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      Impact of evolving practices on SARS-CoV-2 positive mothers and their newborns in the largest public healthcare system in America

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective

          The impact of evolving guidelines and clinical practices on SARS-CoV-2-positive dyads across New York City Health and Hospitals during the early peak of COVID-19.

          Design

          A retrospective cohort study of positive-positive (P/P), positive-negative (P/N), and positive-untested (P/U) dyads delivered from March 1 to May 9, 2020. Wilcoxon rank sum, Chi-squared, and Fisher exact tests were used to analyze demographics, clinical variables, and system-wide management practices.

          Result

          A total of 2598 mothers delivered. 23.8% (286/1198) of mothers tested for SARS-CoV-2 were positive. 89.7% (260/290) newborns of SARS-CoV-2-positive mothers were tested and 11 were positive. Positive-positive newborns were more likely to be breastfed (81%), be admitted to NICU, and have longer length of stay (7.5 days) than P/N and P/U newborns.

          Conclusion

          Our study shows that varied testing, feeding, and isolation practices resulted in favorable short-term outcomes for SARS-CoV-2-positive mothers and their newborns. High-risk populations can be safely and effectively treated in resource-limited environments.

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          Most cited references11

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          COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals

          Noelle Breslin, Caitlin Baptiste, Cynthia Gyamfi-Bannerman … (2020)
          The novel coronavirus 2019, or COVID-19, infection has rapidly spread through the New York metropolitan area since the first reported case in the state on March 1, 2020. New York currently represents an epicenter for COVID-19 infection in the United States, with 84,735 cases reported as of April 2, 2020. We previously presented an early experience with seven COVID-positive patients in pregnancy, including two women who were diagnosed with COVID-19 following an asymptomatic initial presentation. We now describe a series of 43 test-confirmed cases of COVID-19 presenting to a pair of affiliated New York City hospitals over two weeks from March 13 to 27, 2020. Fourteen (32.6%) patients presented without any COVID-associated viral symptoms, and were identified either after developing symptoms during admission or following the implementation of universal testing for all obstetrical admissions on March 22. Of these, 10/14 (71.4%) developed symptoms or signs of COVID-19 infection over the course of their delivery admission or early after postpartum discharge. Of the other 29 (67.4%) patients who presented with symptomatic COVID-19 infection, three women ultimately required antenatal admission for viral symptoms, and an additional patient represented six days postpartum after a successful labor induction with worsening respiratory status that required oxygen supplementation. There were no confirmed cases of COVID-19 detected in neonates upon initial testing on the first day of life. Applying COVID-19 disease severity characteristics as described by Wu et al, 37 (86%) women possessed mild disease, four (9.3%) exhibited severe disease, and two (4.7%) developed critical disease; these percentages are similar to those described for non-pregnant adults with COVID-19 infections (about 80% mild, 15% severe, and 5% critical disease).
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            Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study

            Christine Salvatore, Jin-Young Han, Karen Acker … (2020)
            Summary Background The risk of vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, which causes COVID-19), the most appropriate management, and the neonate's risk of developing COVID-19 during the perinatal period are unknown. Therefore, we aimed to elucidate best practices regarding infection control in mother–newborn dyads, and identify potential risk factors associated with transmission. Methods In this observational cohort study, we identified all neonates born between March 22 and May 17, 2020, at three New York Presbyterian Hospitals in New York City (NY, USA) to mothers positive for SARS-CoV-2 at delivery. Mothers could practice skin-to-skin care and breastfeed in the delivery room, but had to wear a surgical mask when near their neonate and practice proper hand hygiene before skin-to-skin contact, breastfeeding, and routine care. Unless medically required, neonates were kept in a closed Giraffe isolette in the same room as their mothers, and were held by mothers for feeding after appropriate hand hygiene, breast cleansing, and placement of a surgical mask. Neonates were tested for SARS-CoV-2 by use of real-time PCR on nasopharyngeal swabs taken at 24 h, 5–7 days, and 14 days of life, and were clinically evaluated by telemedicine at 1 month of age. We recorded demographics, neonatal, and maternal clinical presentation, as well as infection control practices in the hospital and at home. Findings Of 1481 deliveries, 116 (8%) mothers tested positive for SARS-CoV-2; 120 neonates were identified. All neonates were tested at 24 h of life and none were positive for SARS-CoV-2. 82 (68%) neonates completed follow-up at day 5–7 of life. Of the 82 neonates, 68 (83%) roomed in with the mothers. All mothers were allowed to breastfeed; at 5–7 days of life, 64 (78%) were still breastfeeding. 79 (96%) of 82 neonates had a repeat PCR at 5–7 days of life, which was negative in all; 72 (88%) neonates were also tested at 14 days of life and none were positive. None of the neonates had symptoms of COVID-19. Interpretation Our data suggest that perinatal transmission of COVID-19 is unlikely to occur if correct hygiene precautions are undertaken, and that allowing neonates to room in with their mothers and direct breastfeeding are safe procedures when paired with effective parental education of infant protective strategies. Funding None.
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              Physiological changes in hematological parameters during pregnancy.

              Arvind Kumar Vaish, Surabhi Chandra, Sanjay Mishra … (2012)
              Pregnancy is a state characterized by many physiological hematological changes, which may appear to be pathological in the non-pregnant state. The review highlights most of these changes along with the scientific basis for the same, as per the current knowledge, with a special reference to the red blood and white blood cells, platelets and hemostatic profile.
              Article 0 comments Cited 88 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yogangi Malhotra:
                ORCID: http://orcid.org/0000-0001-8565-0587
                malhotry@nychhc.org
                Journal
                Journal ID (nlm-ta): J Perinatol
                Journal ID (iso-abbrev): J Perinatol
                Title: Journal of Perinatology
                Publisher: Nature Publishing Group US (New York )
                ISSN (Print): 0743-8346
                ISSN (Electronic): 1476-5543
                Publication date (Electronic): 5 March 2021
                Pages: 1-11
                Affiliations
                [1 ]NYC Health + Hospitals/Jacobi, Bronx, NY United States
                [2 ]GRID grid.251993.5, ISNI 0000000121791997, Albert Einstein College of Medicine, ; Bronx, NY United States
                [3 ]NYC Health + Hospitals/Elmhurst, Queens, NY United States
                [4 ]NYC Health + Hospitals/Metropolitan, New York, NY United States
                [5 ]NYC Health + Hospitals/Office of Quality and Safety, New York, NY United States
                [6 ]NYC Health + Hospitals/King’s County, Brooklyn, NY United States
                Author information
                http://orcid.org/0000-0001-8565-0587
                http://orcid.org/0000-0002-1176-4351
                http://orcid.org/0000-0002-5325-0359
                http://orcid.org/0000-0003-3459-3783
                http://orcid.org/0000-0003-1845-9920
                http://orcid.org/0000-0002-2521-2945
                http://orcid.org/0000-0002-6262-0980
                Article
                Publisher ID: 1023
                DOI: 10.1038/s41372-021-01023-8
                PMC ID: 7934805
                PubMed ID: 33674713
                SO-VID: 0884a1a3-09ce-4117-af93-92955a33489c
                Copyright © © The Author(s), under exclusive licence to Springer Nature America, Inc. part of Springer Nature 2021
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 4 July 2020
                Date revision received : 2 February 2021
                Date accepted : 17 February 2021
                Categories
                Subject: Article

                ScienceOpen disciplines: Pediatrics
                Keywords: outcomes research,health policy
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: outcomes research, health policy

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