Prediction of retinopathy of prematurity using the WINROP screening algorithm in a South African population

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Paediatrics Johannesburg, May 2018.Introduction WINROP (Weight, IGF-1, Neonatal Retinopathy of Prematurity) is an online screening algorithm with sensitivities of 84.7 – 100% for severe ROP in other countries. The aim of this study is to test the efficacy of WINROP as a screening tool in a South African population. Methods This retrospective record review included infants born between 1 January 2013 and 1 December 2014 who underwent ROP screening. Gestational age, date of birth, weekly weights and final ophthalmology screening results were entered into WINROP. The outcomes of ophthalmology clinical examinations were compared to alarms triggered on the system. Sensitivity and specificity, positive predictive and negative predictive values, the mean time of alarm and average weight gain per week were calculated. Results were compared between patients with complete and missing weekly weights. Results Two hundred and twenty infants were included with a mean gestational age of 29.1 weeks (SD 1.8 weeks), and a mean birth weight of 1115.5g (SD 201.0 grams). Infants with complete weights totalled 193 patients with a mean gestational age of 29.1 weeks (SD 1.8 weeks) and a mean birth weight of 1115.8g (SD 201.2 grams), with no statistical difference between groups. The rates for all stages/severity of ROP were 5.9% and 2.3% for severe ROP. Weekly weight gain ranged between 4.6 to 83.8g/kg per week. WINROP triggered a high risk alarm in 70.5% of infants at a mean of 30.7 weeks gestational age. The sensitivity for severe ROP was 100%, but 76.9% for ROP in all infants and 83.3% in the complete weight group. The specificity was low for both severe and all ROP at 30.2% (complete weights 26.6%) and 30.0% (complete weights 26.5%) respectively. Conclusion Our rates of ROP are low. Rates of severe ROP have been found to be lower in African populations. The high number of alarms with a low negative predictive value, would reduce the number of screens by 29.5%. The alarms were triggered before scheduled screening, possibly helpful in planning discharges and follow up visits. The poor growth rates postnatally may have resulted in the increased alarms. This may be due to lower levels of IGF-1 and absolute weight gain postnatally in black infants. Screening algorithms relying on growth and IGF-1 levels are race dependent, which needs to be considered in future algorithms for African populations.LG201

An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting

IntroductionThe provision of kangaroo mother care (KMC) involving continuous skin-to-skin care (SSC) is an important intervention in neonatal care, which is recommended even when women are infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2). We report on a nosocomial outbreak of SARS-CoV-2 infections in a KMC ward.MethodsContact tracing was conducted following the diagnosis of SARS-CoV-2 in a mother lodging in the KMC ward. All mother-newborn dyads in the KMC and healthcare workers (HCW) were tested for SARS-CoV-2 within 24–72 h of diagnosing the index case. Nasopharyngeal swab samples were obtained and tested from contacts, with a nucleic acid amplification test (NAAT) assay. Next-generation sequencing was done on positive samples. The secondary attack rate (SAR) was calculated assuming that the mother who presented with symptoms was the source of infection.ResultsTwelve (70.6%) of 17 mothers and 8 (42.1%) of 19 neonates who were in the KMC ward with the index case were found to be positive with SARS-CoV-2. Seven (87.5%) of the 8 neonates who tested positive had mothers who also tested positive. Seventy-five percent (9/12) of the mothers and 62.5% (5/8) of the neonates who tested positive were asymptomatic. Eight (27.6%) of 29 HCW were found to be positive and were all asymptomatic. One neonate died from Acinetobacter baumannii sepsis, and his post-mortem lung histopathology showed features compatible with SARS-CoV-2 pneumonia. The sequencing of 13 specimens, which included 1 mother-newborn dyad, indicated clustering to the same phylogenetic lineage with identical mutations. In assessing for factors contributing to this outbreak, it was found that spaces between beds were less than 1 m and mothers had their meals around the same table at the same time.ConclusionWe report on a nosocomial outbreak of SARS-CoV-2 in a KMC ward, affecting a high number of mothers and neonates, and to a lesser extent HCWs. Although it is difficult to point to the index case as the source of this outbreak, as asymptomatic individuals can spread infection, the inadequate adherence to non-pharmaceutical interventions was assessed to have contributed to the spread of infection. This highlights the need for awareness and adherence to mitigation strategies to avoid SARS-CoV-2 outbreaks