  
pp. 1216-1221
Author(s):  
Kenan Can Ceylan ◽  
Guntug Batihan ◽  
Serkan Yazgan ◽  
Soner Gürsoy ◽  
Sami Cenk Kıraklı ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Chest Tube ◽  
High Efficiency ◽  
Case Series ◽  
Viral Transmission ◽  
Air Filter ◽  
Pulmonary Parenchyma ◽  
Novel Coronavirus ◽  
Tube Application

Abstract OBJECTIVES Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, affects mainly the pulmonary parenchyma and produces significant morbidity and mortality. During the pandemic, several complications have been shown to be associated with coronavirus disease 2019 (COVID-19). Our goal was to present a series of patients with COVID-19 who underwent chest tube placements due to the development of pleural complications and to make suggestions for the insertion and follow-up management of the chest tube. METHODS We retrospectively collected and analysed data on patients with laboratory-confirmed COVID-19 in our hospital between 11 March and 15 May 2020. Patients from this patient group who developed pleural complications requiring chest tube insertion were included in the study. RESULTS A total of 542 patients who were suspected of having COVID-19 were hospitalized. The presence of severe acute respiratory syndrome coronavirus 2 was confirmed with laboratory tests in 342 patients between 11 March and 15 May 2020 in our centre. A chest tube was used in 13 (3.8%) of these patients. A high-efficiency particulate air filter mounted double-bottle technique was used to prevent viral transmission. CONCLUSIONS In patients with COVID-19, the chest tube can be applied in cases with disease or treatment-related pleural complications. Our case series comprised a small group of patients, which is one of its limitations. Still, our main goal was to present our experience with patients with pleural complications and describe a new drainage technique to prevent viral transmission during chest tube application and follow-up.

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