Rapid establishment of a COVID-19 perinatal biorepository: early lessons from the first 100 women enrolled.

BACKGROUND: Collection of biospecimens is a critical first step to understanding the impact of COVID-19 on pregnant women and newborns - vulnerable populations that are challenging to enroll and at risk of exclusion from research. We describe the establishment of a COVID-19 perinatal biorepository, the unique challenges imposed by the COVID-19 pandemic, and strategies used to overcome them. METHODS: A transdisciplinary approach was developed to maximize the enrollment of pregnant women and their newborns into a COVID-19 prospective cohort and tissue biorepository, established on March 19, 2020 at Massachusetts General Hospital (MGH). The first SARS-CoV-2 positive pregnant woman was enrolled on April 2, and enrollment was expanded to SARS-CoV-2 negative controls on April 20. A unified enrollment strategy with a single consent process for pregnant women and newborns was implemented on May 4. SARS-CoV-2 status was determined by viral detection on RT-PCR of a nasopharyngeal swab. Wide-ranging and pregnancy-specific samples were collected from maternal participants during pregnancy and postpartum. Newborn samples were collected during the initial hospitalization. RESULTS: Between April 2 and June 9, 100 women and 78 newborns were enrolled in the MGH COVID-19 biorepository. The rate of dyad enrollment and number of samples collected per woman significantly increased after changes to enrollment strategy (from 5 to over 8 dyads/week, P < 0.0001, and from 7 to 9 samples, P < 0.01). The number of samples collected per woman was higher in SARS-CoV-2 negative than positive women (9 vs 7 samples, P = 0.0007). The highest sample yield was for placenta (96%), umbilical cord blood (93%), urine (99%), and maternal blood (91%). The lowest-yield sample types were maternal stool (30%) and breastmilk (22%). Of the 61 delivered women who also enrolled their newborns, fewer women agreed to neonatal blood compared to cord blood (39 vs 58, P < 0.0001). CONCLUSIONS: Establishing a COVID-19 perinatal biorepository required patient advocacy, transdisciplinary collaboration and creative solutions to unique challenges. This biorepository is unique in its comprehensive sample collection and the inclusion of a control population. It serves as an important resource for research into the impact of COVID-19 on pregnant women and newborns and provides lessons for future biorepository efforts.

Characteristics of dysphagia in elderly patients requiring mechanical ventilation.

The purpose of this study was to describe the swallowing characteristics of elderly patients requiring mechanical ventilation with tracheostomy admitted to a long-term, acute-care hospital. The study was conducted through retrospective record review of patients on mechanical ventilation who had received a Modified Barium Swallow Study (MBSS) during their hospitalization. In a period from 1994 to 2002, 58 patients met the inclusion criteria. The study examined the results of both the clinical and the MBSS evaluations and compared the results and recommendations of the two examinations. Data were obtained from the MBSS records to describe the group in terms of dysphagia symptoms, frequency and occurrence of aspiration, respiratory status, and demographic variables. Parametric and nonparametric statistics were used to determine differences between the evaluations and any significant associations between aspiration and demographic variables, pharyngeal symptoms, and cognitive deficits. Significant differences were found between diet recommendations before and after the MBSS, and significant associations were found between aspiration and three pharyngeal symptoms. Although aspiration and especially silent aspiration occurred frequently in this group, most individuals were able to begin some level of oral intake after the MBSS evaluation. Due to the lack of reliable clinical evaluation measures, the MBSS is necessary for differential diagnosis of dysphagia and dietary recommendations for these individuals.