RESUMO
Background: The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic. Methods: Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the 'EsPnIC Covid paEdiatric NeonaTal REgistry' (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines. Findings: 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March-June 2020 to 74% in January-March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March-June 2020 and January-March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth. Interpretation: This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed. Funding: The National Health and Medical Research Council (Australia): Grant ID 2008212 (DGT), Royal Children's Hospital Foundation: Grant ID 2019-1155 (EJP), Victorian Government Operational Infrastructure Support Program.
RESUMO
OBJECTIVE: The purpose of this study was to know the etiology, clinical background, treatment an evolution of severe infectious diseases in children admitted to Pediatric Intensive Care Units (PICUs). PATIENTS AND METHODS: A multicenter prospective study was carried out. Children with respiratory infections admitted to 10 PICUs throughout Spain between May 1994 and April 1995 were included in a long term survey. The nosocomial infections were not included. Student's t and Wilcoxon tests were used for quantitative variables and Chi square with Yates correction and Fisher's test for the qualitative variables. RESULTS: One hundred twenty-two patients with acute respiratory infections were studied. The mean value on Downes score at admittance was 5.2 +/- 2.3. Diagnosis were allocated as follows: 47 bronchopneumonia (38.5%), 40 bronchiolitis (33%), 15 epiglotitis (12%), 14 laryngitis (11.5%) and "others" 6 (5%). Etiologic agents were identified in 69 cases (56.5%), with respiratory syncytial virus being the most frequently isolated agent (35 cases, 51%), followed by Hemophilus influenzae in 13 cases (19%). The mean PICU stay was 5.8 +/- 7.9 days (1-67 days). Of these cases, 112 (92%) recovered completely and 9 (7%) died (8 with bronchopneumonia and 1 with epiglotitis). A significant association could be seen between the increase in mortality and the variables Downes' score and diagnosis of bronchopneumonia. CONCLUSIONS: The most frequent respiratory infections in the PICU were pneumonia and bronchopneumonia. Viral etiology, with a frequency of 54%, was the main cause of respiratory infection. Bacterial etiology represented 46% of the total cases, with Hemophilus influenzae as the most frequent etiologic agent.
