Congenital infection of SARS-CoV-2 in live-born neonates: a population-based descriptive study.

OBJECTIVE: To evaluate the evidence of mother-to-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This is a descriptive, multicentre, observational study in nine tertiary care hospitals throughout Spain. The study population was women with coronavirus disease 2019 during pregnancy. Mother-to-child transmission was defined as positive real-time RT-PCR of SARS-CoV-2 in amniotic fluid, cord blood, placenta or neonatal nasopharyngeal swabs taken immediately after birth. RESULTS: We included 43 women with singleton pregnancies and one with a twin pregnancy, as a result we obtained 45 samples of placenta, amniotic fluid and umbilical cord blood. The median gestational age at diagnosis was 34.7 weeks (range 14-41.3 weeks). The median interval between positive RT-PCR and delivery was 21.5 days (range 0-141 days). Fourteen women (31.8%, 95% CI 18.6%-47.6%) were positive at the time of delivery. There was one singleton pregnancy with SARS-CoV-2 RT-PCR positive in the placenta, amniotic fluid and umbilical cord blood (2.2%, 95% CI 0.1%-11.8%). Nasopharyngeal aspiration was performed on 38 neonates at birth, all of which were negative (0%, 95% CI 0%-9.3%). In 11 neonates the nasopharyngeal aspiration was repeated at 24-48 hours, and one returned positive (9.1%, 95% CI 0.2%-41.3%). CONCLUSIONS: The presence of SARS-CoV-2 in placenta, amniotic fluid and cord blood shows that mother-to-child transmission is possible but uncommon.

Gestation and COVID-19: clinical and microbiological observational study (Gesta-COVID19).

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) is a novel disease which has been having a worldwide affect since December 2019. Evidence regarding the effects of SARS-CoV-2 during pregnancy is conflicting. The presence of SARS-CoV-2 has been demonstrated in biological samples during pregnancy (placenta, umbilical cord or amniotic fluid); however, maternal and fetal effects of the virus are not well known. METHODS: Descriptive, multicentre, longitudinal, observational study in eight tertiary care hospitals throughout Spain, that are referral centres for pregnant women with COVID-19. All pregnant women with positive SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction during their pregnancy or 14 days preconception and newborns born to mothers infected with SARS-CoV-2 will be included. They will continue to be followed up until 4 weeks after delivery. The aim of the study is to investigate both the effect of COVID-19 on the pregnancy, and the effect of the pregnancy status with the evolution of the SARS-CoV-2 disease. Other samples (faeces, urine, serum, amniotic fluid, cord and peripheral blood, placenta and breastmilk) will be collected in order to analyse whether or not there is a risk of vertical transmission and to describe the behaviour of the virus in other fluids. Neonates will be followed until 6 months after delivery to establish the rate of neonatal transmission. We aim to include 150 pregnant women and their babies. Ethics approval will be obtained from all the participating centres. DISCUSSION: There is little information known about COVID-19 and its unknown effects on pregnancy. This study will collect a large number of samples in pregnant women which will allow us to demonstrate the behaviour of the virus in pregnancy and postpartum in a representative cohort of the Spanish population.

Cures pal·liatives perinatals: acompanyament integral I multidisciplinari des del diagnòstic fins a casa / Cuidados paliativos perinatales / Perinatal palliative care: integrated and multidisciplinary support

FONAMENT: Una tercera part de la mortalitat infantil es concentra en el període neonatal. Un percentatge important d'aquestes morts són previsibles i, per tant, tributàries de rebre cures pal·liatives perinatals (CPP). OBJECTIU: En aquest treball es revisen els aspectes claus en l'atenció pal·liativa dels fetus o nounats amb condicions limitants o amenaçants per a la vida. Mètode. Es realitza una revisió bibliogràfica. RESULTATS: Es revisen els escenaris en què estan indicades les CPP, la importància de les cures centrades en el desen-volupament I la família (CCDF) que es duen en terme a les unitats neonatals, així com els aspectes de comunicació, presa de decisions, maneig multidisciplinari I coordinació entre els diferents nivells assistencials per atendre els nadons I a les seves famílies. CONCLUSIONS: L'acompanyament integral, multidisciplinari I individualitzat, I les cures centrades en el nadó I la família són les claus en les CPP

FUNDAMENTO: Una tercera parte de la mortalidad infantil se concentra en el período neonatal. Un porcentaje importante de estas muertes son previsibles y, por lo tanto, tributarias de recibir cuidados paliativos perinatales (CPP). OBJETIVO: En este trabajo se revisan los aspectos claves en la atención paliativa de los fetos o recién nacidos con condiciones limitantes o amenazantes para la vida. MÉTODO: Se realiza una revisión bibliográfica. RESULTADOS: Se revisan los escenarios en que están indicados los CPP, la importancia de los cuidados centrados en el desarrollo y la familia (CCDF) que se llevan a cabo en las unidades neonatales, así como los aspectos de comunicación, toma de decisiones, manejo multidisciplinario y coordinación entre los diferentes niveles asistenciales para atender a los bebés ya sus familias. CONCLUSIONES: El acompañamiento integral, multidisciplinar e individualizado, y los cuidados centrados en el bebé y la familia son claves en los CPP

BACKGROUND: A third of infant mortality occurs in the neonatal period. A significant proportion of those deaths are predictable and perinatal palliative care (PPC) is thus indicated. OBJECTIVE: We reviewed the key aspects in palliative care of fetuses and newborns with life-threatening conditions. Method. Bibliography review. RESULTS: We reviewed the different scenarios where PPC is indicated and the importance of development and family centered care in the newborn units, as well as communication, multidisciplinary management, decision-making process and coordination among care levels to optimize care for newborns and their families. CONCLUSIONS: Integrated, multidisciplinary, and individualized support, and care centered around the newborn and the family are key in PPC

Less Invasive Surfactant Administration in Spain: A Survey Regarding Its Practice, the Target Population, and Premedication Use.

OBJECTIVE: Scientific evidence supports the use of less invasive surfactant administration (LISA) techniques, but certain issues may be limiting its generalized incorporation in clinical practice. The objectives were to determine the level of acceptance of LISA techniques in Spanish hospitals, the types of methods used, the target population, and the premedication administered. STUDY DESIGN: An online survey was designed and sent to various secondary/tertiary hospitals in Spain. RESULTS: Among 67 neonatal units contacted, 44 (65.7%) participated. LISA was used in 89%, and those that did not perform the technique were contemplating its use in the future. In total, 77% of hospitals used some type of pharmacologic sedation/analgesia before the procedure: 28% always and 49% sometimes. In all cases, the reason for premedication was concerned about pain and discomfort. The types of drugs and doses varied. CONCLUSION: LISA has been incorporated in clinical practice of the hospitals surveyed, with a utilization rate higher than what has been reported to date. Sedation and analgesia are commonly administered. LISA is viewed as potentially involving some degree of pain and discomfort. Further studies are needed to determine the safest and most effective pharmacologic and nonpharmacologic measures to apply in these procedures.