MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, Florida.
Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas.
Am J Perinatol. 2021 Jan;38(1):93-98. doi: 10.1055/s-0040-1718944. Epub 2020 Oct 19.
This study aimed to determine the prevalence of confirmed novel coronavirus disease 2019 (COVID-19) disease or infants under investigation among a cohort of U.S. neonatal intensive care units (NICUs). Secondarily, to evaluate hospital policies regarding maternal COVID-19 screening and related to those infants born to mothers under investigation or confirmed to have COVID-19.
Serial cross-sectional surveys of MEDNAX-affiliated NICUs from March 26 to April 3, April 8 to April 19, May 4 to May 22, and July 13 to August 2, 2020. The surveys included questions regarding COVID-19 patient burden and policies regarding infant separation, feeding practices, and universal maternal screening.
Among 386 MEDNAX-affiliated NICUs, responses were received from 153 (42%), 160 (44%), 165 (45%), 148 (38%) across four rounds representing an active patient census of 3,465, 3,486, 3,452, and 3,442 NICU admitted patients on the day of survey completion. Confirmed COVID-19 disease in NICU admitted infants was rare, with the prevalence rising from 0.03 (1 patient) to 0.44% (15 patients) across the four survey rounds, while the prevalence of patients under investigation increased from 0.8 to 2.6%. Hospitals isolating infants from COVID-19-positive mothers fell from 46 to 20% between the second and fourth surveys, while centers permitting direct maternal breastfeeding increased 17 to 47% over the same period. Centers reporting universal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) screening for all expectant mothers increased from 52 to 69%.
Among a large cohort of NICU infants, the prevalence of infants under investigation or with confirmed neonatal COVID-19 disease was low. Policies regarding universal maternal screening for SARS-CoV-2, infant isolation from positive mothers, and direct maternal breastfeeding for infants born to positive mothers are rapidly evolving. As universal maternal screening for SARS-CoV-2 becomes more common, the impact of these policies requires further investigation.
· In this cohort, neonatal COVID-19 is rare.. · Policies regarding isolation and breastfeeding for infants are rapidly evolving.. · Most hospitals are now providing universal screening for expectant mothers for SARS-CoV-2..
本研究旨在确定美国新生儿重症监护病房（NICU）中确诊的新型冠状病毒病 2019（COVID-19）患儿或接受调查的患儿的患病率。其次，评估医院针对 COVID-19 产妇筛查的政策以及与接受调查或确诊为 COVID-19 的产妇所生婴儿相关的政策。
2020 年 3 月 26 日至 4 月 3 日、4 月 8 日至 4 月 19 日、5 月 4 日至 5 月 22 日和 7 月 13 日至 8 月 2 日，对 MEDNAX 附属 NICU 进行了一系列横断面调查。这些调查包括关于 COVID-19 患者负担以及与婴儿分离、喂养实践和普遍产妇筛查相关政策的问题。
在 386 家 MEDNAX 附属 NICU 中，共有 153 家（42%）、160 家（44%）、165 家（45%）和 148 家（38%）在四轮调查中做出了回应，分别代表了调查当天活跃的 3465 名、3486 名、3452 名和 3442 名 NICU 入院患者的患者普查。NICU 入院患儿中确诊 COVID-19 疾病的情况很少见，患病率从第一轮调查的 0.03%（1 例患儿）上升至第四轮调查的 0.44%（15 例患儿），而接受调查的患儿的患病率从第二轮调查的 0.8%上升至第四轮调查的 2.6%。将婴儿与 COVID-19 阳性母亲隔离的医院从第二轮调查的 46%下降至第四轮调查的 20%，而允许母婴直接母乳喂养的中心在同一时期增加了 17 至 47%。报告对所有孕妇进行普遍严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）筛查的中心比例从第二轮调查的 52%上升至第四轮调查的 69%。
在新生儿重症监护病房的大量患儿中，接受调查或确诊为新生儿 COVID-19 疾病的患儿的比例较低。关于对所有孕妇进行 SARS-CoV-2 普遍筛查、对阳性母亲的婴儿进行隔离以及对阳性母亲所生婴儿进行直接母乳喂养的政策正在迅速演变。随着对 SARS-CoV-2 的普遍产妇筛查变得更加普遍，这些政策的影响需要进一步研究。
· 在该队列中，新生儿 COVID-19 很少见。· 针对婴儿隔离和母乳喂养的政策正在迅速演变。· 大多数医院现在为 SARS-CoV-2 为所有孕妇提供普遍筛查。
