Nosocomial SARS-CoV-2 transmission in a neonatal unit in Botswana: chronic overcrowding meets a novel pathogen

We describe a cluster of six SARS-CoV-2 infections occurring in a crowded neonatal unit in Botswana, including presumed transmission among mothers, postnatal mother-to-neonate transmission and three neonate-to-healthcare worker transmissions. The affected neonate, born at 25 weeks’ gestation weighing 785 g, had a positive SARS-CoV-2 test at 3 weeks of age which coincided with new onset of hypoxaemia and worsening respiratory distress. Because no isolation facility could accommodate both patient and mother, they were separated for 10 days, during which time the patient was switched from breastmilk to formula. Her subsequent clinical course was marked by several weeks of supplemental oxygen, sepsis-like presentations requiring additional antibiotics and bronchopulmonary dysplasia. Despite these complications, adequate growth was achieved likely due to early initiation of nutrition. This nosocomial cluster highlights the vulnerabilities of neonates, caregivers and healthcare workers in an overcrowded environment, and underscores the importance of uninterrupted bonding and breast feeding, even during a pandemic.

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Chorioamnionitis and Early Lung Inflammation in Infants in Whom Bronchopulmonary Dysplasia Develops

PEDIATRICS ◽

10.1542/peds.97.2.210 ◽

1996 ◽

Vol 97 (2) ◽

pp. 210-215 ◽

Cited By ~ 14

Author(s):

Kristi L. Watterberg ◽

Laurence M. Demers ◽

Susan M. Scott ◽

Shirley Murphy

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Bronchopulmonary Dysplasia ◽

Lung Inflammation ◽

Distress Syndrome ◽

Causative Factor ◽

Supplemental Oxygen ◽

Leukotriene B4 ◽

Thromboxane B2 ◽

Lung Maturation

Objective. The development of bronchopulmonary dysplasia (BPD) often has been attributed to injury from mechanical ventilation and supplemental oxygen. Early lung inflammation in infants with BPD has been thought to be secondary to these factors. The purpose of this study was to evaluate whether preexisting (prenatal) inflammation may be a primary causative factor in the development of BPD. Methods. Intubated newborns of less than 2000 g birth weight were prospectively enrolled. The presence or absence of chorioamnionitis was documented. Lung inflammation was evaluated on days 1, 2, and 4 of intubation by assaying concentrations of interleukin 1β(IL-1β), thromboxane B2, leukotriene B4, and prostaglandin E2 in tracheal lavages. Infants in whom BPD developed were compared with those in whom it did not using these measures. Results. Fifty-three infants were enrolled; 41 survived. Thirty-eight had respiratory distress syndrome; 15 were intubated for other diagnoses. Infants prenatally exposed to chorioamnionitis were less likely to present with respiratory distress syndrome; however, chorioamnionitis was significantly associated with both the presence of IL-1β from the first day of intubation and the development of BPD. Tracheal lavage concentrations of IL-1β were higher in infants in whom BPD developed. Thromboxane B2 concentrations were similar on day 1 but were higher on days 2 and 4 in infants in whom BPD developed. Conclusions. In this study, intubated infants weighing less than 2000 g at birth in whom BPD developed had increased exposure to inflammation prenatally (chorioamnionitis) and evidence of increased lung inflammation from the first postnatal day. We speculate that chorioamnionitis may accelerate lung maturation but that it also causes lung inflammation and subsequent lung injury in intubated infants, fostering the development of BPD.

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Chronic Pulmonary Insufficiency of Prematurity

PEDIATRICS ◽

10.1542/peds.57.2.294 ◽

1976 ◽

Vol 57 (2) ◽

pp. 294-294

Author(s):

Richard A. Ehrenkranz

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Bronchopulmonary Dysplasia ◽

Premature Infants ◽

Lung Volume ◽

Distress Syndrome ◽

Clinical Course ◽

Initial Period ◽

Well Being ◽

Pulmonary Insufficiency

In the January 1975 issue of Pediatrics, Krauss et al.1 described "the pathophysiology and clinical course of a group of small premature infants, generally under 1,200 gm at birth, who develop a syndrome of delayed respiratory insufficiency." This syndrome, which they termed "chronic pulmonary insufficiency of prematurity" (CPIP) occurred after the first four to seven days of life, following an initial period of general well-being; was characterized by a 50% to 70% loss of lung volume, marked hypoxemia, and hypercapnia; and could be distinguished from respiratory distress syndrome (RDS), Wilson-Mikity syndrome, bronchopulmonary dysplasia, and pneumonia.

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Barriers to infection prevention and control practice among Amhara region teaching hospitals in Ethiopia: Qualitative study

International Journal of Infection Control ◽

10.3396/ijic.v15i2.007.19 ◽

2019 ◽

Vol 15 (2) ◽

Author(s):

Walelegn Worku Yallew ◽

Abera Kumie ◽

Feleke Moges Yehuala

Keyword(s):

Healthcare Worker ◽

Prevention And Control ◽

Healthcare Workers ◽

Infection Prevention ◽

Teaching Hospitals ◽

Infection Prevention And Control ◽

Amhara Region ◽

Implementation Barriers ◽

Control Practice ◽

And Control

Healthcare workers have good perception towards infection prevention, but there has been a poor practice towards it. Therefore, the aim of this study was to explore barriers to practice of infection prevention and control practice in teaching hospitals in Amhara region. A phenomenological approach used to explore the lived experience of healthcare workers and management staffs towards infection prevention practice and control. The data was collected from ten in-depth interviews and 23 focus group discussion participants, by face to face interview using open ended interview performed in safe and quiet places. Data was managed using OpenCode software version 4.03 and contents were analyzed thematically. Totally ten different barriers were identified, such as availability of facilities, shortage of material supply, lack of maintenance of facilities and equipment, high patient flow, experience, emergency situation, healthcare worker behaviour and healthcare worker’s information about infection prevention, low awareness of patients and visitors and overflow of families and visitors to the hospital. For effective infection prevention practice implementation, barriers should be considered via identifying specific organizational, healthcare worker, patients and visitors as targets.

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CLINICAL AND PARA-CLINICAL CHARACTERISTICS OF SICK NEWBORN BABIES TREATED AT PEDIATRIC DEPARTMENT OF HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.2.15 ◽

2011 ◽

pp. 112-117

Author(s):

Thi Kieu Nhi Nguyen

Keyword(s):

Respiratory Distress ◽

Congenital Malformation ◽

Clinical Characteristics ◽

Descriptive Study ◽

Neonatal Unit ◽

University Hospital ◽

Pediatric Department ◽

Sick Newborn ◽

Observational Descriptive Study

Objectives: 1. Describe neonatal classification of WHO. 2. Identify some principal clinical and paraclinical signs of term, preterm, post term babies. Patients and method: an observational descriptive study of 233 newborns hospitalized in neonatal unit at Hue university‘ s hospital was done during 12 months from 01/01/2009 to 31/12/2009 for describing neonatal classification and identifying principal clinical and paraclinical signs. Results: Premature (16.74%); Term babies (45.5%); Post term (37.76%); Premature: asphyxia (43.59%), hypothermia (25.64%), vomit (30.77%), jaundice (61.54%), congenital malformation (17.95%); CRP > 10mg/l (53.85%); anemia Hb < 15g/dl (12.82%). Term babies: poor feeding (21.7%); fever (24.53%); CRP > 10mg/l (53.77%); Hyperleucocytes/ Leucopenia (35.85%). Post term: respiratory distress (34%); lethargy (29.55%); vomit (26.14%); polycuthemia (1.14%); hypoglycemia (22.73%). Conclusion: each of neonatal type classified by WHO presente different clinical and paraclinical. Signs. The purpose of this research is to help to treat neonatal pathology more effectively.

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An Inquiry into Unionizing Home Healthcare Workers: Benefits for Workers and Patients

American Journal of Law & Medicine ◽

10.1017/s0098858800002355 ◽

2003 ◽

Vol 29 (1) ◽

pp. 117-138

Author(s):

Kristin Jenkins Gerrick

Keyword(s):

Health Insurance ◽

Chest Pain ◽

Healthcare Worker ◽

Healthcare Workers ◽

Constant Stress ◽

Home Healthcare ◽

Client Needs

Susan Carter has not been feeling well for days. She would like to see a doctor about her chest pain and wheezing, but Susan knows that missing work will leave her client without a replacement and, worse, she could be fired. Susan is a home healthcare worker in Illinois. Like many of her fellow workers, Susan has no health insurance and cannot afford to risk losing her job by going to see a doctor.Often, Susan feels unable to handle the constant stress of her job. She helps her clients bathe and dress, prepares their meals and assists them with their medications and housekeeping. Susan travels by bus daily to care for two to five clients. She carries a pager day and night in case a client needs help with a plugged catheter or another emergency. Susan often has to work seven days a week, and she steps in to care for patients whose caregivers have left for better-paying jobs.

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Socioeconomic and Behavioral Correlates of COVID-19 Infections among Hospital Workers in the Greater Jakarta Area, Indonesia: A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105048 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5048

Author(s):

Adrianna Bella ◽

Mochamad Thoriq Akbar ◽

Gita Kusnadi ◽

Olivia Herlinda ◽

Putri Aprilia Regita ◽

...

Keyword(s):

Healthcare Worker ◽

Healthcare Workers ◽

Hospital Staff ◽

Cross Sectional Study ◽

Household Size ◽

Risk Of Infection ◽

Sectional Study ◽

Hospital Workers ◽

Behavioral Correlates ◽

Cross Sectional

(1) Background: because of close contacts with COVID-19 patients, hospital workers are among the highest risk groups for infection. This study examined the socioeconomic and behavioral correlates of COVID-19 infection among hospital workers in Indonesia, the country hardest-hit by the disease in the Southeast Asia region. (2) Methods: we conducted a cross-sectional study, which collected data from 1397 hospital staff from eight hospitals in the Greater Jakarta area during April–July 2020. The data was collected using an online self-administered questionnaire and Reverse Transcription-Polymerase Chain Reaction (RT-PCR) tests. We employed descriptive statistics and adjusted and unadjusted logistic regressions to analyze the data of hospital workers as well as the subgroups of healthcare and non-healthcare workers. (3) Results: from a total of 1397 hospital staff in the study, 22 (1.6%) were infected. In terms of correlates, being a healthcare worker (adjusted odds ratio (AOR) = 8.31, 95% CI 1.27–54.54) and having a household size of more than five (AOR = 4.09, 1.02–16.43) were significantly associated with a higher risk of infection. On the other hand, those with middle- and upper-expenditure levels were shown to have a lower risk of infection (AOR = 0.06, 0.01–0.66). Behavioral factors associated with COVID-19 infection among healthcare and non-healthcare workers included knowledge of standard personal protective equipment (PPE) (AOR = 0.08, 0.01–0.54) and application of the six-step handwashing technique (AOR = 0.32, 0.12–0.83). (4) Conclusion: among hospital staff, correlates of COVID-19 infection included being a healthcare worker, household size, expenditure level, knowledge and use of PPE, and application of appropriate hand washing techniques.

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CLINIC AND COMPLICATIONS OF COVID-19 CORONAVIRUS DISEASE WITH PATHOGENESIS ELEMENTS

International Medical Journal ◽

10.37436/2308-5274-2020-3-14 ◽

2020 ◽

pp. 72-79

Author(s):

I. V. Аndrusovich

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Tract ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Clinical Symptoms ◽

Clinical Course ◽

Clinical Manifestations ◽

Second Phase ◽

Upper Respiratory Tract

The longer the COVID−19 coronavirus pandemic lasts, the more information about its clinical manifestations is accumulated. The incubation period of COVID−19 ranges from 2 to 14 days, rarely up to 3 weeks, but in a significant number of cases an infection is not accompanied with the appearance of clinical symptoms. Currently, the following variants of the clinical course of COVID−19 can be identified as follows: viral load; subclinical; slight; uncomplicated with damage to only the upper respiratory tract; mild pneumonia, severe pneumonia, acute respiratory distress syndrome, etc. The clinical course of COVID−19 depends on the severity, the criteria of which are the intoxication manifestation, the degree of fever and the dominant syndrome. Mild / moderate forms are manifested by frequent increase in body temperature up to 38 ° C, respiratory symptoms, headache, myalgias, palpitations and general malaise. Patients stop distinguishing smells and feel the taste of food. Approximately from the 7th to the 9th days of the disease there are problems with breathing, which indicates the impairment of the lower respiratory tract and the beginning of the second phase of the disease, and its course is regarded as severe. Severe forms of the disease can also be manifested by impaired coordination of movements, slurred speech. In 1 to 4 % of patients there is developed the psychosis in the form of hallucinations. In the elderly, COVID−19 may be accompanied by delirium, lowering blood pressure. The risks of adverse disease are associated with somatic diseases: cardiovascular and nervous systems, respiratory tract, hormonal disorders, etc. Otitis, sinusitis, sepsis, bronchopulmonary infection, thrombosis, myocarditis etc. can be the complications of COVID−19. Computer tomography is an instrumental test that demonstrates the damage of lungs with coronavirus and allows to assess its severity. Key words: coronavirus infection, COVID−19, clinical variants, severity, pneumonia, acute respiratory distress syndrome.

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PULMONARY FUNCTION IN THE NEWBORN INFANT

PEDIATRICS ◽

10.1542/peds.30.6.975 ◽

1962 ◽

Vol 30 (6) ◽

pp. 975-989

Author(s):

N. M. Nelson ◽

L. S. Prod'hom ◽

R. B. Cherry ◽

P. J. Lipsitz ◽

C. A. Smith

Keyword(s):

Pulmonary Function ◽

Respiratory Distress ◽

Newborn Infant ◽

Dead Space ◽

Clinical Course ◽

Average Difference ◽

Alveolar Dead Space ◽

Physiological Dead Space ◽

New Born ◽

Pulmonary Capillary

The arterial-alveolar tension gradient for CO2 has been investigated in 17 normal new born infants and in 15 with some degree of respiratory distress. Whereas the normal infants had virtually no Pco2 gradient from pulmonary capillary to alveolus, an average difference of 13.9 mm Hg was detected in sick infants. This gradient for Pco2 is caused by increased alveolar (and total physiological dead space, the relative amount of which closely parallels the clinical course of the disease. The data obtained indicate the increase in alveolar dead space to be largely due to poor perfusion of ventilated alveoli. In severely ill infants more than 60% of ventilated alveoli appear to be under-perfused.

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Factors affecting the course of body and kidney growth in infants with urolithiasis: A critical long-term evaluation

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.4.249 ◽

2016 ◽

Vol 88 (4) ◽

pp. 249 ◽

Cited By ~ 4

Author(s):

Kemal Sarica ◽

Fatma Narter ◽

Kubilay Sabuncu ◽

Ahmet Akca ◽

Utku Can ◽

...

Keyword(s):

Breast Feeding ◽

Clinical Course ◽

Stone Disease ◽

The Body ◽

Renal Growth ◽

Related Factors ◽

Growth Status ◽

Long Term Follow Up

Objective: To investigate the possible effects of dietary, patient and stone related factors on the clinical course of the stone disease as well as the body and renal growth status of the infants. Patients and Methods: A total of 50 children with an history of stone disease during infancy period were studied. Patient (anatomical abnormalities, urinary tract infection - UTI, associated morbidities), stone (obstruction, UTI and required interventions) and lastly dietary (duration of sole breast feeding, formula feeding) related factors which may affect the clinical course of the disease were all evaluated for their effects on the body and renal growth during long-term follow-up. Results: Mean age of the children was 2.40 ± 2.65 years. Our findings demonstrated that infants receiving longer period of breast feeding without formula addition seemed to have a higher rate of normal growth percentile values when compared with the other children. Again, higher frequency of UTI and stone attacks affected the growth status of the infants in a remarkable manner than the other cases. Our findings also demonstrated that thorough a close follow-up and appropriately taken measures; the possible growth retardation as well as renal growth problems could be avoided in children beginning to suffer from stone disease during infancy period. Conclusions: Duration of breast feeding, frequency of UTI, number of stone attacks and stone removal procedures are crucial factors for the clinical course of stone disease in infants that may affect the body as well as kidney growth during long-term follow-up.

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