COVID-19 pandemic in the neonatal intensive care unit: any effect on late-onset sepsis and necrotizing enterocolitis?

Indrio, Flavia; Salatto, Alessia; Amato, Orsola; Bartoli, Fabio; Capasso, Letizia; Corvaglia, Luigi; Maffei, G; Mosca, Fabio; Pettoello-Mantovani, Massimo; Raimondi, Francesco; Rinaldi, Matteo; Roggero, Paola; Aceti, Arianna

doi:10.1007/s00431-021-04254-1

Cited by 10 publications

(10 citation statements)

References 10 publications

(9 reference statements)

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“…Reports of clusters of outbreaks of NEC suggest infectious agents as a casual factor [ 20 ]. A previous study from four Italian NICUs concluded that COVID-19-related implementation of NICU hygiene policies was likely to reduce the occurrence of LOS in high-risk settings [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Necrotizing Enterocolitis and Late-Onset Sepsis during the COVID-19 Pandemic in Sweden: A Population-Based Cohort Study

Palleri,

Svenningsson,

Markasz

et al. 2024

Neonatology

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Introduction: The effect of the pandemic restrictions in the NICUs is not well studied. Necrotizing enterocolitis (NEC) is characterized by intestinal inflammation and bacterial invasion. This study aimed to investigate whether the incidence of NEC has changed during the COVID-19 pandemic in Sweden and whether it was associated with a change in the frequency of extremely preterm births. Methods: Data were retrieved from the Swedish Neonatal Quality Register (SNQ) for infants registered between January 2017 and December 2021 born below a gestational age of 35 weeks. The registry completeness is 98–99%. The diagnosis of NEC was the primary outcome. Generalized linear model analysis was used to calculate the risk ratio for NEC. Results: Totally 13,239 infants were included. 235 (1.8%) infants developed NEC, out of which 91 required surgical treatment. 8,967 infants were born before COVID-19 pandemic and 4,272 during. Median gestational age at birth was 32.8 weeks in both periods. The incidence of NEC was significantly lower during COVID-19 pandemic compared to the prior period (1.43 vs. 1.94%, p 0.037), but not the incidence of surgical NEC. The crude risk ratio of developing NEC during COVID-19 pandemic was 0.74 (95% CI: 0.55–0.98). The incidence of late-onset sepsis with positive culture was also declined during COVID-19 (3.21 vs. 4.15%, p value 0.008). Conclusion: While we found significant reduction in the incidence of NEC and culture-positive late-onset sepsis during the COVID-19 pandemic, the number of extremely preterm births was unchanged.

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Section: Discussionmentioning

confidence: 99%

The Incidence of Necrotizing Enterocolitis and Late-Onset Sepsis during the COVID-19 Pandemic in Sweden: A Population-Based Cohort Study

Palleri,

Svenningsson,

Markasz

et al. 2024

Neonatology

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“…Therefore, it could be likely to conclude that COVID-19 has influenced the pattern of incidence trend of neonatal sepsis to decline with a particular trend. The current decline in incidence trend is consistent with a significant decline in China [ 28 ], India [ 24 ], and Rwanda [ 32 ], unlike Italy, where there was no change between the pre-COVID-19 and COVID-19 impacted periods [ 61 ].…”

Section: Discussionmentioning

confidence: 65%

Epidemiologic features of neonatal sepsis and its COVID-19 associated temporal patterns in Jimma Medical Center, Ethiopia: A Joinpoint regression analysis

Geleta,

Abebe,

Workneh

et al. 2023

PLoS ONE

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Background Neonatal sepsis remains a leading cause of morbidity and mortality in neonates across all regions, including Africa. Compared to developed and some developing countries, there are relatively few epidemiological trends for neonatal sepsis and associated patterns with COVID-19 in Ethiopia. We modeled an epidemiological trend and pattern to aid in the monitoring of changes in neonatal sepsis. Methods Retrospective data were collected from all admissions to the Neonatal Intensive Care Unit (NICU) in Ethiopia at Jimma Medical Center between May 2019 and April 2022. We analyzed the monthly neonatal sepsis incidence, mortality, and case-fatality rates using STATA software. Finally, we modeled a monthly time series of neonatal sepsis incidence trends and patterns associated with the COVID-19-impacted period using Joinpoint software. For all analyses, a P value of 0.05 was considered statistically significant at the 95% confidence interval (CI). Results In the 36 months, 6796 cases were admitted to the NICU, with a 9.5% (95% CI: 9.1, 10.0) incidence rate of neonatal sepsis. The overall admission mortality rate was 16.5% (95% CI: 13.6, 19.8), while sepsis-attributed mortality was 7.1% (95% CI: 5.8, 8.5). The data showed an unstable decreasing trend for three Joinpoints (August 2020, December 2020, and August 2021). Notably, a decrease in the incidence trend was observed from May 2019 to August 2020 (MPC, -4.1; 95% CI: -7.6, -0.5; P = 0.03), followed by a sharp increase (MPC, 23.7; 95% CI: -13.8, 77.7; P = 0.24) from August 2020 to December 2020. From December 2020 to August 2021, there was again a decreasing trend (MPC, -13.8; 95% CI: -23.3, -3.5; P = 0.01), followed by a slight increase from August 2021 to April 2022 (MPC, 4.2; 95% CI: -8.4, 18.6; P = 0.52). Finally, the study revealed an association between patterns of neonatal sepsis incidence trends and COVID-19, with a Joinpoint jump model comparability ratio (CR = 0.43) between pre- and COVID-19-impacted periods. Conclusions Neonatal sepsis was prevalent at Jimma Medical Center, but it was on an unstably declining trend. The current results suggest a potential temporal association between the intensity of COVID-19 containment measures and a change in the incidence trend and patterns of neonatal sepsis. However, the quantified contribution of a particular containment measure requires further investigation.

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“…Interestingly, despite stricter infection control practices brought on by the COVID-19 pandemic, necrotizing enterocolitis or late-onset neonatal sepsis rates remained unchanged. 55 The changes in guidelines and clinical management of maternal COVID-19 infection during the early pandemic have had potentially indirect effects on neonatal outcomes, particularly related to maternal–infant separation. The long-term psychosocial impact of maternal–infant separation, increased cesarean section deliveries at many centers (likely secondary to maternal complications), and a lower threshold for cesarean delivery in the early course of the pandemic 54 56 changed breastfeeding practices, and limited family visitation in the hospital, remaining less understood.…”

Section: Maternal–newborn Contact and Evolving Infection Prevention G...mentioning

confidence: 99%

Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic

Gupta

Kamity²,

Sharma

et al. 2022

Am J Perinatol

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Coronavirus disease 2019 (COVID-19) pandemic caused significant mortality and morbidity in people of all age groups worldwide. Given the uncertainty regarding the mode of transmission and potential effects of COVID-19 on pregnant mothers and their newborns, guidelines for taking care of maternal–newborn dyads have evolved tremendously since the pandemic began. There has been an enormous influx of published materials regarding the outcomes of mothers and newborns. Still, multiple knowledge gaps regarding comprehensive information about risk to the mothers and newborns exist, which need to be addressed. Current evidence suggests that mothers with symptomatic COVID-19 infection are at increased risk of severe illness during pregnancy, with a higher need for respiratory support and premature deliveries. Neonates born to mothers with COVID-19 are at increased risk of needing intensive care; however, most newborns do well after birth. As new mutant variants arise, we need to be cautious while proactively understanding any new evolving patterns. All leading health authorities strongly recommend COVID-19 vaccination before or during pregnancy to reduce the risk of maternal morbidities and benefit from passing antibodies to newborns prenatally and via breastmilk. Additionally, there are racial, ethnic, and socioeconomic disparities in outcomes and vaccination coverage for pregnant women. This article summarizes the rapidly evolving evidence for the last 1.5 years and aims to help health care professionals care for mothers with COVID-19 and their newborns. Key Points

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COVID-19 pandemic in the neonatal intensive care unit: any effect on late-onset sepsis and necrotizing enterocolitis?

Cited by 10 publications

References 10 publications

The Incidence of Necrotizing Enterocolitis and Late-Onset Sepsis during the COVID-19 Pandemic in Sweden: A Population-Based Cohort Study

The Incidence of Necrotizing Enterocolitis and Late-Onset Sepsis during the COVID-19 Pandemic in Sweden: A Population-Based Cohort Study

Epidemiologic features of neonatal sepsis and its COVID-19 associated temporal patterns in Jimma Medical Center, Ethiopia: A Joinpoint regression analysis

Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic

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