John Fiascone at South Shore Hospital

Molly Fraust Wylie, BIDMC

Lucienne Sanchez Holy Family Hospital

Joan Pezzano Fairview Hospital

Laura Madore Baystate Medical Center

Karen Sussman-Karten from Boston Childrens Hospital

Hello! Emily Whitesel from BIDMC

Erica Anstey, Breastfeeding Specialist, CDC

Mimi Pomerleau BWH

Helen Healy, fellow

Are the tests for newborns done only in newborns br

Feel free to chat in comments or questions. If we don't have time to get to all questions, we can follow-up by email or next time!

born to diagnosed with COVID-19 women, please?

Erini, those newborn screening questions were about all babies. All infants get CCHD, newborn screen, hepatitis B, etc.

Eirinni, Beverly, yes, babies born to PUI or covid + moms, if mom's test comes back neg baby is NOT tested

Thanks, meant about COVID-19 tests for newborns. Thanks for the input.

For Maria @ Mercy Hospital. Sick newborn sent to Baystate Med Ctr. ? full term vs preterm ? Mother COVID + ? outcome ? NB COVID +

Lucienne, we'll try not to discuss details of individual patients on these webinars, but we can put you in touch with Maria afterwards.

THX

For mothers who refuse testing we are using full PPE as they are PUI and baby is rooming in

At Baystate, if mom's refuse COVID testing and are asymptomatic then PPE is not worn. If symptoms then is treated as PUI

How is anybody else treating testing refusal?

At Winchester, if mother's refuse COVID testing and are ASYMPTOMATIC then we do NOT treat as PUI.

Are there any hospitals NOT testing all pregnant women upon arrival to L&D with rapid tests

Is anybody testing the asymptomatic support person of a Covid positive mom?

We share same concern for asymptomatic +ve mothers who are separated - especially for mothers inexperienced at breastfeeding, even more so the ones looking (understandably) for an early discharge.

We had that situation here at Berkshire. We ended up leaving the baby in the room with the Mom

We do not have a rapid test.

WE are testing mothers and partners 48h prior scheduled CS/induction. No universal testing yet

At Winchester, we do universal testing but do not have a rapid test. We do not treat these mothers as PUI if they are asymptomatic.

We also do pre C/S and induction tests about 48 hrs pta.

SSH has rapid test available for inpatient now

What is everyone doing for chorioamnionitis? Is mother treated as PUI?

Thank you so much to our presenters! Everyone is struggling with the same issues. One area that may lead to discussion/controversy is "how does one define joint medical decision making"?, Who has those discussions with the mothers and when? Are all options presented equally or is one option presented and other options are only mentioned if parents push back from the initial recommendation? What are the ethics in this scenario when there is so much unknown?

At Winchester we treat mother and baby as PUI if there is fever during labor.

Lisa - we are doing a prenatal consult whenever feasible. docs are using scripted consult template to provide overview of risks/benefits

What are others doing with mothers presenting with PP pre-eclampsia? Are yo testing them for Covid?

Zuzanna, intrapartum fever above 100.4 does make mom a PUI; for those moms, a rapid test comes back in a few hours.

No testing for PEC alone

We also don't test for pre-clampsia alone.

great job Laura

We have universal testing at NWH. If mom develops fever and is not typical for chorio then we retest

Munish: Exactly; that is why we decided to do it and now we got results quickly

Lisa, for shared decision-making, we try to present rooming-in and separation as neutral options, but probably there is some favoring of rooming-in for term deliveries if mom isn't that sick.

with universal testing, what are the rates of asymptomatic positive mothers? Is it as high as the NYC experience?

Yes, a fair number of asymptomatic mothers are positive for us at Baystate

Within Partners hospitals , most recent data of Covid positive mothers picked up by universal testing in 0.1%

BWH has had only 2 asymptomatic tested + moms

We have not seen any asymptomatic moms here at Berkshire yet

Great idea to electively test support person!!

What percent of mothers are found positive with universal testing, please?

Rate of asymptomatic positive mothers may influence how we treat mothers who refuse treatment. And it may vary by hospital/community. Lawrence has a very high amount of COVID in their community, Berkshires may not.

Eirini, I don't think we've seen formal data yet from Massachusetts centers on rates of asymptomatic positive moms. Just from the chats, you can see that it seems low in some centers and higher in others.

Lisa, agree. Our rate of asymptomatic positive is low at present, so if a mother declines testing, we do NOT consider her a PUI.

Re rooming in vs. separation: For folks involved in networks of hospitals- has there been a push to have a similar approach among the network or are individual hospitals approaching it differentely based on consensus of team and/or practical issues

3 out of our so far 10 positive mothers were asymptomatic so that is 30 %

Push to unify approach in Tufts network but some local variability based on resources/hospital culture

Steward developed corporate policy that recommends separation, but with caveat that should be discussed beforehand with parents and mutual decision reached.

for beverly/lahey/BI there IS no delivery.baby care at Lahey so very much driven by Beverly, winchester and BI

Different approaches in different hospitals mostly due to differences in space

Within BILH network have guidelines and then provide local context at individual hospitals based on logistics, etc.

actual rates of separation depend on hospital resources and different individual culture

Mostly depends on Hospitals logistics due to space

Rachana, do you know what percent of your asymptomatic mothers were positive? So 3 out of how many mothers that were screened?

If you are interested, AAP SONPM registry has started sharing weekly updates of their data, every Friday. Report from last Friday had 102 mother/infant dyads. Is available through SONPM website, and here: https://my.visme.co/view/ojq9qq8e-npc-19-registry.

The rate if out of positive mothers - no one is currently keeping a count of how many are tested overall and then end up being negative.

Even for our bigger database for Baystate they are planning only on collecting data for positive patients. However the current prevalence rate for Baystate in about 17% out of all the tests done.

At BWH <2% of asymptomatic mother’s have tested positive (>170 tested)

Are people making F/U calls to Covid pos families discharged from NICU?

If I remember correctly MGH reported during last Town Hall 6% positivity amongst screened mothers

Applause for all presenters and organizers!! THANK YOU VERY MUCH!!!

Silvia, great question. We are not making follow-up calls, but we would like to. Are you? Anyone else?

We are staring now

starting

Great presentations all the way around! Thank you to organizers and presenters!

Thank you very much for all these presentations! So helpful.

Thank you all presenters. Interesting and helpful.

Would be great if DPH reported cases in infants <1month of age

I am interested to learn how many times newborns are tested, after the first at 24h, in Nursery or Nicu

Thank you to all! Great to learn what others are doing. Really informs us about where we are and whether we should make changes or not.

have to join another meeting. thank you all. bye

If anyone isn't getting our periodic emails about these COVID-19 webinars, please let me know and I will add you to that list.

Thank you for a great session!!

Thank you!

thank you everyone.

thanks!

thank you