The effects of the COVID-19 pandemic on newborn screening program services

Amaç: Yenidoğan Tarama Programları; yenidoğan döneminde sık görülen hastalıklara karşı erken dönemde tanı koyabilme imkanı sağlayan, ucuz ve kolay uygulanabilir, optimal duyarlılık ve özgüllüğe sahip yöntemler olarak tanımlanmaktadır. Bu çalışmada amacımız; COVID-19 pandemisi döneminde yenidoğan döneminde yapılması gereken tarama programlarına uyumu geçmiş yıllarla karşılaştırmaktır. Gereç ve Yöntemler: Çalışmamız Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi Rize Eğitim Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları ABD’ nda, 11 Mart-1 Haziran 2020 tarihleri temel alınarak gerçekleştirilmiştir. Elde edilen tüm veriler 2018 ve 2019 yıllarının aynı zaman dilimlerindeki veriler ile karşılaştırılmıştır. Bulgular: 2020 yılı çalışma döneminde tüm Rize ilinde toplam doğan çocuk sayısı 789 olup işitme testi taraması yapılma oranı %89,1 olarak, kalça USG çekim oranı %53,4 ve topuk kanı alınma oranı %99,6 olarak gözlenmiştir. Bu durum geçmiş yıllar ile karşılaştırıldığında; işitme testi ve kalça USG tarama oranları düşüş gösterirken topuk kanı alınma oranı artış göstermiştir. Ayrıca Yenidoğan Polikliniğimizde muayene/kontrolü gerçekleştirilen hastaların (n=560) doğumlara (n=501) oranı geçmiş yıllara göre azalarak 1,12 olarak tespit edilmiştir. Sonuç: COVID-19 pandemisinin ilk aylarında, işitme ve kalça USG tarama oranlarında bir azalma gözlenmiş, Topuk kanı taramasında geçmiş yılların aynı dönemine göre azalma gözlenmemiştir. Pandemi gibi kriz durumlarında, temel sağlık hizmetlerinin sunumunda değişim gözlenebileceği unutulmamalı ve gerekli tedbirler alınmalıdır.Aim: Newborn screening programs are inexpensive and easily applied methods with optimal sensitivity and specificity that permit early diagnosis of diseases frequently seen in the neonatal period. This study compared compliance with screening programs in the neonatal period during the COVID-19 pandemic with that in previous years. Material and Methods: The study was conducted for the period between 11 March and 1 June, 2020, at the Recep Tayyip Erdogan University Medical Faculty Rize Education and Research Hospital Children’s Health and Diseases Department. All data obtained were compared with the same periods in 2018 and 2019. Results: The number of children born in the entire province of Rize in the 2020 study period was 789. The hearing test performance rate was 89.1%, the hip USG rate was 53.4%, and the heel lance blood sampling test rate was 99.6%. Hearing test and hip USG screening rates decreased compared to previous years, while an increase was observed in heel blood sampling. The rate of patients undergoing examinations/controls in our neonatal clinic (n=560) to births (n=501) also decreased to 1.12 compared to previous years. Conclusion: A decrease was observed in hearing and hip USG screening in the first months of the COVID-19 pandemic. No decrease was observed in heel blood screening compared to the same period in previous years. Changes may be observed in the provision of basic health services in crises such as pandemics, and the requisite measures must be taken

An implicit cause of prolonged neonatal jaundice: vitamin B12 deficiency

Objective Prolonged jaundice is defined as a serum bilirubin level of more than 5 mg/dL, which persists at postnatal 14 days in term infants and 21 days following birth in preterm infants. Although the underlying causes cannot be found in the majority of prolonged jaundice cases, this may be the first sign of a serious issue. Therefore, this study aimed to evaluate the association between vitamin B12 deficiency and prolonged jaundice in newborns.Material and Methods This descriptive cross-sectional study was performed in a university hospital between January 1, 2015 and October 1, 2020. All participants consisted of infants who were admitted to the pediatric outpatient clinics. Infants > 35 weeks of gestation and with prolonged jaundice of unknown etiology were included in the study group. The control group consisted of infants > 35 weeks of gestation without prolonged jaundice. Demographic and clinical characteristics and serum vitamin B12 levels were evaluated comparatively.Results A total of 126 infants, 66 of whom had prolonged jaundice, were included. The mean gestational week of the study group was 38.4 +/- 1.8, and the control group was 38.6 +/- 1.9 weeks. There was no difference between the groups in terms of demographics and laboratory data. The vitamin B12 level of the study group was significantly lower (median = 170 pg/mL) than the control (median = 268 pg/mL).Conclusion Based on the findings of this study, vitamin B12 deficiency was thought to be an important cause of prolonged jaundice, and further studies are needed to explain the role of vitamin B12 deficiency in the etiology of prolonged jaundice

The effects of Coronavirus disease-2019 (COVID-19) pandemic on routine antenatal care visits and complications of pregnancy

OBJECTIVE: Routine follow-up of pregnancy is a comprehensive care process starting from planning of pregnancy that involves rational and careful use of medical, psychological, and social support. In this study, our objective was to compare the adherence rate to routine antenatal follow-up program during the COVID-19 pandemic with that of previous years among pregnant women, in an effort to shed light on health policies to be developed similar events in the future. METHODS: This retrospective cross-sectional study was carried out between March 11, 2019, when isolation measures were initiated in the context of precautionary steps taken in Turkey against the COVID-19 pandemic, and June 1, 2020, when the "normalization" was initiated. RESULTS: During the study period in 2020, the proportion of cesarean sections were higher, 61.1%, as compared to previous years (p=0.27). The stillbirths were numerically lower (1.2%, p=0.77), but the rate of spontaneous abortions was significantly higher (19.6%, p=0.009). The number of follow-up visits per pregnancy was lower than in previous years (3.8, p=0.02), although the proportion of patients visiting the outpatient units for regular controls to the overall patient group increased as compared to previous years (52.0%). CONCLUSION: During the flare-up of the COVID-19 pandemic (i.e. between March and June 2020), the rate of obstetric/neonatal morbidity and mortality except spontaneous abortion was not significantly higher as compared to the corresponding period in previous years. However, considering the potential increase in the risk of obstetric complications during a pandemic, specialized management programs targeting basic pregnancy follow-up services should be developed

Early Detection of Cardiotoxic Side Effects of Anthracyclines with the Use of N-Terminal Pro-BNP and Six-Minute Walk Test in Childhood Cancer Patients.

Her geçen yıl kanserli hasta sayısının hızla artmasına karşın bu hastaların kardiyak izlemlerinde kullanılacak fiyat-yarar değeri en yüksek test bilinmemektedir. Çalışmamızda antrasiklin türevi kemoterapi almış olan çocukların izlemlerinde klinik kardiyotoksisite ortaya çıkmadan pro-BNP ve 6DYT kullanılarak erken kardiyotoksisiteyi saptamanın yeri araştırılmıştır. Yakınması olmayan, son kemoterapi dozundan bu yana en az 9 en fazla 16 yıl süre geçen 16 hasta ve 16 sağlıklı günülü ile yapılan çalışmamızda olgulardan önce pro-BNP için serum örnekleri alınmış, bir sonraki gün Amerikan Toraks Derneği standartlarına uygun olarak 6DYT uygulanmıştır. Sonuçlar, pro-BNP’ nin antrasiklin tedavisi alanlarda sağlıklı gönüllülere göre yüksek olduğunu (p:0,051) ve alınan kümülatif antrasiklin dozu arttıkça yüksek korelasyonla (p:0,02) pro- BNP düzeylerinin de arttığını göstermektedir; bu fark özellikle kemoterapi dozu 250 mg/m2’ nin üzerine çıktığında istatistiksel olarak anlamlı olmaktadır (p:0,016). Alınan kümülatif antrasiklin dozu arttıkça hastaların yürüdüğü 6DYT azalmakla birlikte (negatif korelasyon, p:0,092) kümülatif kemoterapi dozu 250 mg/m2’ den daha yüksek olanlar ve kemoterapi almayanlar arasında 6DYT açısından istatistiksel olarak anlamlı bir fark bulunmamaktadır (p:0,076). Kardiyotoksik ilaç alan hastaların uzun dönem izlemlerinde hastalara ulaşmada yaşanan sıkıntılar ve 6DYT’ nin ülkemizde ve dünyada çocuk hastalarda yeni uygulanmaya başlayan bir test olması nedeniyle kanser hastalarında kardiyotoksisitenin izleminde 6DYT ve pro-BNP’ nin yerini belirlemek amacı ile yeni çalışmaların yapılmasına gerek vardır.Despite the fact that the number of pediatric cancer patients rapidly increasing each year, the most cost-effective cardiac follow-up test is still unknown. The significance of pro-BNP and six-minute walk test in the follow-up of pediatric cancer patients who accomplished chemotherapy and out of clinical cardiotoxicity, has been investigated in this study. Pro-BNP levels were measured in the serum samples of 16 patients who have no symptoms of heart failure and completed their chemotherapy between 9 and 16 years ago, and 16 healthy control subjects. The day after, six-minute walk test was performed according to American Thorax Society recommendations. According to results; patients treated with anthracyclines have higher serum pro-BNP levels than control subjects (p:0,051). As cumulative anthracycline dosage increases the levels of pro-BNP are elevated with a high correlation rate (p:0,02); and the difference between two groups is getting statistically significant when the cumulative dosage exceeds 250 mg/m2 (p:0,016). As cumulative anthracycline dosage increases the distance in six-minute walk test decreases (negative correlation p:0,092) but there is no statistically significant difference between the patients who received chemotherapy with a cumulative dosage more than 250 mg/m2 and the ones who had none (p:0,076). In all countries it is very difficult to reach pediatric cancer patients after completing their chemotherapy. Moreover, six-minute walk test is newly becoming familliar in pediatricians in our country. Eventually, the value of pro-BNP and six-minute walk test in the follow-up of pediatric cancer patients should be studied and supported with following studies

Intergluteal sulcus flattening in a newborn

abdominal mass, congenital abnormality, congenital heart disease, cystic mass, newborn, pelvis, perinatal period, prenatal diagnosis, respiratory distress, teratoma A 2,700-g female infant born at 40 weeks' gestation to a 26-year-old woman (gravida 1 para 1) is brought to the NICU with respiratory distress. While the infant is being treated for transient tachypnea of the newborn, the attending nurse notices that the sacral region does not appear normal and calls for the physician (Fig 1). The physician’s assistant agrees and orders ultrasonography for a possible diagnosis of vertebral fusion defect. Ultrasonography reveals a cystic mass extending into the abdomen. The neonatologist is consulted. Physical examination reveals a small nontender bulging mass, which has a rubberlike sensation on palpation at the sacral region. Abdominal magnetic resonance imaging confirms that the cystic mass is approximately 8,5 × 5,5 × 4 cm in size and is located behind the bladder in the pelvis (Fig 2, Video). Neurologic examination findings are completely normal, she shows no signs of..

Health service delivery quality and patient satisfaction in pediatric emergency department

Introduction: Pediatric emergency care units serve continuous labor to a large group of patients with variable complaints. Waiting time is the period from the admission to discharge of a patient and is one of the main determinants of patient satisfaction. We aimed to measure satisfaction levels of the patients and the factors influencing it with particular attention to waiting time. Methods: We conducted the study in a level 3 pediatric emergency care unit of Rize Governmental University Hospital. We measured the period from the admission to physical examination, laboratory and radiological investigation, emergency medication, prescription, and discharge. At the end of discharge, we measured the level of satisfaction with Likert scale questions. Results: From 2.041 patients admitted to the pediatric emergency care between 4th and 10th of March 2019, we surveyed 662 patients. The mean age was 76.2±63.5 (0-204) months with a female to male ratio of 320/342. Three hundred seventy patients (55.7%) were classified as green, 289 (43.9%) as yellow and 3 (0.4%) as red. The mean waiting time of all patients was 8.9±11.6 (0-94) minutes. Doctors’ level of paying attention to the patient was the highest-rated parameter in the questionnaire whereas waiting time was the lowest. Conclusion: According to the results, the waiting time of patients in our pediatric emergency department is less than the previous national and international reports. On the other hand, the ratio of the patients hospitalized or referred to another hospital is too low, which puts forward the problem of “unneeded patient admission”. Avoidable patient density together with inconvenient use of medical resources may lead to insufficient care of the patients in absolute urgent need and decrease patient satisfaction. In order to enhance the quality of care, we need to educate health professionals, design the physical conditions of the institution, establish a well-functioning triage system and put the waiting time of patients under a reasonable duration. © 2021 Çocuk Acil Tıp ve Yoğun Bakım Derneği Çocuk Acil ve Yoğun Bakım Dergisi, Galenos Yayınevi tarafından yayınlanmıştır

Epidemiologic and clinical characteristics of neonates with late-onset COVID-19: 1-year data of Turkish Neonatal Society

The literature on neonates with SARS-CoV-2 is mainly concerned with perinatal cases, and scanty data are available about environmentally infected neonates. To fill knowledge gaps on the course and prognosis of neonatal cases, we analyzed 1-year data from the Turkish Neonatal Society in this prospective cohort study of neonates with postnatal transmission. Data from 44 neonatal intensive care units (NICUs), of neonates with positive RT-PCR results at days 5-28 of life, were extracted from the online registry system and analyzed. Of 176 cases, most were term infants with normal birth weight. Fever was the most common symptom (64.2%), followed by feeding intolerance (25.6%), and cough (21.6%). The median length of hospitalization was 9 days, with approximately one quarter of infants receiving some type of ventilatory support. Myocarditis (5.7%) was the most common complication during follow-up. Among the clinical findings, cough (odds ratio [OR]: 9.52, 95% confidence interval [CI]: 4.17-21.71), tachypnea (OR: 26.5, 95% CI: 9.59-73.19), and chest retractions (OR: 27.5, 95% CI: 5.96-126.96) were associated with more severe clinical disease. Also, there were significant differences in the C-reactive protein level, prothrombin time (PT), partial thromboplastin time, international normalized ratio, and days in the NICU (p = 0.002, p = 0.012, p = 0.034, p = 0.008, and p < 0.001, respectively) between patients with mild-moderate and severe-critical presentations. A PT above 14 s was a significant predictor of severe/critical cases, with a sensitivity of 64% and specificity of 73%

Epidemiologic and clinical characteristics of neonates with late-onset COVID-19: 1-year data of Turkish Neonatal Society

The literature on neonates with SARS-CoV-2 is mainly concerned with perinatal cases, and scanty data are available about environmentally infected neonates. To fill knowledge gaps on the course and prognosis of neonatal cases, we analyzed 1-year data from the Turkish Neonatal Society in this prospective cohort study of neonates with postnatal transmission. Data from 44 neonatal intensive care units (NICUs), of neonates with positive RT-PCR results at days 5-28 of life, were extracted from the online registry system and analyzed. Of 176 cases, most were term infants with normal birth weight. Fever was the most common symptom (64.2%), followed by feeding intolerance (25.6%), and cough (21.6%). The median length of hospitalization was 9 days, with approximately one quarter of infants receiving some type of ventilatory support. Myocarditis (5.7%) was the most common complication during follow-up. Among the clinical findings, cough (odds ratio [OR]: 9.52, 95% confidence interval [CI]: 4.17-21.71), tachypnea (OR: 26.5, 95% CI: 9.59-73.19), and chest retractions (OR: 27.5, 95% CI: 5.96-126.96) were associated with more severe clinical disease. Also, there were significant differences in the C-reactive protein level, prothrombin time (PT), partial thromboplastin time, international normalized ratio, and days in the NICU (p = 0.002, p = 0.012, p = 0.034, p = 0.008, and p < 0.001, respectively) between patients with mild-moderate and severe-critical presentations. A PT above 14 s was a significant predictor of severe/critical cases, with a sensitivity of 64% and specificity of 73%. Conclusions: Our data showed that late-onset COVID-19 infection in neonates who need hospitalization can be severe, showing associations with high rates of ventilatory support and myocarditis. Cough, tachypnea, and retractions on admission suggest a severe disease course

A multicenter study on epidemiological and clinical characteristics of 125 newborns born to women infected with COVID-19 by Turkish Neonatal Society

Limited data are available on pregnant women with COVID-19 and their neonates. We aimed to evaluate the epidemiological and clinical characteristics of newborns born to women infected with COVID-19. A multicenter cohort study was conducted among newborns born to mothers with COVID-19 in 34 neonatal intensive care units (NICUs) in Turkey. Pregnant women (n = 125) who had a positive RT-PCR test and their newborns were enrolled. Cesarean section, prematurity, and low-birthweight infant rates were 71.2%, 26.4%, and 12.8%, respectively. Eight of 125 mothers (6.4%) were admitted to an intensive care unit for mechanical ventilation, among whom six died (4.8%). Majority of the newborns (86.4%) were followed in isolation rooms in the NICU. Four of 120 newborns (3.3%) had a positive RT-PCR test result. Although samples taken on the first day were negative, one neonate became positive on the second day and the other two on the fifth day. Sample from deep tracheal aspirate was positive on the first day in an intubated case

A multicenter study on epidemiological and clinical characteristics of 125 newborns born to women infected with COVID-19 by Turkish Neonatal Society

Palalioglu, Rabia Merve/0000-0003-2717-7925WOS: 000558113600001PubMed: 32776309Limited data are available on pregnant women with COVID-19 and their neonates. We aimed to evaluate the epidemiological and clinical characteristics of newborns born to women infected with COVID-19. A multicenter cohort study was conducted among newborns born to mothers with COVID-19 in 34 neonatal intensive care units (NICUs) in Turkey. Pregnant women (n = 125) who had a positive RT-PCR test and their newborns were enrolled. Cesarean section, prematurity, and low-birthweight infant rates were 71.2%, 26.4%, and 12.8%, respectively. Eight of 125 mothers (6.4%) were admitted to an intensive care unit for mechanical ventilation, among whom six died (4.8%). Majority of the newborns (86.4%) were followed in isolation rooms in the NICU. Four of 120 newborns (3.3%) had a positive RT-PCR test result. Although samples taken on the first day were negative, one neonate became positive on the second day and the other two on the fifth day. Sample from deep tracheal aspirate was positive on the first day in an intubated case. Conclusion: COVID-19 in pregnant women has important impacts on perinatal and neonatal outcomes. Maternal mortality, higher rates of preterm birth and cesarean section, suspected risk of vertical transmission, and low rate of breastfeeding show that family support should be a part of the care in the NICU. Trial registration:identifier: NCT04401540 What is Known: center dot the common property of previous reports was the conclusions on maternal outcomes, rather than neonatal outcomes. center dot Published data showed similar outcomes between COVID-19 pregnant women and others. What is New: center dot Higher maternal mortality, higher rates of preterm birth and cesarean section, suspected risk of vertical transmission especially in a case with deep tracheal aspiration during the intubation, and the possible role of maternal disease severity on the outcomes are remarkable findings of this study. center dot in contrast to recommendation for breastfeeding, parents' preference to formula and expressed breast milk due to anxiety and lack of information shows that family support should be a part of the care in the NICU. Trial registration: ClinicalTrials.gov identifier: NCT0440154