//Background//---
The
first surge of the SARS-CoV-2 pandemic in the United States of America from
March to June 2020 occurred with the highest prevalence in the Northeast region
including the New York and the Boston. Therefore, the hospitals confronted the
challenge to minimize disruption and provide health-promoting practices. In
this situation, the medical staff needed to provide the care for many patients
with SARS-CoV-2, so the resource paucity may occur also in the perinatal care.
Furthermore, mother-to-child transmission through childbirth and breastfeeding
is crucial risk, so the breastfeeding may be partly avoided in a prophylactic
manner. In previous reports, mother-to-child transmission is unlikely, but
still, more evidence is needed(6). However, some oligosaccharides in a
breastmilk have “Decoy”
function for some viruses(7), and helps immune system(7). Therefore, even if
infection risk exists, the advantage of the breastfeeding is ensured. According
to the investigation by the Massachusetts perinatal quality collaborative (PQC),
60% of hospitals encouraged and 28% of hospital prohibited or discouraged
mother to provide the direct breastfeeding for her neonate(2). Evidence of
disparity, like race/ethnicity and language status, was confirmed in perinatal
care(3-5).
Katherine
Sullivan, Mandy B. Belfort, Patrice Melvin, Asimenia Angelidou, Aviel Peaceman,
Jessica E. Shui, Ruben Vaidya, Rachana Singh, Ruby Bartolome, Silvia Patrizi,
Neha Chaudhary, Ilona Telefus Goldfarb, Ivana Culic, Diana Yanni, Munish Gupta,
Mark Hudak & Margaret G. Parker investigate perinatal quality
longitudinally and evaluate equity for the perinatal care(1).
//Research objective(1)//---
The Massachusetts
perinatal quality collaborative (PQC) address perinatal quality in SARS-CoV-2
pandemic in the following two ways.
*Reducing mother-to-infant SARS-CoV-2
transmission
*Ensuring equity such as, race/ethnicity,
language status and social vulnerability
//Evaluation method(1)//---
*Period: From March/2020 to July/2020
*Among 11 hospitals
*Measured outcome: Cesarean delivery /
Preterm delivery / Room-in / Breastfeeding
*Compared group: Race/ethnicity, language
status and social vulnerability
//Brief results(1)(See Fig.1)//---
*Population size: 255 mothers
*Threshold time: March to May week3 / from
May week4 to July
*Cesarean delivery: 49% to 35% Decreasing
(General rate in U.S 30-32%)
*Room-in: 55% to 86% Increasing
*Breastfeeding: 53% to 72% Increasing
(Start 84.1% ⇒ 58.3% at 6 months)
*Preterm delivery : 25% to 7% Decreasing (General
rate in U.S. from 9.57% to 9.85%)
The changing didn’t differ among
race/ethnicity, language status and social vulnerability.
//Conclusion//---
The environment of perinatal care is significantly improved as of
July/2020, which is almost same to pre-pandemic period. However, in the period
of the first surge of SARS-CoV-2 pandemic, we can evaluate the negative effect
for the perinatal care at least in the Boston. Equality for the perinatal care
was ensured even in the pandemic among investigated 11 hospitals.
//Contributions//---
Parker and Sullivan drafted the original
manuscript, conceived and designed the study, and contributed to data
acquisition and analysis. Belfort, Melvin, Angelidou conceived and designed the
study, contributed to data acquisition and analysis, preparation of the
manuscript. Peaceman and Shui, Vaidya, Singh, Bartolome, Patrizi, Culic, Yanni,
Chaudhary, and Goldfarb contributed to data acquisition and analysis; reviewed
and revised the manuscript for intellectual content. Gupta and Hudak critically
reviewed and revised the manuscript for important intellectual content. All
authors approved the final manuscript as submitted and agree to be accountable
for all aspects of the work.
(Reference)
(1)
Katherine Sullivan, Mandy B. Belfort,
Patrice Melvin, Asimenia Angelidou, Aviel Peaceman, Jessica E. Shui, Ruben
Vaidya, Rachana Singh, Ruby Bartolome, Silvia Patrizi, Neha Chaudhary, Ilona
Telefus Goldfarb, Ivana Culic, Diana Yanni, Munish Gupta, Mark Hudak &
Margaret G. Parker
Leveraging the Massachusetts perinatal
quality collaborative to address the COVID-19 pandemic among diverse
populations
Journal of Perinatology (2021)
---
Author information
Affiliations
Department of Pediatrics, UMass Memorial
Health Center, UMass Memorial Medical School, Worcester, MA, USA
Katherine Sullivan
Department of Pediatric Newborn Medicine,
Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Mandy B. Belfort & Silvia Patrizi
Center for Applied Pediatric Quality
Analytics, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
Patrice Melvin
Department of Neonatology, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Asimenia Angelidou, Neha Chaudhary, Ivana
Culic, Diana Yanni & Munish Gupta
Precision Vaccines Program, Division of
Infectious Diseases, Boston Children’s Hospital, Boston, MA, USA
Asimenia Angelidou
Department of Pediatrics, Boston Medical
Center, Boston University School of Medicine, Boston, MA, USA
Aviel Peaceman, Ruby Bartolome & Margaret
G. Parker
Department of Pediatrics, Division of
Neonatology and Newborn Medicine, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, USA
Jessica E. Shui
Department of Pediatrics, University of
Massachusetts Medical Center-Baystate, Springfield, MA, USA
Ruben Vaidya & Rachana Singh
Department of Pediatrics, Tufts Children’s
Hospital, Boston, MA, USA
Rachana Singh
Department of Pediatrics, Cambridge Health
Alliance, Cambridge, MA, USA
Neha Chaudhary
Deparatment of Obstetrics and Gynecology,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Ilona Telefus Goldfarb
Department of Pediatrics, University of
Florida Health, University of Florida College of Medicine, Jacksonville, FL,
USA
Mark Hudak
(2)
Parker MG. Massachusetts perinatal COVID-19
practice survey results April 2020.
https://5d529773-b98a-4c63-93e5-85485fbbebad.
fi
lesusr.com/ugd/55ea1e_4efcbfdd37b746729da38423d2c2aaef.pdf. Accessed 4 Dec
2020.
(3)
Profit J, Gould JB, Bennett M, Goldstein
BA, Draper D, Phibbs CS et al.
Racial/ethnic disparity in NICU quality of
care delivery.
Pediatrics. 2017; 140.
https://doi.org/10.1542/peds.2017-0918.
(4)
Sigurdson K, Mitchell B, Liu J, Morton C,
Gould JB, Lee HC et al. Racial/ethnic
disparities in neonatal intensive care: a
systematic review. Pediatrics. 2019; 144.
https://doi.org/10.1542/peds.2018-3114.
(5)
Palau MA, Meier MR, Brinton JT, Hwang SS,
Roosevelt GE, Parker TA.
The impactof parental primary language on
communication in the neonatal intensive careunit.
J Perinatol. 2019;39:307 – 13.
(6)
Lion KC, Raphael JL.
Partnering health disparities research with
qualityimprovement science in pediatrics.
Pediatrics. 2015;135:354 – 61.
(7)
Michał Wiciński, Ewelina Sawicka, Jakub Gębalski,
Karol Kubiak, and Bartosz Malinowski
Human Milk Oligosaccharides: Health
Benefits, Potential Applications in Infant Formulas, and Pharmacology
Nutrients. 2020 Jan; 12(1): 266.
登録:
コメントの投稿 (Atom)
0 コメント:
コメントを投稿