scholarly journals Center-Based Experiences Implementing Strategies to Reduce Risk of Horizontal Transmission of SARS-Cov-2: Potential for Compromise of Neonatal Microbiome Assemblage

2021 ◽  
Author(s):  
Joann Romano-Keeler ◽  
Dana Fiszbein ◽  
Jilei Zhang ◽  
Joseph Horowitz ◽  
Karen Hayani ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Horizontal Transmission ◽  
Perinatal Transmission ◽  
Neonatal Intensive Care Units ◽  
Delayed Cord Clamping ◽  
Average Hospital ◽  
Skin Contact ◽  
Cord Clamping ◽  
Hospital Stays ◽  
Skin To Skin

Perinatal transmission of COVID-19 is poorly understood and many neonatal intensive care units' (NICU) policies minimize mother-infant contact to prevent transmission. We present our unit's approach and ways it may impact neonatal microbiome acquisition. We attending COVID-19 positive mothers' deliveries from March-August 2020. Delayed cord clamping and skin-to-skin were avoided and infants were admitted to the NICU. No parents' visits were allowed and discharge was arranged with COVID-19 negative family members. Maternal breast milk was restricted in the NICU. All twenty-one infants tested negative at 24 and 48 hours and had average hospital stays of nine days. 40% of mothers expressed breastmilk and 30% of infants were discharged with COVID-19 negative caregivers. Extended hospital stays, no skin-to-skin contact, limited maternal milk use, and discharge to caregivers outside primary residences, potentially affect the neonatal microbiome. Future studies are warranted to explore how ours and other centers'with similar policies influence this outcome.

Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact

2014 ◽  
Vol 99 (4) ◽  
pp. F309-F314 ◽  
Author(s):  
Marrit Smit ◽  
Jennifer A Dawson ◽  
Angelina Ganzeboom ◽  
Stuart B Hooper ◽  
Jos van Roosmalen ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Delayed Cord Clamping ◽  
Skin Contact ◽  
Cord Clamping ◽  
Skin To Skin

scholarly journals Coverage of the WHO’s four essential elements of newborn care and their association with neonatal survival in southern Nepal

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Emily Bryce ◽  
Luke C. Mullany ◽  
Subarna K. Khatry ◽  
James M. Tielsch ◽  
Steven C. LeClerq ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Newborn Care ◽  
Newborn Health ◽  
Essential Elements ◽  
Delayed Cord Clamping ◽  
Skin Contact ◽  
Cord Clamping ◽  
Risk Of Mortality ◽  
Skin To Skin ◽  
Initiation Of Breastfeeding

Abstract Background Despite recent improvements in child survival, neonatal mortality continues to decline at a slower rate and now represents 47% of under-five deaths globally. The World Health Organization developed core indicators to better monitor the quality of maternal and newborn health services. One such indicator for newborn health is “the proportion of newborns who received all four elements of essential care”. The four elements are immediate and thorough drying, skin to skin contact, delayed cord clamping, and early initiation of breastfeeding. Although there is existing evidence demonstrating an association with decreased neonatal mortality for each element individually, the cumulative impact has not yet been examined. Methods This analysis uses data from a randomized trial to examine the impact of sunflower versus mustard seed oil massage on neonatal mortality and morbidity in the Sarlahi district in Southern Nepal from 2010 to 2017. The proportion of newborn infants receiving an intervention was the exposure and neonatal mortality was the outcome in this analysis. Neonatal mortality was defined as a death between three hours and less than 28 days of age. Associations between neonatal mortality and the essential elements were estimated by Cox proportion hazards models. The hazard ratios and corresponding 95% confidence intervals were reported. Results 28,121 mother-infant pairs and 753 neonatal deaths were included. The percent receiving the individual elements ranged from 19.5% (skin to skin contact) to 68.2% (delayed cord clamping). The majority of infants received one or two of the elements of essential care, with less than 1% receiving all four. Skin to skin contact and early initiation of breastfeeding were associated with lower risk of neonatal mortality (aHR = 0.64 [0.51, 0.81] and aHR = 0.72 [0.60, 0.87], respectively). The risk of mortality declined as the number of elements received increased; receipt of one element compared to zero was associated with a nearly 50% reduction in risk of mortality and receipt of all four elements resulted in a 72% decrease in risk of mortality. Conclusions The receipt of one or more of the four essential elements of newborn care was associated with improved neonatal survival. The more elements of care received, the more survival improved.

Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care Units

2019 ◽  
Vol 37 (02) ◽  
pp. 151-157 ◽  
Author(s):  
Chinh L. Tran ◽  
Janella M. Parucha ◽  
Priya Jegatheesan ◽  
Henry C. Lee
Keyword(s):  
Intensive Care ◽  
Confidence Interval ◽  
Intensive Care Units ◽  
Odds Ratio ◽  
Neonatal Intensive Care ◽  
Quality Care ◽  
Patient Characteristics ◽  
Neonatal Intensive Care Units ◽  
Delayed Cord Clamping ◽  
Cord Clamping

Objective To assess the current practice of delayed cord clamping (DCC) and to determine patient and hospital factors that predict DCC. Study Design The California Perinatal Quality Care Collaborative (CPQCC) collects data on preterm and acutely ill infants. In 2016, 52 CPQCC neonatal intensive care units (NICUs) collected data on DCC. Hospital and patient characteristics were analyzed using multivariable logistic regression. Results Of 5,332 deliveries, 1,555 (29%) newborns received DCC. Hospital rates ranged from 0 to 74.5% and increased from 21 to 37% throughout 2016. Infants delivered at <32 weeks or with birth weight <1,500 g were more likely to receive DCC (odds ratio: 2.80; 95% confidence interval: 2.33, 3.36). Cesarean delivery was associated with less likelihood of DCC (odds ratio: 0.68; 95% confidence interval: 0.59, 0.79). After risk adjustment, 17 (33%) hospitals had higher than expected DCC rate. Hospitals with less than 50 NICU beds are more likely to practice DCC, whereas Level 3 American Academy of Pediatrics NICUs, nonprofit owned hospitals, and teaching institutions were less likely to practice DCC (p < 0.001). Conclusion There are opportunities to implement quality improvement activities to increase DCC rates.

scholarly journals Newborns at risk of Covid-19 ― lessons from the last year

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Malika D. Shah ◽  
Ola Didrik Saugstad
Keyword(s):  
Horizontal Transmission ◽  
Mode Of Delivery ◽  
Newborn Infants ◽  
World Health ◽  
Premature Delivery ◽  
Mortality And Morbidity ◽  
Skin Contact ◽  
Cord Clamping ◽  
Increased Risk ◽  
Health Organization

Abstract After more than 1 year of the SARS-CoV-2 pandemic, a great deal of knowledge on how this virus affects pregnant women, the fetus and the newborn has accumulated. The gap between different guidelines how to handle newborn infants during this pandemic has been minimized, and the American Academy of Pediatrics (AAP)’s recommendations are now more in accordance with those of the World Health Organization (WHO). In this article we summarize present knowledge regarding transmission from mother to the fetus/newborn. Although both vertical and horizontal transmission are rare, SARS-CoV-2 positivity is associated with an increased risk of premature delivery and higher neonatal mortality and morbidity. Mode of delivery and cord clamping routines should not be affected by the mother’s SARS-CoV-2 status. Skin to skin contact, rooming in and breastfeeding are recommended with necessary hygiene precautions. Antibodies of infected or vaccinated women seem to cross both the placenta and into breast milk and likely provide protection for the newborn.

scholarly journals Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Tazeen Tahsina ◽  
◽  
Aniqa Tasnim Hossain ◽  
Harriet Ruysen ◽  
Ahmed Ehsanur Rahman ◽  
...  
Keyword(s):  
Newborn Care ◽  
Health Indicators ◽  
Newborn Health ◽  
Public Hospitals ◽  
Maternal And Newborn Health ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Improve Measurement ◽  
Immediate Newborn Care ◽  
Skin To Skin

Abstract Background Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. “Every Newborn Birth Indicators Research Tracking in Hospitals” (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. Methods The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women’s exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. Results Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8–21.0). Survey-reported (53.2, 95% CI 39.4–66.8) and register-recorded results (85.9, 95% CI 58.1–99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5–93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3–73.5%) and drying (7.3–29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5–3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. Conclusions Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.

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