New Jersey was among the first states impacted by the COVID-19 pandemic, with one of the highest overall death rates in the nation. Nevertheless, relatively few reports have been published focusing specifically on New Jersey. Here we report on molecular, clinical, and epidemiologic observations from the largest healthcare network in the state, in a cohort of vaccinated and unvaccinated individuals with laboratory-confirmed SARS-CoV-2 infection. We conducted molecular surveillance of SARS-CoV-2-positive nasopharyngeal swabs collected in nine hospitals from December 2020 through June 2022, using both whole genome sequencing (WGS) and a real-time RT-PCR screening assay targeting spike protein mutations found in variants of concern (VOC) within our region. De-identified clinical data were obtained retrospectively, including demographics, COVID-19 vaccination status, ICU admission, ventilator support, mortality, and medical history. Statistical analyses were performed to identify associations between SARS-CoV-2 variants, vaccination status, clinical outcomes, and medical risk factors. A total of 5,007 SARS-CoV-2-positive nasopharyngeal swabs were successfully screened and/or sequenced. Variant screening identified three predominant VOC, including Alpha (n =714), Delta (n =1,877), and Omicron (n =1,802). Omicron isolates were further sub-typed as BA.1 (n =899), BA.2 (n =853), and BA.4/BA.5 (n =50); the remaining 614 isolates were classified as “Other”. Approximately 31.5% (1,577/5,007) of the samples were associated with vaccine breakthrough infections, which increased in frequency following the emergence of Delta and Omicron. Severe clinical outcomes included ICU admission (336/5007 = 6.7%), ventilator support (236/5007 = 4.7%), and mortality (430/5007 = 8.6%), with increasing age being the most significant contributor to each (p <0.001). Unvaccinated individuals accounted for 79.7% (268/336) of ICU admissions, 78.3% (185/236) of ventilator cases, and 74.4% (320/430) of deaths. Highly significant (p <0.001) increases in mortality were observed in individuals with cardiovascular disease, hypertension, cancer, diabetes, and hyperlipidemia, but not with obesity, thyroid disease, or respiratory disease. Significant differences (p <0.001) in clinical outcomes were also noted between SARS-CoV-2 variants, including Delta, Omicron BA.1, and Omicron BA.2. Vaccination was associated with significantly improved clinical outcomes in our study, despite an increase in breakthrough infections associated with waning immunity, greater antigenic variability, or both. Underlying comorbidities contributed significantly to mortality in both vaccinated and unvaccinated individuals, with increasing risk based on the total number of comorbidities. Real-time RT-PCR-based screening facilitated timely identification of predominant variants using a minimal number of spike protein mutations, with faster turnaround time and reduced cost compared to WGS. Continued evolution of SARS-CoV-2 variants will likely require ongoing surveillance for new VOCs, with real-time assessment of clinical impact.
Objective: Determine if a post-resuscitation care (PRC) protocol in the well baby nursery (WBN) would improve identification of infants requiring NICU (Neonatal Intensive Care Unit) admission. Study design: This is a retrospective and prospective cohort study of a PRC protocol in 765 WBN admissions after delivery room (DR) resuscitation with continuous positive airway pressure (CPAP) and/or positive pressure ventilation (PPV). Results: After protocol initiation, NICU transfers during the birth hospitalization increased significantly (11.17% vs 16.08%, p<0.05). There was no difference in incidence of NICU transfer (5.99% vs 7.29%, pre-PRC vs PRC, p=0.47) during the first four hours of life during protocol administration. Respiratory distress was the most common indication for NICU transfer in both cohorts (7.90% vs 11.81%, p=0.09, pre-PRC vs PRC). Non-invasive positive pressure and/or high flow nasal cannula (5.72% vs 9.55%, p=0.06, pre-PRC vs PRC) were routinely administered in the NICU to transferred infants. Conclusions: After apparent recovery from DR resuscitation WBN admissions experience significant risk of complications requiring NICU transfer, supporting NRP recommendation for enhanced monitoring. In our study, we demonstrated the feasibility of standardized PRC protocol in the WBN. NICU transfers increased after initiation of a PRC protocol, however, further studies are needed to confirm possible benefits of this PRC protocol in improving identification of infants requiring a higher level of care.
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