(Press-News.org) Two-thirds of 1,120 healthcare workers surveyed worldwide would separate mothers and babies with a positive or unknown COVID-19 status.
Implementing Kangaroo Mother Care and keeping mothers and babies together could save more than 125,000 newborn lives, representing 65x decreased risk of newborn death compared to the risk of newborn deaths from COVID-19.
New research underscores the need for decision-makers and providers, particularly in LMICs, to protect and strengthen care for small and sick newborns during the pandemic.
The COVID-19 pandemic is affecting the quality of care given to small and sick newborn babies in all regions of the world and threatening implementation of life-saving interventions, suggests new research published in BMJ Global Health.
The study is the first published survey to focus on small and sick newborns during the pandemic. It was conducted by a global collaboration, facilitated by the London School of Hygiene & Tropical Medicine (LSHTM) St. John's Medical College, Bangalore, India and NEST360.
Through an online questionnaire, the research team surveyed thousands of neonatal healthcare providers from 62 countries around the world, collecting data on the effect of the pandemic on newborn care. Africa and Asia had the largest numbers of respondents (>76%).
More than 85% of surveyed respondents reported 'fearing for their own health', with PPE shortages, stress and safety concerns among the issues reported. In some hospitals, they reported vital resources including staff and equipment, notably oxygen supplies, being moved from newborn wards to COVID-19 care wards.
A crucial finding was that two-thirds of health workers wouldn't support Kangaroo Mother Care (KMC), a life-saving technique involving early, prolonged skin-to-skin contact for preterm babies and exclusive breastfeeding, for mothers having a positive or unknown COVID-19 test status. Instead, these newborns are separated from their mothers and are at increased risk of death.
The importance of this finding is reinforced by new research published in EClinicalMedicine. Conducted by a global collaboration led by the World Health Organization with LSHTM and the University of California San Francisco (UCSF), which undertook analyses for 127 countries, the study estimated that if universal coverage of KMC was achieved, more than 125,000 newborn lives would be saved. Conversely, the risk of newborns catching COVID and dying would result in fewer than 2,000 deaths. Together, this shows at least a 65-fold increase in the risk of death by not doing KMC.
Professor Suman P N Rao, from St. John's Medical College, Bangalore, India, and a lead author on both studies, said:
"Kangaroo Mother Care is one of our most cost-effective ways to protect small and sick newborns. Now it is more critical than ever to ensure mothers are supported to do KMC and that healthcare professionals feel safe and comfortable to support in the delivery. Our data show huge promise for many lives saved with universal KMC, so it's vital that we use this opportunity to strengthen care now and build back better after the pandemic."
Newborns are the most vulnerable citizens worldwide. Each year 2.5 million newborns die within 28 days of their birthday, and more than 80% of these are low birth weight. Despite this, small and sick newborns haven't been considered in global assessments of pandemic-related disruptions.
A total of 1,120 participants responded to the survey, designed by a multidisciplinary team. Healthcare workers reported higher than usual stress levels with 85% fearing for their own health. More than 70% of respondents reported shortages in eye shields and high-quality face masks and less than one-fifth of healthcare providers felt confident about guidelines for treating newborns of COVID-19 infected mothers.
Lack of SARS-CoV-2 testing was flagged as a major challenge by many of the respondents. Only one-third of the respondents reported that testing was routinely available for pregnant women admitted for delivery (36.2%), and those with symptoms or contact history (30.7%). Testing of pregnant women admitted for delivery was reported as unavailable by 21.9% of respondents from Africa.
Dr Queen Dube, co-author, Paediatrician and Director of Health Services, Malawi, said:
"COVID-19 has had a devastating toll on our small and sick newborns across Africa. In Malawi we've been seeing this on the front-line - overstretched stressed staff, equipment and oxygen supplies being moved to other areas managing COVID-19 patients. It's heart-breaking yet we can do more to protect mothers and babies. We are seeing excellent innovations daily. Through clever engineering and agile turnarounds, NEST360 in Malawi was able to develop and make PPE. Now is the time to use learnings to strengthen health systems and radically improve care for 15 million newborns born too soon worldwide every year."
Reductions in hospital births and neonatal admissions were reported in all regions in addition to compromised newborn care due to women fearing to come to hospital, reallocation of personnel and/or equipment from newborn units. Those who did enter hospital for birth and newborn care were likely to request early discharge and not request newborn follow-up care. Of great concern are reports of oxygen supply reallocation from newborns and delays treating babies until a COVID-19 result had been received.
Further research is required, exploring how to enable healthcare workers performance, notably addressing fear of contact with undiagnosed infected patients (inadequate testing kits), and inadequate protective equipment (face masks and shields). Infection prevention in practice is also key. Guidelines for newborn care in the pandemic may be missing, unknown, unclear or potentially mistrusted. Urgent research is required regarding mitigation strategies to promote the health and mental wellbeing of the frontline healthcare workers, as well as how to protect women and their newborns.
Professor Joy Lawn from LSHTM, as well as NEST360, and senior author on both papers said:
"Our findings show how COVID-19 is disrupting care for small and sick newborns across the globe. Newborns can die in minutes and are the most vulnerable, even more so in a pandemic.
Policymakers can and must protect newborn health services, ensuring evidence-based practices for all, including women who are SARS-CoV-2-positive. Healthcare workers around the world are doing outstanding work despite challenging circumstances, and vaccines to protect them are urgently required. Data and rapid implementation research must be part of driving action. We could see reversals for hard-earned gains in newborn survival if we don't act now."
The authors acknowledge limitations, including that the online survey was only available in three languages, which could have affected the representativeness of respondents in some regions, as well as those working in extremely rural and remote areas where internet access is limited.
INFORMATION:
This survey stemmed from a partnership of newborn researchers globally, led by WHO and LSHTM with MRC Unit The Gambia at LSHTM, MRC/UVRI & LSHTM Uganda Research Unit, UCL, UCSF, and NEST360.
These researchers are funded though the Bill & Melinda Gates Foundation, MRC-UK, NIHR, Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health, and the NEST360 consortium of funders.
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
1. Switching from TDF- to TAF-containing ART associated with the development of obesity in people living with HIV
Abstract: https://www.acpjournals.org/doi/10.7326/M20-4853
URL goes live when the embargo lifts
Switching from antiretroviral therapy ...
In Switzerland about 17 000 people are living with an HIV infection, worldwide there are about 38 million. Today, the disease can be treated so successfully that a normal life can be ensured to a great extent. However, weight increases are often observed at the beginning of HIV therapy due to adaptations of the metabolism, which are part of a successful therapy. Therefore, body weight control plays an important role in HIV therapy. It is important, for example, to avoid metabolic problems that can lead to heart attacks or diabetes over the long term.
Tenofovir is the drug used as part of the standard HIV therapies. The previously, widely used TDF-based therapy (tenofovir disoproxil fumarate, TDF) has been associated with renal side effects and ...
An important Maya man buried nearly 1,300 years ago led a privileged yet difficult life. The man, a diplomat named Ajpach' Waal, suffered malnutrition or illness as a child, but as an adult he helped negotiate an alliance between two powerful dynasties that ultimately failed. The ensuing political instability left him in reduced economic circumstances, and he probably died in relative obscurity.
During excavations at El Palmar, a small plaza compound in Mexico near the borders of Belize and Guatemala, archaeologists led by Kenichiro Tsukamoto, an assistant professor of anthropology at UC Riverside, discovered a hieroglyph-adorned stairway ...
(Boston)-- Newly published National Institute of Neurological Disorders and Stroke (NINDS) Consensus Diagnostic Criteria for Traumatic Encephalopathy Syndrome (TES) are the first expert consensus criteria developed for the clinical disorder associated with Chronic Traumatic Encephalopathy (CTE) brain pathology. CTE is a degenerative brain disease associated with a history of repetitive head impacts, including those sustained in contact and collision sports such as American football and boxing. At this time, CTE can only be diagnosed after death through a neuropathological examination of brain tissue. There has been no accepted approach or agreed upon criteria for the diagnosis of CTE and its clinical manifestations during life until now.
"The publication of these criteria ...
Exercise during pregnancy may let mothers significantly reduce their children's chances of developing diabetes and other metabolic diseases later in life, new research suggests.
A study in lab mice has found that maternal exercise during pregnancy prevented the transmission of metabolic diseases from an obese parent - either mother or father - to child. If the finding holds true in humans, it will have "huge implications" for helping pregnant women ensure their children live the healthiest lives possible, the researchers report in a new scientific paper.
This means that one day soon, a woman's first trip to the doctor after conceiving might include a prescription for an exercise ...
The $1.9 trillion American Rescue Plan, a stimulus package introduced by the Biden Administration, recently received Congress' approval. The stimulus package, like its two predecessors aimed at providing relief for individuals and businesses hindered by the COVID-19 pandemic, includes another round of funding for the Paycheck Protection Program (PPP).
The American Rescue Plan includes $7.25 billion for PPP loans as well as a number of changes to make it easier for the smallest of businesses to gain access to the funding. With billions on the table for struggling small businesses, new research from the University of Florida Warrington College of ...
How important is fame? What about self-acceptance? Benevolence? The messages children between the ages of 8 and 12 glean from TV play a significant role in their development, influencing attitudes and behaviors as they grow into their teenage years and beyond, UCLA psychologists say.
Now, a new report by UCLA's Center for Scholars and Storytellers assesses the values emphasized by television programs popular with tweens over each decade from 1967 to 2017, charting how 16 values have waxed and waned in importance during that 50-year span.
Among the key findings is that fame, after nearly 40 years of ranking near the bottom (it was 15th in 1967, 1987 and 1997), rose to become the No. 1 ...
Louisiana State University researchers recently published findings that blight leads to an increased abundance of disease-carrying mosquitoes. The researchers investigated the presence of several mosquito species in two adjacent but socio-economically contrasting neighborhoods in Baton Rouge: the historic Garden District, a high-income neighborhood, and the Old South neighborhood, a low-income area. They found significantly higher adult and larvae abundance of the Asian tiger mosquito (a carrier of Zika and dengue) and higher mosquito habitat availability--particularly discarded tires--in the Old South neighborhood. This indicates that environmental conditions in the low-income neighborhood were most ideal for this mosquito to breed and proliferate.
"These ...
Some invasive species targeted for total eradication bounce back with a vengeance, especially in aquatic systems, finds a study led by the University of California, Davis.
The study, published today in the journal PNAS, chronicles the effort --and failure -- to eradicate invasive European green crabs from a California estuary. The crabs increased 30-fold after about 90 percent had been removed. The study is the first experimental demonstration in a coastal ecosystem of a dramatic population increase in response to full eradication.
"A failure in science often leads to ...
The world's oceans are a vast repository for gases including ozone-depleting chlorofluorocarbons, or CFCs. They absorb these gases from the atmosphere and draw them down to the deep, where they can remain sequestered for centuries and more.
Marine CFCs have long been used as tracers to study ocean currents, but their impact on atmospheric concentrations was assumed to be negligible. Now, MIT researchers have found the oceanic fluxes of at least one type of CFC, known as CFC-11, do in fact affect atmospheric concentrations. In a study appearing today in the Proceedings of the National Academy of Sciences, the team reports that the global ocean will reverse its longtime role as a sink for the potent ozone-depleting chemical.
The researchers ...
