Out-of-hospital Delivery: A Case Report

Unplanned out-of-hospital birth is defined as a birth that occurs before arrival and without a planned midwife or medical doctor. The frequency of complications in mothers and babies is higher in unplanned deliveries out of hospital. Due to the shortness of the uterus and a history of bleeding at the 17th week, a 27-year-old mother who was administered betamethasone three times intermittently and her baby who was 22 weeks old were brought to the pediatric emergency service by ambulance, with the umbilical cord not separated from the clamped placenta between the legs of the mother. The baby was hypothermic at the first evaluation. The baby was immediately warmed up, the navel was clamped and separated from the placenta, and nasal oxygen therapy was initiated. While the body temperature was 35.5 °C at the 20th minute of birth; placed in a thermal bag, placed in a transfer incubator, connected to nasal continuous positive airway pressure, and admitted to the neonatal intensive care unit. On the 9th day of her follow-up, baby died due to apnea, desaturation, and resistant acidosis and hypotension. This case is presented in order to minimize the complications related to out-of-hospital delivery and to emphasize the necessity for the healthcare professionals to be adequately trained and equipped for delivery and neonatal resuscitation management, and to develop protocols between health and ambulance services

COVID-19 Disease in Presenting to the Pediatric Emergency Department: A Multicenter Study of 8886 Cases.

Background: The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical out-comes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population.Methods: This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific anti-bodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of con-tact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded.Results: A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU.Conclusion: Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.(c) 2022 Elsevier Inc. All rights reserved