Hospital Survey Finds Reasons for Both Optimism and Concern About COVID-19 and Newborns

By Linda Carroll

October 28, 2020

(Reuters Health) - An April survey of hospitals around the world found low rates of infection with SARS-CoV-2 among newborns, but also shortages of testing equipment, personal protective equipment (PPE) and personnel.

Survey responses from more than 400 hospitals queried in April, 75% of which were in the U.S., found a low number of newborns infected: 54 confirmed cases and 311 suspected cases of COVID-19. It also found more than 50% said they had shortages of what was needed to care for the infants, according to results published in Pediatrics.

"The take-home message for us was that while the number of cases in April was low, over half of the hospitals reported shortages of equipment, testing or personnel, disrupting their ability to care for newborns," said study coauthor Erika Edwards, director of data science at the Vermont Oxford Network and a research associate professor at the University of Vermont, in Burlington.

"These results were from a survey done in April, but we continued the audit after that," Edwards said. "We did one in May, one in June, and one in September. Those audits didn't necessarily involve the same hospitals that responded in April. We haven't tracked the specific hospitals that participated."

The most recent audit, Edwards said, found a much lower number of newborns with confirmed infections, 3, as well as suspected infections, 61. "But in September, 41% were still experiencing a shortage of PPE, testing equipment and personnel," she added. "So just from what we've seen from these audits, while there are still infections in newborns as far as we can tell they are not raging through nurseries."

The authors note in their report that, "Preterm delivery and neonatal and postneonatal mortality increased during the 1918-1919 influenza pandemic, and more recent influenza outbreaks revealed ready transmission in NICUs. Whether SARS-Cov-2 will behave similarly is unknown."

To get a better understanding of how SARS-CoV-2 was impacting newborns and their care, Edwards and her colleagues invited hospitals via email to answer questions on Survey Monkey. Each participating hospital was asked to conduct an audit on a single day of their choice and report the results on that website.

The first part of the survey identified the census of infants admitted within 28 days of birth, confirmed infant cases, and suspected infant cases on the day of the audit in mother-infant rooms; level I, II, III or IV neonatal units, and special units created for the care of infants with COVID-19.

For the second part, hospitals were asked about shortages of personal protective equipment, beds, medical devices or equipment, or medications; about the availability or timeliness of testing; and about the availability of physicians, nurses, respiratory therapists or other personnel who significantly impacted the care of infants and families.

A total of 434 hospitals participated and 359 completed the audit. The 275 hospitals completing the first part reported 54 confirmed cases and 311 suspected cases of COVID-19 among 11,341 eligible infants. Overall, 62% of the hospitals reported no confirmed or suspected cases, while 90% reported three or fewer cases.

Of the 332 hospitals that completed the second part, 54% reported significant shortages of equipment, testing or personnel and 73% reported minor disruptions in care for infants and families, with 3% reporting an inability to care for some, most, or all infants.

One limitation of the study, the researchers note, is the possibility that hospitals with high numbers of COVID-19 cases were less likely to participate or that hospitals with limited numbers of cases were more likely to participate, which would potentially result in over- or under-estimates of the impact.

Edwards and her colleagues plan to survey hospitals again in December.

The new study suggests that there was a low number of newborns with confirmed COVID-19, even in April, said Dr. Christopher Golden, an associate professor of pediatrics at the Johns Hopkins School of Medicine in Baltimore, who wasn't involved in the research.

"The biggest concern could be that we were missing babies who could be infected but asymptomatic," Dr. Golden said, adding that, as the authors noted, the numbers could be over- or under-estimates of the impact of the disease.

Dr. Golden would like to see more audits published as this will shine a light on how things are changing with time and also "allow us to know where we are nationally and regionally, for example showing if there are differences between Maryland and Wisconsin. This speaks to the fact that there still needs to be a concerted effort to take the pandemic seriously and there is still a need for more personal protective equipment."

"It will be important to take another look at this as we head into winter to see if there are any changes," Dr. Golden said. "We are seeing an uptick in Maryland in terms of the number of cases."

SOURCE: Pediatrics, online October 27, 2020.