Background There are few reports of miscarriages or stillbirths in women infected with SARS-CoV-2. We present five consecutive cases of fetal death (≥12 weeks) without other putative causes in women with laboratory-confirmed (RT-PCR) COVID-19 managed in a single Brazilian institution. Case series All five women were outpatients with mild or moderate forms of COVID-19 and were not taking any medication. Four were nulliparous, all were overweight or obese, and none had any comorbidities or pregnancy complications that could contribute to fetal demise. Fetal death occurred at 21–38 weeks of gestation, on COVID-days 1–22. SARS-Cov-2 was detected by RT-PCR in amniotic fluid in one case and in placental specimens in two cases. All five women had acute chorioamnionitis on placental histology, massive deposition of fibrin, mixed intervillitis/villitis, and intense neutrophil and lymphocyte infiltration. One fetus had neutrophils inside alveolar spaces, suggestive of fetal infection. Conclusions These five cases of fetal demise in women with confirmed COVID-19 without any other significant clinical or obstetric disorders suggest that fetal death can be an outcome of SARS-CoV-2 infection in pregnancy. The intense placental inflammatory reaction in all five cases raises the possibility of a direct effect of SARS-CoV-2 on the placenta.
BackgroundThe occurrence of a respiratory syncytial virus (RSV) outbreak in a Neonatal Intensive Care Unit (NICU) is related to unfavorable outcomes, as this infection can lead to respiratory distress and death in premature in infants. Report the successful control of an outbreak that occurred in April 2010 in a NICU.MethodsAfter the index case, of 18 premature infants placed in the same room 10 infants were infected. Of those 10, 6 developed mild to moderate respiratory symptoms, 4 persisted asymptomatic and no death occurred. Contact and respiratory precautions were rapidly initiated, the infants were cohorted in 3 different rooms and palivizumab was administered to all contacts.ResultsThe outbreak was controlled and no new cases were subsequently indentified.ConclusionStandard infection control measures plus palivizumab prophylaxis were efficient in rapid control of the outbreak.
The majority of coronavirus disease 2019 (COVID-19) have been confirmed in adults, with only a few reported cases in children. In the pediatric population, COVID-19 infection appears to be often unremarkable or associated with mild respiratory symptoms. Little is known about neurologic complications related to COVID-19 in newborns. We present a case of severe encephalitis with cytotoxic brain edema in a newborn with COVID-19.
Background: Following the first reports of the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the 1970s, several measures to prevent its transmission were introduced in hospitals. However, controversy continues regarding the best approach to prevent and control MRSA, especially in neonatal intensive care units (NICUs). Objective: To report the reduction of colonization and primary central venous catheter–related bloodstream infection (CRBSI) caused by MRSA through surveillance, decolonization, and adoption of best practices in intravenous catheter care. Methods: Quasi-experimental, nonrandomized, before-and-after intervention study conducted in a 70-bed NICU in a private maternity hospital in Brazil. Period studied comprehended between August 2018 and May 2019 (period 1 - preintervention) and June to December 2019 (period II - postintervention). At the end of period 1, several measures were implanted to control and prevent colonization and CRBSI in the unit. The following measures were implemented: incentive to hand hygiene; best practices training on medication preparation and central catheter manipulation; systematic screening of colonized patients with nasal and umbilical swabs; contact precautions for colonized newborn (NB); contact precautions for twins of a colonized NB even when they had a negative swab; decolonization of patients with nasal mupirocin and chlorohexidine (oral preparation) for oral hygiene; concurrent linen change at the end of the patient’s decolonization; decolonization of parents of colonized siblings with chlorohexidine bath and nasal mupirocin; environmental organization; intensification of cleaning and disinfection of equipment and articles; cohort of patients and workers; isolation and precautions compliance audit; professional investigation and decolonization and universal chlorhexidine bath for newborns. Results: In periods I and II, the positivity rates of the collected swabs were 4.14% and 0.75% (P < .0001), respectively, with a peak of positivity of 11.8% in January. Also, 12 episodes of CRBSI were documented in period I (incidence, 2.9%) versus no episode in period 2, with a significant difference in incidence rate between the 2 periods (P = .002). Conclusion: The innovative measures were effective for eradicating the outbreak when instituted together with recognized good practices. In an outbreak scenario is difficult to define the isolated impact of each measure, although, parents’ decolonization to prevent the colonization of other siblings and contact precautions for twins of colonized NB seemed to improve the results.Funding: NoneDisclosures: None
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