Neonatal Admission Research Articles

Identifying neonatal intensive care (NICU) admissions using administrative claims data.

To define a method for identifying neonatal intensive care unit (NICU) admissions using administrative claims data. This was a retrospective cohort study using claims from Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2016 -2020. We developed a definition to identify NICU admissions using a list of codes from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), and revenue codes frequently associated with NICU admissions. We compared agreement between codes using Kappa statistics and calculated positive predictive values (PPV) and 95% confidence intervals (CI). On average, revenue codes (3.3%) alone identified more NICU hospitalizations compared to CPT codes alone (1.5%), whereas the use of CPT and revenue (8.9%) and CPT or revenue codes (13.7%) captured the most NICU hospitalizations, which aligns with rates of preterm birth. Gestational age alone (4.2%) and birthweight codes alone (2.0%) identified the least number of potential NICU hospitalizations. Setting CPT codes as the standard and revenue codes as the "test,", revenue codes resulted in identifying 86% of NICU admissions (sensitivity) and 97% of non-NICU admissions (specificity). Using administrative data, we developed a robust definition for identifying neonatal admissions. The identified definition of NICU codes is easily adaptable, repeatable, and flexible for use in other datasets.

Effect of Meconium Stained Liquor on Mode of Delivery and Fetomaternal Outcome in a Tertiary Level Hospital

Background: The appearance of meconium-stained liquor during labour is generally considered to be a sign of hypoxia and a predictor of poor fetal outcome.It is one of the clinical events where normal pregnancy can turn into a high risk one for the mother as well as for the foetus.
 Objective: To evaluate the obstetric outcome in meconium stained liquor during labour.
 Study design: Prospective comparative study.
 Study setting and period: Gynaecology and Obstetrics department of Sir Salimullah Medical College and Mitford Hospital (SSMC and MH), Dhaka, between January 2019 to June 2019.
 Study population: The study patients in labour with meconium stained amniotic fluid and women in labour but having clear amniotic fluid who admitted for delivery during study period.
 Result: A total 75 cases were enrolled in the study as case and 75 cases were enrolled as control. The mean age was found 29.14±5.59 years in case group and 28.9±6.2 years in control group. Patients received irregular ANC was 20(26.7%) and 25(33.3%) in case and control group respectively. Patients who did not receive ANC was 24(32.0%) in case group and 12(16.0%) in control group. Mean gestational age at delivery was found 38.87±1.4 weeks in case group and 38.75±1.6 weeks in control group. Primigravida was predominant in both groups. Caesarean deliveries were high (80.0%) in cases and it was much higher with thick meconium (74.7%) as compared to thin meconium (25.3%). APGAR scores in first minute and fifth minute were also low in cases. Birth asphyxia was found 20.0% in case group and 6.3% in control group. Meconium aspiration syndrome 25.0% and convulsion 3.8% developed only in cases. Neonatal ward admission was 22.0% in case group and 6.3% in control group. Neonatal mortality was higher (3.8%) in cases than control 1.3%. Majority (6.65%) patients had post partum hemorrhage in case group and 3(4.0%) in control group.
 Conclusion: Meconium stained amniotic fluid were associated with higher rate of caesarian delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission, and mortality. Electronic foetal monitoring, timely obstetrical intervention and neonatal care can reduce associated complications and improve foetal outcome.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 43-49

Neonatal outcomes of maternal prenatal coronavirus infection.

The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.

Missed opportunity for aspirin prophylaxis for preeclampsia prevention: a cross-sectional study from Sub-Saharan Africa

BackgroundRecent studies show that aspirin for pre-eclampsia prevention is underutilized despite it's effectiveness in preventing pre-eclampsia in patients with moderate and high risk factors. Little is known about this issue in the Sub-Saharan setting, including Ethiopia. ObjectiveTo determine the missed opportunity for ASA prophylaxis among candidates for this preeclampsia preventive intervention at a national tertiary referral hospital in Ethiopia. Study DesignThis was a cross-sectional study on pregnant women complicated by preeclampsia who were managed at St. Paul's Hospital Millennium Medical College (Ethiopia) over 6 months (April 1, 2023-September 30, 2023). Data were collected prospectively using a structured questionnaire. The primary outcome was proportion of women who had an indication for ASA prophylaxis for preeclampsia prevention but were not given the opportunity (missed opportunity for ASA) among all pregnant preeclampsia patients presenting to our hospital. Secondary outcomes were adverse maternal and perinatal outcomes. An intention-to-treat (ITT) analysis was used. Data were analyzed using SPSS version 23. Descriptive statistics were employed to analyze the data. Proportions and percentages were used to present the results. ResultsA total of 427 pregnant women with preeclampsia were screened for inclusion and 32 of them were excluded according to the inclusion and exclusion criteria. Among the 395 preeclamptic pregnant women included in the final analysis, 195(50.6%) had an indication for ASA prophylaxis for the prevention of preeclampsia. The mean systolic and diastolic blood pressures at presentation were 153.8(±12.8) and 100.6(±8.5) mm Hg, respectively. Most patients had proteinuria (51.7% had urine dip-stick protein +2 while another 18.5% (74/395) had urine dip-stick protein +1 and 10.9% had 24-hour urine protein in the pre-eclampsia range). Among these women who had indication for ASA prophylaxis, in only 1.1 % was ASA utilized (the missed opportunity for ASA prophylaxis for preeclampsia prevention was 98.9%). The perinatal morality rate was 11.9 % while neonatal ICU admission rate was 20.5%. The 5th minute low Apgar score rate was 8.9% Eight mothers (2.1%) were complicated by HELLP syndrome while another 3(0.8%) mothers developed pulmonary edema. ConclusionIn this study, the missed opportunity for administration of ASA prophylaxis for the prevention of preeclampsia was unacceptably high though more than half of the study subjects were candidates for this preventive intervention. Preeclampsia was also associated with higher rates adverse perinatal outcomes and serious maternal morbidity.

Pregnancy in Seronegative Myasthenia Gravis: A Single-Center Case Series.

The course of double-seronegative myasthenia gravis (DSNMG) during and after pregnancy has not been well described. To assess the course of DSNMG during pregnancy and within 6 months postpartum. A retrospective cohort study of women with DSNMG seen in the Duke Myasthenia gravis (MG) Clinic after 2003. Review of the Duke MG Clinic Registry and electronic medical record identified 8 patients who became pregnant after MG onset; the mean age at disease onset was 17.6 (SD = 10.0) years. Increased MG symptoms were observed in the first and third trimester and, most commonly, postpartum in 6 of 18 pregnancies. Except for 1 infant who developed respiratory distress that required neonatal intensive care admission, all the newborns were healthy at birth. As in seropositive MG, increased MG symptoms during pregnancy and within 6 months postpartum is also seen in women with DSNMG.

Maternal education and its association with maternal and neonatal adverse outcomes in live births conceived using medically assisted reproduction (MAR)

BackgroundTo examine the association between maternal education and adverse maternal and neonatal outcomes in women who conceived using medically assisted reproduction, which included fertility medications, intrauterine insemination, or in vitro fertilization.MethodsWe conducted a retrospective cohort study utilizing the US Vital Statistics data set on national birth certificates from 2016 to 2020. Women with live, non-anomalous singletons who conceived using MAR and had education status of the birthing female partner recorded were included. Patients were stratified into two groups: bachelor’s degree or higher, or less than a bachelor’s degree. The primary outcome was a composite of maternal adverse outcomes: intensive care unit (ICU) admission, uterine rupture, unplanned hysterectomy, or blood transfusion. The secondary outcome was a composite of neonatal adverse outcomes: neonatal ICU admission, ventilator support, or seizure. Multivariable modified Poisson regression models with robust error variance adjusted for maternal age, race, marital status, prenatal care, smoking during pregnancy, neonatal sex, and birth year estimated the relative risk (RR) of outcomes with a 95% confidence interval (CI).Results190,444 patients met the inclusion criteria: 142,943 had a bachelor’s degree or higher and 47,501 were without a bachelor’s degree. Composite maternal adverse outcomes were similar among patients with a bachelor’s degree (10.1 per 1,000 live births) and those without a bachelor’s degree (9.4 per 1,000 live births); ARR 1.05, 95% CI (0.94–1.17). However, composite adverse neonatal outcomes were significantly lower in women with a bachelor’s degree or higher (94.1 per 1,000 live births) compared to women without a bachelor’s degree (105.9 per 1,000 live births); ARR 0.91, 95% CI (0.88–0.94).ConclusionsOur study demonstrated that lower maternal education level was not associated with maternal adverse outcomes in patients who conceived using MAR but was associated with increased rates of neonatal adverse outcomes. As access to infertility care increases, patients who conceive with MAR may be counseled that education level is not associated with maternal morbidity. Further research into the association between maternal education level and neonatal morbidity is indicated.

Placental Streptococcus agalactiae DNA is associated with neonatal unit admission and foetal pro-inflammatory cytokines in term infants

Streptococcus agalactiae (Group B Streptococcus; GBS) is a common cause of sepsis in neonates. Previous work detected GBS DNA in the placenta in ~5% of women before the onset of labour, but the clinical significance of this finding is unknown. Here we re-analysed this dataset as a case control study of neonatal unit (NNU) admission. Of 436 infants born at term (≥37 weeks of gestation), 7/30 with placental GBS and 34/406 without placental GBS were admitted to the NNU (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.3–7.8). We then performed a validation study using non-overlapping subjects from the same cohort. This included a further 239 cases of term NNU admission and 686 term controls: 16/36 with placental GBS and 223/889 without GBS were admitted to the NNU (OR 2.4, 95% CI 1.2–4.6). Of the 36 infants with placental GBS, 10 were admitted to the NNU with evidence of probable but culture-negative sepsis (OR 4.8, 95% CI 2.2–10.3), 2 were admitted with proven GBS sepsis (OR 66.6, 95% CI 7.3–963.7), 6 were admitted and had chorioamnionitis (inflammation of the foetal membranes) (OR 5.3, 95% CI 2.0–13.4), and 5 were admitted and had funisitis (inflammation of the umbilical cord) (OR 6.7, 95% CI 12.5–17.7). Foetal cytokine storm (two or more pro-inflammatory cytokines >10 times median control levels in umbilical cord blood) was present in 36% of infants with placental GBS DNA and 4% of cases where the placenta was negative (OR 14.2, 95% CI 3.6–60.8). Overall, ~1 in 200 term births had GBS detected in the placenta, which was associated with infant NNU admission and morbidity.

Risk factors and outcomes in patients with cochlear nerve deficiency

IntroductionCochlear nerve deficiency (CND) is a cause of sensorineural hearing loss made by radiologic criteria. There is sparse literature involving audiological outcomes and cochlear implantation (CI) success in patients with CND. MethodsA retrospective chart review of all patients with sensorineural hearing loss at a tertiary children's hospital from 2000 to 2020 was conducted. Patients with CND on radiographic imaging were included and categorized as hypoplastic, aplastic, or indeterminate. ResultsIn this study, 53 patients were identified with CND, totaling 70 ears. Of the 53 patients, 30 (56.6 %) were male, 8 (16.0 %) had a family history of childhood hearing loss, 6 (11.3 %) were born preterm, and 11 (23.4 %) required neonatal intensive care admission. The median maternal age was 29 years old [IQR: 27, 35], and 8 (15 %) patients were born to mothers with diabetes. Of the 70 ears, 49 (70 %) utilized conventional hearing aids, 12 (17.1 %) utilized a bone-anchored hearing aid, and 10 (14.3 %) underwent CI. Of the 10 ears implanted, 4 (40 %) ears had nerves classified as hypoplastic, 3 (30 %) as aplastic, and 3 (30 %) as indeterminate. Improvement in pure tone averages compared to preoperative testing was demonstrated in 8 (80 %), and 6 (60 %) displayed improved speech awareness thresholds. ConclusionThis study demonstrates that there may be an association between CND and maternal diabetes and NICU admission. There are variable results with hearing amplification options in patients with CND, and further research is needed to better describe the role of CI, bone-anchored hearing aids and conventional hearing aids in patients with CND.

Effect of Anti-TNF Biologic Exposure During Pregnancy on Villitis of Unknown Etiology Diagnoses in Patients with Autoimmune Disease.

Tumor necrosis factor-α (TNF-α) antagonists are highly effective in controlling autoimmune diseases. This has led to speculation that they might also be useful in treating inflammatory placental conditions, such as chronic villitis of unknown etiology (VUE). VUE affects 10-15% of term placentas and is associated with recurrent fetal growth restriction (FGR) and pregnancy loss. We aimed to evaluate outcomes in patients with autoimmune diseases with and without anti-TNF-α biologic exposure during gestation. This retrospective cohort study compared pregnant women with autoimmune disease taking anti-TNF-α biologics (n = 89) to pregnant women with autoimmune disease but not taking a biologic (n = 53). We extracted data on all patients meeting our inclusion criteria over a 20-year period. Our primary outcome was the diagnosis of VUE by histology. Our secondary outcomes were maternal and neonatal complications such as preeclampsia, FGR, and neonatal intensive care admission. Kruskal-Wallis and chi-squared tests were performed as appropriate for statistical analysis. Maternal characteristics were comparable between groups, and there was no increase in adverse pregnancy outcomes based on anti-TNF-α treatment. Exposure to anti-TNF-α therapy had no significant effect on the incidence of VUE or other obstetric complications. Within the cohort exposed to anti-TNF-α biologics during pregnancy, the rate of VUE was 9.3%, which is comparable to the reported general population risk. Our data support the safety profile of biologic use in pregnancy.

Neonatal staff perceptions and attitudes towards Family Integrated Care and Fathers: A Multi-site Survey

An anonymous questionnaire study was conducted to explore the attitudes and current practices of neonatal clinical staff to fathers and Family Integrated Care (FICare) in 2 neonatal units (level 2 and level 3).166 (65%) staff members responded. The majority agreed with parents' involvement in their baby's care, including providing skin-to-skin as soon as possible whilst receiving intensive care. Overall, parental presence for non-invasive procedures was welcomed. Staff strongly valued the role of fathers in caring for their baby and supporting the mother. They recognised the impact of the NICU admission on fathers' well-being.The study found a positive attitude towards the involvement of both parents in their baby's care in intensive care. Staff believed that fathers play an important role during a baby's neonatal admission. Further education and training are required to improve knowledge and support practice, particularly with challenging or complex scenarios.

Neonatal Hyperbilirubinemia Admissions Following Clinical Practice Guideline Implementation.

Treatment of neonatal hyperbilirubinemia remains one of the most common reasons for readmission following delivery. Revised clinical practice guidelines (CPGs) for the treatment of neonatal hyperbilirubinemia were published on August 5, 2022. This report describes the preliminary outcomes following implementation of the new CPGs at Tripler Army Medical Center. A retrospective chart review was performed for the 12 months prior to implementation and the 5 months post implementation. Bilirubin admissions decreased from 15.6% of total admissions during the 12 months prior to the new guidelines (69/441) to 4.1% of admissions (8/194) during the 5 months after implementation of the new guidelines (P < 0.001). This corresponds to a 74% reduction (risk ratio = 0.26, 95% confidence interval [CI] 0.13 to 0.54). The decrease in admissions was found to correlate to greater than $140,000 in annual savings. Adhering to the revised CPGs has the potential to increase resource availability at a time when nursing shortages and financial instability are impacting health care systems nationwide. No short-term adverse events were noted; however, long-term follow up will be needed.

Prediction of adverse outcome by ophthalmic artery Doppler and angiogenic markers in pregnancies with new onset hypertension

ObjectivesTo compare the ophthalmic artery Doppler peak systolic velocity ratio (OA PSV-ratio) and soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF ratio) in predicting adverse maternal and perinatal outcomes in women presenting with new onset hypertension. Study designProspective cohort study in a specialist hypertension clinic, within a tertiary referral centre. Main outcome measuresComparison between the OA PSV-ratio and sFlt-1/PlGF ratio in predicting delivery within one week from presentation and adverse maternal and perinatal outcomes e.g. severe hypertension, neonatal unit admission, small for gestational age. ResultsWomen who delivered within one week, compared to those who did not, had a higher OA PSV-ratio (0.82 vs 0.71, p < 0.01) and sFlt-1/PlGF ratio (93.3 vs 40.5, p = 0.08). Independent predictors of the OA PSV-ratio included mean arterial pressure and maternal weight and predictors of the sFlt-1/PlGF ratio included diastolic blood pressure and use of antihypertensive medications. Prediction of adverse outcomes with both ratios were similar and only modest e.g. AUROC for predicting delivery within one week for OA PSV-ratio was 0.57 (95% CI 0.47–0.67) and for sFlt-1/PlGF ratio was 0.61 (95% CI 0.52–0.70) (p = 0.53). ConclusionsIn women presenting with new onset hypertension, the OA PSV-ratio and sFlt-1/PlGF ratio have similar and modest performance in predicting adverse outcomes.

A Cross-Sectional Study of Postpartum Depression in a Tertiary Care Hospital in South India

Background: South India has a high prevalence of postpartum depression (PPD) compared to other regions. With declining maternal mortality, physicians need to focus on decreasing maternal morbidities, including postpartum mental health disorders. Objectives: To evaluate the incidence of PPD and the influence of demographic and pregnancy related factors on PPD, and to identify major symptom subsets manifested postnatally. Methods: This cross-sectional study was conducted on 435 women between 2 weeks to 6 months postpartum, in a tertiary care centre in South India, Postnatal mothers were administered questionnaires including Edinburgh Postnatal Depression Scale (EPDS) and patient demographics and pregnancy related factors. Chi squared test was used to evaluate the association between EPDS scores and demographic and pregnancy variables. Subset analysis was carried out to identify the predominant symptoms in the patients. Results: Completed questionnaires were obtained from 427 postpartum women, among which 26.2% (n=112) had EPDS score &gt;12. Among demographic variables, EPDS scores showed a significant association with relationship problems (p=.000) only, while among pregnancy factors, preterm birth (p=.019), neonatal intensive care admission (p=.005), pregnancy complications (p=.009), and history of depression (p=.043) were significantly associated with EPDS scores. Subset analysis revealed a high mean EPDS score for anxiety (1.91), followed by depressive (1.38) and anhedonia (0.91) symptoms. Conclusion: Several clinical factors and adverse events during pregnancy, including sociodemographic factors and pregnancy-related complications itself, can set the stage for PPD and other mental health conditions. Simple assessments like EPDS can be considered part of routine postnatal check-up examinations for early recognition and treatment of PPD.

Magnitude of Neonatal Admission Diagnosis and Associated Factors at Selected Hospitals in Wollo, Northeast Ethiopia

Magnitude of Neonatal Admission Diagnosis and Associated Factors at Selected Hospitals in Wollo, Northeast Ethiopia

Impact of COVID-19 pandemic on retinopathy of prematurity services in low resource settings.

Retinopathy of prematurity is an increasingly important cause of blindness in children in low- and middle-income countries. Timely screening and treatment greatly reduce blindness. This study assessed the impact of the COVID-19 pandemic on ROP services in low- and middle-income countries. An online survey with closed and open-ended questions in Microsoft Teams was sent to 304 ophthalmologists providing screening, treatment and/or vitreoretinal services (January 15 to March 12 2021). Categories were used to report impact on services. 28 participants were purposively selected for interview. 184/201 completed forms from 32 countries were received. Two thirds of participants worked in government facilities and 45.6% were paediatric ophthalmologists. A moderate to severe impact was reported by 13% for screening, 9% for treatment and 16% for vitreoretinal surgery with some variation between government, private and not-for-profit sectors. 22% thought services would take a year to recover. Fifteen ophthalmologists from 12 countries were interviewed. Many reported fewer neonatal admissions, and several reported more ROP blind infants once restrictions lifted. Themes associated with services continuing included limited lockdown, autonomy and flexibility, commitment, advocacy and technology. Themes associated with a negative impact include fear and panic, closure of facilities, COVID infection or quarantining of health workers and parents, lack of transport and exacerbation of poverty. The COVID pandemic had a very variable impact on the provision of ROP services. In some countries where the impact was great, more infants may have become blind from ROP. Lessons can be learnt for planning pandemic preparedness.

A Case Report on the Unique Challenges of COVID-19 Infection During Perioperative Anesthesia Care for a Laboring COVID-19-Infected Mother in a Low-Resource Area

BACKGROUND:Recently, the rate of cesarean sections has increased, addressing the concern of anesthesia for cesarean sections in a similar manner. Physiological changes during pregnancy, such as increased cardiac output, heart rate, and oxygen consumption, decreased lung compliance and capacity, immune modulation (an altered response of the cell-mediated immunity), and increased risk of thromboembolic disease reduce maternal compensation during stress and certain pathological conditions like infections. Importantly, the provision of anesthesia for a pregnant mother is perceived as a challenging situation because of the attendant physiological, anatomical, and pharmacological changes in pregnancy. This culminates in the modification and dosage adjustment for certain medications, especially sedative-hypnotics and delivery, as well as the management of anesthetic techniques, to optimize and ensure maternal organ function and fetal well-being.Certain perioperative factors, such as COVID-19 infection, comorbid disease, and obstetric complications, increase the risk of maternal morbidity and mortality with a subsequent fetal compromise during the perioperative state, besides the aforementioned anesthetic challenges. Moreover, COVID-19 infection increases the perils of complicating pregnancy and pregnancy outcomes, including maternal artificial ventilation and intensive care admission, preterm labor, fetal distress, neonatal intensive care admission, and fetal and maternal deaths.CONCLUSION:Preventive strategies toward the spread of the COVID-19 infection, vaccines, and the proper use of personnel protective equipment by healthcare providers reduce the spread and severity of the COVID-19 infection and improve obstetric and pregnancy outcomes.

Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy

The study team previously showed that maternal mRNA COVID-19 vaccination during pregnancy confers protection against SARS-CoV-2 infection and COVID-19-related hospital admission in newborns and young infants. In this study, the study team evaluated newborn and early infant safety outcomes following maternal messenger RNA (mRNA) COVID-19 vaccination during pregnancy, for which there is limited comparative epidemiological evidence. To determine if maternal mRNA COVID-19 vaccination during pregnancy is associated with adverse newborn and early infant outcomes. This population-based retrospective cohort study took place in Ontario, Canada, using multiple linked health administrative databases. Singleton live births with an expected delivery date between May 1, 2021, and September 2, 2022, were included. Data were analyzed from January 2023 through March 2023. Maternal mRNA COVID-19 vaccination (1 or more doses) during pregnancy. Severe neonatal morbidity (SNM), neonatal death, neonatal intensive care unit (NICU) admission, neonatal readmission, and hospital admission up to 6 months of age. The study team calculated inverse probability of treatment weighted risk ratios (RRs) and fit weighted Cox proportional hazards regression models comparing outcomes in infants of mothers who received COVID-19 vaccination during pregnancy with those who received no COVID-19 vaccine doses before delivery. In total, 142 006 infants (72 595 male [51%]; mean [SD] gestational age at birth, 38.7 [1.7] weeks) were included; 85 670 were exposed to 1 or more COVID-19 vaccine doses in utero (60%). Infants of vaccinated mothers had lower risks of SNM (vaccine exposed 7.3% vs vaccine unexposed 8.3%; adjusted RR [aRR], 0.86; 95% CI, 0.83-0.90), neonatal death (0.09% vs 0.16%; aRR, 0.47; 95% CI, 0.33-0.65), and NICU admission (11.4% vs 13.1%; aRR, 0.86; 95% CI, 0.83-0.89). There was no association between maternal vaccination during pregnancy and neonatal readmission (5.5% vs 5.1%; adjusted hazard ratio, 1.03; 95% CI, 0.98-1.09) or 6-month hospital admission (8.4% vs 8.1%; adjusted hazard ratio, 1.01; 95% CI, 0.96-1.05). In this population-based cohort study in Ontario, Canada, maternal mRNA COVID-19 vaccination during pregnancy was associated with lower risks of SNM, neonatal death, and NICU admission. In addition, neonatal and 6-month readmissions were not increased in infants of mothers vaccinated during pregnancy.

Management of neonates with maternal prenatal coronavirus infection and influencing factors.

The coronavirus disease 2019 (COVID-19) in pregnancy causes adverse outcomes for both the mother and the fetus. Neonates are at risk of vertical transmission and in-utero infection. Additionally, intensive care unit (ICU) admission and impairment in the organ systems of the mother are associated with neonatal outcomes, including impaired intrauterine growth, prematurity, and neonatal ICU admission. The management of neonates born from infected mothers has changed over the progress of the pandemic. At the beginning of the pandemic, cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoiding of skin-to-skin contact, breast milk, and breastfeeding were the main practices to reduce vertical and horizontal transmission risk in the era of insufficient knowledge. The effects of antenatal steroids and delayed cord clamping on COVID-19 were also not known. As the pandemic progressed, data showed that prenatal, delivery room, and postnatal care of neonates can be performed as pre-pandemic practices. Variants and vaccines that affect clinical course and outcomes have emerged during the pandemic. The severity of the disease and the timing of infection in pregnancy also influence maternal and neonatal outcomes. The knowledge and lessons from COVID-19 will be helpful for the next pandemic if it happens. IMPACT: Prenatal infection with COVID-19 is associated with adverse maternal and neonatal outcomes. Our review includes the management of neonates with prenatal COVID-19 infection exposure, maternal-fetal, delivery room, and postnatal care of neonates, clinical features, treatment of neonates, and influencing factors such as variants, vaccination, severity of maternal disease, and timing of infection during pregnancy. There is a growing body of data and evidence about the COVID-19 pandemic. The knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.

Gestational diabetes mellitus screening and diagnosis criteria before and during the COVID-19 pandemic: a retrospective pre-post study.

To determine whether perinatal outcomes after excluding gestational diabetes mellitus (GDM) on the basis of fasting venous plasma glucose (FVPG) assessment during the coronavirus disease 2019 (COVID-19) pandemic in 2020 were similar to those during the preceding year after excluding GDM using the standard oral glucose tolerance test (OGTT) procedure. Retrospective pre-post study. All women who gave birth in Queensland during 1 July - 31 December 2019 and 1 July - 31 December 2020. Perinatal (maternal and neonatal) outcomes for pregnant women assessed for GDM, by assessment method (2019: OGTT/glycated haemoglobin [HbA1c ] assessment; 2020: GDM could be excluded by an FVPG value below 4.7 mmol/L). 3968 of 29 113 pregnant women in Queensland during 1 July - 31 December 2019 (13.6%) were diagnosed with GDM, and 4029 of 28 778 during 1 July - 31 December 2020 (14.0%). In 2020, FVPG assessments established GDM in 216 women (1.1%) and excluded it in 1660 (5.8%). The frequencies of most perinatal outcomes were similar for women without GDM in 2019 and those for whom it was excluded in 2020 on the basis of FVPG values; the exception was caesarean delivery, for which the estimated probability increase in 2020 was 3.9 percentage points (95% credibility interval, 2.2-5.6 percentage points), corresponding to an extra 6.5 caesarean deliveries per 1000 births. The probabilities of several outcomes - respiratory distress, neonatal intensive care or special nursery admission, large for gestational age babies - were about one percentage point higher for women without GDM in 2020 (excluding those diagnosed on the basis of FVPG assessment alone) than for women without GDM in 2019. Identifying women at low absolute risk of gestational diabetes-related pregnancy complications on the basis of FVPG assessment as an initial step in GDM screening could reduce the burden for pregnant women and save the health system substantial costs.

Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study.

Although the survival of preterm neonates has improved, thanks to advanced and specialized neonatal intensive care, it remains the main reason for neonatal admission, death, and risk of lifelong complication. In this study, we assessed time to death and its predictors among preterm neonates admitted to neonatal intensive care units (NICU) at public hospitals in southern Ethiopia. A hospital based retrospective cohort was conducted among preterm neonates admitted to NICU at public hospitals in west Guji and Borena zones, Oromia National Regional State, southern Ethiopia. Simple random sampling technique was used to select records of preterm neonates admitted to both major hospitals in the study area. Data on neonatal condition, obstetric information, and status at discharge were collected from admission to discharge by trained research assistant through review of their medical records. Kaplan Meir curve and Log rank test were used to estimate the survival time and compare survival curves between variables. Cox-Proportional Hazards model was used to identify significant predictors of time to death at p<0.05. Of 510 neonates enrolled, 130(25.5%; 95% CI: 22-29) neonates died at discharge or 28days. The median survival time was 18 days with an interquartile range of (IQR = 6, 24). The overall incidence of neonatal mortality was 47.7 (95% CI: 40.2-56.7) per 1000 neonatal days. In the multivariable cox-proportional hazard analysis, lack of antenatal care (AHR: 7.1; 95%CI: 4-12.65), primipara (AHR: 2.3; 95% CI: 1.16-4.43), pregnancy complications (AHR: 3.4; 95% CI: 1.94-6.0), resuscitation at birth (AHR: 2.1, 95% CI: 0.28-0.77) and not receiving Kangaroo mother care (AHR: 9.3, 95% CI: 4.36-19.9) were predictors of preterm neonatal death. Despite admission to NICU for advanced care and follow up, mortality of preterm neonates was found to be high in the study settings. Addressing major intrapartum complications is required to improve survival of neonates admitted to NICU.