Neighborhood Characteristics and Racial Disparities in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Seropositivity in Pregnancy.

2022

1018-1026

06/2022

1873-233X

OBJECTIVE: To quantify the extent to which neighborhood characteristics contribute to racial and ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity in pregnancy.

METHODS: This cohort study included pregnant patients who presented for childbirth at two hospitals in Philadelphia, Pennsylvania from April 13 to December 31, 2020. Seropositivity for SARS-CoV-2 was determined by measuring immunoglobulin G and immunoglobulin M antibodies by enzyme-linked immunosorbent assay in discarded maternal serum samples obtained for clinical purposes. Race and ethnicity were self-reported and abstracted from medical records. Patients' residential addresses were geocoded to obtain three Census tract variables: community deprivation, racial segregation (Index of Concentration at the Extremes), and crowding. Multivariable mixed effects logistic regression models and causal mediation analyses were used to quantify the extent to which neighborhood variables may explain racial and ethnic disparities in seropositivity.

RESULTS: Among 5,991 pregnant patients, 562 (9.4%) were seropositive for SARS-CoV-2. Higher seropositivity rates were observed among Hispanic (19.3%, 104/538) and Black (14.0%, 373/2,658) patients, compared with Asian (3.2%, 13/406) patients, White (2.7%, 57/2,133) patients, and patients of another race or ethnicity (5.9%, 15/256) (P<.001). In adjusted models, per SD increase, deprivation (adjusted odds ratio [aOR] 1.16, 95% CI 1.02-1.32) and crowding (aOR 1.15, 95% CI 1.05-1.26) were associated with seropositivity, but segregation was not (aOR 0.90, 95% CI 0.78-1.04). Mediation analyses revealed that crowded housing may explain 6.7% (95% CI 2.0-14.7%) of the Hispanic-White disparity and that neighborhood deprivation may explain 10.2% (95% CI 0.5-21.1%) of the Black-White disparity.

CONCLUSION: Neighborhood deprivation and crowding were associated with SARS-CoV-2 seropositivity in pregnancy in the prevaccination era and may partially explain high rates of SARS-CoV-2 seropositivity among Black and Hispanic patients. Investing in structural neighborhood improvements may reduce inequities in viral transmission.

10.1097/AOG.0000000000004791

Obstet Gynecol

35675599

Assessment of SARS-CoV-2 serostatus and hypertensive disorders of pregnancy.

2022

06/2022

1097-6868

10.1016/j.ajog.2022.06.012

Am J Obstet Gynecol

35718110

Perinatal COVID-19 maternal and neonatal outcomes at two academic birth hospitals.

2022

07/2022

1476-5543

OBJECTIVE: Describe 1-month outcomes among newborns of persons with perinatal COVID-19.

STUDY DESIGN: Prospective observational study of pregnant persons who tested positive for SARS-CoV-2 between 14 days before and 3 days after delivery and their newborns, from 3/2020 to 3/2021 at two urban high-risk academic hospitals. Phone interviews were conducted to determine 1-month newborn outcomes.

RESULTS: Among 9748 pregnant persons, 209 (2.1%) tested positive for perinatal SARS-CoV-2. Symptomatically infected persons were more likely to have a preterm delivery due to worsening maternal condition and their newborns were more likely to test positive for SARS-CoV-2 compared with asymptomatic persons. Six of 191 (3.1%) infants tested were positive for SARS-CoV-2; none had attributable illness before discharge. Of 169 eligible families, 132 (78.1%) participated in post-discharge interviews; none reported their newborn tested positive for SARS-CoV-2 by 1 month of age.

CONCLUSION: Symptomatic perinatal COVID-19 had a substantial effect on maternal health but no apparent short-term effect on newborns.

10.1038/s41372-022-01446-x

J Perinatol

35778485

Neonatal infections: Insights from a multicenter longitudinal research collaborative.

2022

151637

06/2022

1558-075X

For more than 30 years, the Neonatal Research Network (NRN) has conducted studies addressing the epidemiology of neonatal infections, including incidence, microbiology, maternal and neonatal risk factors, associated clinical findings, and outcomes. These studies have provided clinicians and policymakers critical data needed to inform national guidance for infection risk assessment and support daily practice. Further, NRN studies have prompted research into optimal approaches to infection diagnosis, treatment, and antimicrobial stewardship. In this article, we summarize the key findings of NRN infection-related studies, with an emphasis on those published in 2000 or later.

10.1016/j.semperi.2022.151637

Semin Perinatol

35864010

Early childhood antibiotic utilization for infants discharged from the neonatal intensive care unit.

2022

2022 Apr 05

1476-5543

<p><strong>OBJECTIVE: </strong>To determine antibiotic utilization for NICU infants, as compared to non-NICU infants, in the first 3 years after birth hospital discharge.</p>

<p><strong>STUDY DESIGN: </strong>Retrospective observational study using data from Medicaid Analytic Extract including 667 541 newborns discharged from 2007-2011. Associations between NICU admission and antibiotic prescription were assessed using regression models, adjusting for confounders, and stratified by gestational age and birth weight.</p>

<p><strong>RESULTS: </strong>596 999 infants (89.4%) received ≥1 antibiotic, with a median of 4 prescriptions per 3 person-years (IQR 2-8). Prescribed antibiotics and associated indication were similar between groups. Compared to non-NICU infants (N = 586 227), NICU infants (N = 81 314) received more antibiotic prescriptions (adjusted incidence rate ratio 1.08, 95% confidence interval [CI] (1.08,1.08)). Similar results were observed in all NICU subgroups.</p>

<p><strong>CONCLUSIONS: </strong>Antibiotic utilization in early childhood was higher among infants discharged from NICUs compared to non-NICU infants.</p>

10.1038/s41372-022-01380-y

J Perinatol

35383276

Time to positivity of blood cultures in neonatal late-onset bacteraemia.

2022

2022 Mar 10

1468-2052

<p><strong>OBJECTIVE: </strong>To determine the time to positivity (TTP) of blood cultures among infants with late-onset bacteraemia and predictors of TTP &gt;36 hours.</p>

<p><strong>DESIGN: </strong>Retrospective cohort study.</p>

<p><strong>SETTING: </strong>16 birth centres in two healthcare systems.</p>

<p><strong>PATIENTS: </strong>Infants with positive blood cultures obtained &gt;72 hours after birth.</p>

<p><strong>OUTCOME: </strong>The main outcome was TTP, defined as the time interval from specimen collection to when a neonatal provider was notified of culture growth. TTP analysis was restricted to the first positive culture per infant. Patient-specific and infection-specific factors were analysed for association with TTP &gt;36 hours.</p>

<p><strong>RESULTS: </strong>Of 10 235 blood cultures obtained from 3808 infants, 1082 (10.6%) were positive. Restricting to bacterial pathogens and the first positive culture, the median TTP (25th-75th percentile) for 428 cultures was 23.5 hours (18.4-29.9); 364 (85.0%) resulted in 36 hours. Excluding coagulase-negative staphylococci (CoNS), 275 of 294 (93.5%) cultures were flagged positive by 36 hours. In a multivariable model, CoNS isolation and antibiotic pretreatment were significantly associated with increased odds of TTP &gt;36 hours. Projecting a 36-hour empiric duration at one site and assuming that all negative evaluations were associated with an empiric course of antibiotics, we estimated that 1164 doses of antibiotics would be avoided in 629 infants over 10 years, while delaying a subsequent antibiotic dose in 13 infants with bacteraemia.</p>

<p><strong>CONCLUSIONS: </strong>Empiric antibiotic administration in late-onset infection evaluations (not targeting CoNS) can be stopped at 36 hours. Longer durations (48 hours) should be considered when there is pretreatment or antibiotic therapy is directed at CoNS.</p>

10.1136/archdischild-2021-323416

Arch Dis Child Fetal Neonatal Ed

35273079

Group B Streptococcal Infection in Extremely Preterm Neonates and Neurodevelopmental Outcomes at 2 Years.

2022

2022 Mar 22

1537-6591

<p><strong>BACKGROUND: </strong>Determine the incidence of GBS disease among extremely preterm infants and assess risk of death or neurodevelopmental impairment (NDI) at 18-26 months' corrected age.</p>

<p><strong>METHODS: </strong>Observational cohort study of infants enrolled in a multicenter registry. GBS disease incidence was assessed in infants born 1998-2016 at 22-28 weeks' gestation surviving &gt;12 hours. The composite outcome, death or NDI, was assessed in infants born 1998-2014 at 22-26 weeks' gestation. Infection was defined as GBS isolation in blood/CSF culture at ≤72 hours (early-onset disease, EOD) and &gt;72 hours (late-onset disease, LOD) after birth. The outcome was compared in infants with GBS disease, infants infected with other pathogens, and uninfected infants using Poisson regression models.</p>

<p><strong>RESULTS: </strong>Incidence of GBS EOD (2.70/1000 births [95% CI: 2.15-3.36]) and LOD (8.47/1000 infants [7.45-9.59]) did not change significantly over time. The adjusted relative risk (aRR, 95% CI) of death/NDI was higher among GBS EOD cases compared to infants with other infections (1.22, [1.02-1.45]) and uninfected infants (1.44, [1.23-1.69]). Death/NDI did not differ between infants with GBS LOD and comparator groups. GBS LOD occurred at a significantly later age than non-GBS late-onset infection. Among infants surviving &gt;30 days, the risk of death was higher with GBS LOD (1.90, [1.36-2.67]), compared to uninfected infants.</p>

<p><strong>CONCLUSIONS: </strong>In a cohort of extremely preterm infants, incidence of GBS disease did not change during the study period. Increased risk of death/NDI with GBS EOD, and of death among some infants with GBS LOD, supports the need for novel preventive strategies for disease reduction.</p>

10.1093/cid/ciac222

Clin Infect Dis

35323895

Updated Guidance: Prevention and Management of Perinatal Group B Streptococcus Infection.

2021

e177-e188

2021 Mar 01

1526-9906

<p>Group B Streptococcus (GBS) remains the most common cause of neonatal early-onset sepsis among term infants and a major cause of late-onset sepsis among both term and preterm infants. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists published separate but aligned guidelines in 2019 and 2020 for the prevention and management of perinatal GBS disease. Together, these replace prior consensus guidelines provided by the Centers for Disease Control and Prevention. Maternal intrapartum antibiotic prophylaxis based on antenatal screening for GBS colonization remains the primary recommended approach to prevent perinatal GBS disease, though the optimal window for screening is changed to 36 0/7 to 37 6/7 weeks of gestation rather than beginning at 35 0/7 weeks' gestation. Penicillin, ampicillin, or cefazolin are recommended for prophylaxis, with clindamycin and vancomycin reserved for cases of significant maternal penicillin allergy. Pregnant women with a history of penicillin allergy are now recommended to undergo skin testing, because confirmation of or delabeling from a penicillin allergy can provide both short- and long-term health benefits. Aligned with the American Academy of Pediatrics recommendations for evaluating newborns for all causes of early-onset sepsis, separate consideration should be given to infants born at less than 35 weeks' and more than or equal to 35 weeks' gestation when performing GBS risk assessment. Empiric antibiotics are recommended for infants at high risk for GBS early-onset disease. Although intrapartum antibiotic prophylaxis is effective in preventing GBS early-onset disease, currently there is no approach for the prevention of GBS late-onset disease.</p>

Neoreviews

35148404

National Healthcare Safety Network 2018 Baseline Neonatal Standardized Antimicrobial Administration Ratios.

2022

2022 Jan 24

2154-1671

<p><strong>BACKGROUND: </strong>The microbiologic etiologies, clinical manifestations, and antimicrobial treatment of neonatal infections differ substantially from infections in adult and pediatric patient populations. In 2019, the Centers for Disease Control and Prevention developed neonatal-specific (Standardized Antimicrobial Administration Ratios SAARs), a set of risk-adjusted antimicrobial use metrics that hospitals participating in the National Healthcare Safety Network's (NHSN's) antimicrobial use surveillance can use in their antibiotic stewardship programs (ASPs).</p>

<p><strong>METHODS: </strong>The Centers for Disease Control and Prevention, in collaboration with the Vermont Oxford Network, identified eligible patient care locations, defined SAAR agent categories, and implemented neonatal-specific NHSN Annual Hospital Survey questions to gather hospital-level data necessary for risk adjustment. SAAR predictive models were developed using 2018 data reported to NHSN from eligible neonatal units.</p>

<p><strong>RESULTS: </strong>The 2018 baseline neonatal SAAR models were developed for 7 SAAR antimicrobial agent categories using data reported from 324 neonatal units in 304 unique hospitals. Final models were used to calculate predicted antimicrobial days, the SAAR denominator, for level II neonatal special care nurseries and level II/III, III, and IV NICUs.</p>

<p><strong>CONCLUSIONS: </strong>NHSN's initial set of neonatal SAARs provides a way for hospital ASPs to assess whether antimicrobial agents in their facility are used at significantly higher or lower rates compared with a national baseline or whether an individual SAAR value is above or below a specific percentile on a given SAAR distribution, which can prompt investigations into prescribing practices and inform ASP interventions.</p>

10.1542/hpeds.2021-006253

Hosp Pediatr

35075483

Delivery Characteristics and the Risk of Early-Onset Neonatal Sepsis.

2022

2022 Jan 12

1098-4275

<p>&nbsp;</p>

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Multiple strategies are used to identify newborn infants at high risk of culture-confirmed early-onset sepsis (EOS). Delivery characteristics have been used to identify preterm infants at lowest risk of infection to guide initiation of empirical antibiotics. Our objectives were to identify term and preterm infants at lowest risk of EOS using delivery characteristics and to determine antibiotic use among them.</p>

<p><strong>METHODS: </strong>This was a retrospective cohort study of term and preterm infants born January 1, 2009 to December 31, 2014, with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Criteria for determining low EOS risk included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. We determined the association between these characteristics, incidence of EOS, and antibiotic duration among infants without EOS.</p>

<p><strong>RESULTS: </strong>Among 53 575 births, 7549 infants (14.1%) were evaluated and 41 (0.5%) of those evaluated had EOS. Low-risk delivery characteristics were present for 1121 (14.8%) evaluated infants, and none had EOS. Whereas antibiotics were initiated in a lower proportion of these infants (80.4% vs 91.0%, P &lt; .001), duration of antibiotics administered to infants born with and without low-risk characteristics was not different (adjusted difference 0.6 hours, 95% CI [-3.8, 5.1]).</p>

<p><strong>CONCLUSIONS: </strong>Risk of EOS among infants with low-risk delivery characteristics is extremely low. Despite this, a substantial proportion of these infants are administered antibiotics. Delivery characteristics should inform empirical antibiotic management decisions among infants born at all gestational ages.</p>

10.1542/peds.2021-052900

Pediatrics

35022750