NICU-KFSH & RC

17/11/2020

On the 17th November, staff of KFSH&RC, Riyadh, Saudi Arabia, their premature babies and their families, past and present, come together with our neonatal staff to celebrate the 15 million babies born early every year around the world.
60 000 of these babies are born prematurely in Saudi Arabia.

15/10/2020

Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring

Chunyuan Qiu, MD, MS1; Jane C. Lin, MS2; Jiaxiao M. Shi, PhD2; et al Ting Chow, MPH2; Vimal N. Desai, MD1; Vu T. Nguyen, MD1,3; Robert J. Riewerts, MD4; R. Klara Feldman, MD5; Scott Segal, MD, MHCM6; Anny H. Xiang, PhD2
Author Affiliations
JAMA Pediatr. Published online October 12, 2020. doi:10.1001/jamapediatrics.2020.3231
Key Points
Question Is there an association between maternal labor epidural analgesia given for vaginal delivery and risk of autism spectrum disorders in children?

Findings In this multiethnic population-based clinical birth cohort that included 147 895 children, autism spectrum disorders were diagnosed in 1.9% of the children delivered vaginally with epidural analgesia vs 1.3% of the children delivered vaginally without the exposure, a 37% relative increase in risk that was significant after adjusting for potential confounders.

Meaning This study suggests that exposure to epidural analgesia for vaginal delivery may be associated with increased risk of autism in children; further research is warranted to confirm the study findings and understand the potential mechanisms.

This cohort study assesses the association between maternal exposure to labor epidural analgesia and risk of autism spectrum disorders in offspring

21/08/2020

https://bit.ly/30VeqIi Pediatrics, online August 14, 2020.

We describe an ex-premature infant presenting with severe acute respiratory syndrome coronavirus 2 infection in the fifth week of life. In current reports, researchers indicate that acute symptomatic severe acute respiratory syndrome coronavirus 2 infection is relatively rare and much less severe th...

03/07/2020

Neonatal SARS-CoV-2 May Present With Hypoxemia Without Respiratory Distress

By Lisa Rappaport
July 01, 2020

(Reuters Health) - Neonatal SARS-CoV-2 infection may present in the first days of life with clinically significant hypoxemia in a newborn that doesn't have overt signs of respiratory distress or require oxygen therapy, one case report suggests.
"In mild disease, there may be non-specific signs such as poor feeding that alert the care-providers, before signs of respiratory distress are noted," said Dr. Shaili Amatya, an assistant professor in neonatal-perinatal medicine at Penn State Health Children's Hospital in Hershey, Pennsylvania, who wasn't involved in the study.
"The physiological mechanisms underlying the effects in infants versus older children are unknown," Dr. Amatya said by email. "The immature immune system of children may respond to SARS-CoV-2 differentially in various age groups."
The case, highlighted in Pediatrics, involved a full-term male newborn with an uncomplicated vaginal delivery with Apgar scores of 9 and 10 at 1 minute and 5 minutes, respectively. On the second day after delivery, the mother developed a fever and had a nasopharyngeal swab that was positive for SARS-CoV-2; the infant was subsequently swabbed, and also positive.
Mother and baby were transferred to an airborne isolation room. After 48 hours, the newborn developed poor sucking and perioral cyanosis without signs of respiratory distress. The baby's respiratory rate was 15 to 20 per minute, heart rate was 120 beats per minute, and blood pressure was normal.
Cardiac abnormalities were ruled out by echocardiogram, and PCR on the nasopharyngeal specimen ruled out other respiratory viruses.
The baby was moved to the NICU, where he was put on 30% inspired oxygen via high flow nasal cannula. Lung ultrasound at this point didn't show consistent abnormalities, and chest radiograph showed mild bilateral ground glass opacities. After 36 hours, no major abnormalities were found on CT scan.
Fifty hours after NICU admission, the infant improved enough to have respiratory support discontinued. He was fed maternal expressed milk via nasogastric tube for 48 hours, then was able to bottle feed.
At day 18, the baby was discharged. On days 15 and 21, his qualitative PCR for SARS-CoV-2 remained positive, the researchers note. This suggests that newborns could be a source of horizontal transmission, the study team concludes in Pediatrics.
The authors did not respond to a request for comments.
The case report does suggest that birth should take place in a health facility, where any suspected infections in mothers or newborns can be addressed, and that preventive measures to prevent infection in newborns are necessary at the health facility and at home after discharge, said Dr. Pablo Duran of the Latin American Center of Perinatology, Women and Reproductive Health in Montevideo, Uruguay.
"Newborns may show higher vulnerability, and this implies that especially when other conditions are present, they may have transient episodes of hypoxemia or other clinical conditions," Dr. Duran, who wasn't involved in the study, said by email. "The speed and adequacy of care and response provided are essential."
SOURCE: https://bit.ly/2YLINjj Pediatrics, online June 30, 2020.
Reuters Health Information © 2020
Cite this: Neonatal SARS-CoV-2 May Present With Hypoxemia Without Respiratory Distress - Medscape - Jun 30, 2020.

We describe a case of neonatal SARS-CoV-2 infection, in an infant diagnosed 3 days after birth, and manifesting with silent hypoxemia, requiring respiratory support.

22/04/2020

Severe COVID-19 during Pregnancy and Possible Vertical Transmission

Thieme E-Books & E-Journals

13/04/2020

https://www.cps.ca/documents/p…

Canadian Paediatric Society: Protecting and promoting the health and well-being of children and youth.

13/04/2020

https://www.health.qld.gov.au/__data/assets/pdf_file/0033/947148/g-covid-19.pdf

16/12/2019

26/07/2019

Why 'Burnout' Is the Wrong Term for Physician Suffering

Wendy Dean, MD; Austin Charles Dean; Simon G. Talbot, MD
DISCLOSURES July 23, 2019

Make no mistake, no nefarious entity is solely responsible for this situation. No single administrator is making decisions expressly intended to harm his or her staff.
Rather, the focus on "burnout" and bolstering resilience arose in acknowledgement of physician dissatisfaction. In the absence of an alternative explanation, researchers latched onto "burnout" as an explanation, because the symptoms seemed to fit. Even better, there were well-marketed programs used in other professions, which administrators, who were also overburdened, could turn to for ready solutions to their employees' distress.
Unfortunately, surveys confirmed that physicians were struggling, but most of the burnout inventories used did not assess for systems challenges that physicians were pointing out as the source of their distress. Once there was the diagnosis of "burnout," we all failed to revisit that conclusion, even though physicians continue to suffer as burnout interventions abound.
One of the reasons for this is that there has been an erosion of the partnership between physicians, other clinicians, administrators, insurers, and national policy-makers in understanding the impact of policy and regulatory changes on clinical work. In most cases, meaningful input from clinicians is lacking before leadership (at many levels) makes decisions about how care is delivered, how physicians are incentivized, or how work hours are allocated.
While any one of the decisions that regulators, legislators, and administrators make might be innocuous, the sum of their decisions has become a tangle of contradictory requirements in the treatment room, which in turn has led to an epidemic of moral injury as physicians try to parse the impossible with every patient encounter.
The primary challenge for doctors is that we have not made it a priority to shout about our experience.
Administrators' primary sin is that they are not listening carefully to what those at the front lines of care are saying, and they are not making substantive changes based on that feedback. The primary challenge for doctors is that we have not made it a priority to shout about our experience.
For healthcare organizations to implement changes that truly improve physician well-being, they need to listen to how physicians experience their work life. Clinicians need to participate in focus groups, listening sessions, and truly confidential free-text surveys from leadership asking for unvarnished input. They need to watch their organization stand up in opposition to another performance metric, or another regulatory requirement, or another satisfaction survey, in defense of their staff. They need to see their practice environment change in response to their feedback or in the resources allocated to care. Physicians need to see that administrators are making a concerted effort to understand their distress and make real changes to mitigate the drivers.
Administrators also should be included in the experience of delivering care as regular team members on rounds or in the clinic or in the community. Watching clinicians try to develop treatment plans while balancing all of the competing allegiances facing them would be helpful. Watching them do it for 60 hours (or more) every week, all year long, would be eye-opening. That might help them realize that we are experiencing something bigger than "burnout," and that gaslighting us, telling us that wellness initiatives will solve our distress, only alienates their clinicians.
The challenges in healthcare are enormous and are felt by all involved—patients, clinicians, and administrators. It's time to make concerted efforts to understand the physician's perspective and the environment of moral distress that is the healthcare industry. Only then can we do what is really necessary: work together in the service of the patients who entrust us with their care.
When physicians fail to listen to their patients and consider their unique circumstances, they risk missing important diagnostic and therapeutic opportunities. When organizational leadership doesn't listen carefully to what drives physicians' distress, no meaningful progress can be made toward alleviating it. No amount of healthy dieting, rest, or exercise will fix what ails us.
We cannot outrun a dysfunctional healthcare system.