Thomas Brune

OBJECTIVE: Parental involvement in the care of preterm infants in NICUs is becoming increasingly common, but little is known about its effect on infants' length of hospital stay and infant morbidity. Our goal was to evaluate the effect of a new model of family care (FC) in a level 2 NICU, where parents could stay 24 hours/day from admission to discharge. METHODS: A randomized, controlled trial was conducted in 2 NICUs (both level 2), including a standard care (SC) ward and an FC ward, where parents could stay from infant admission to discharge. In total, 366 infants born before 37$$\raisebox{1ex}{$0$}\!\left/ \!\raisebox{-1ex}{$7$}\right.$$ weeks of gestation were randomly assigned to FC or SC on admission. The primary outcome was total length of hospital stay, and the secondary outcome was short-term infant morbidity. The analyses were adjusted for maternal ethnic background, gestational age, and hospital site. RESULTS: Total length of hospital stay was reduced by 5.3 days: from a mean of 32.8 days (95% confidence interval [CI]: 29.6-35.9) in SC to 27.4 days (95% CI: 23.2-31.7) in FC (P = .05). This difference was mainly related to the period of intensive care. No statistical differences were observed in infant morbidity, except for a reduced risk of moderate-to-severe bronchopulmonary dysplasia: 1.6% in the FC group compared with 6.0% in the SC group (adjusted odds ratio: 0.18 [95% CI: 0.04-0.8]). CONCLUSIONS: Providing facilities for parents to stay in the neonatal unit from admission to discharge may reduce the total length of stay for infants born prematurely. The reduced risk of moderate-to-severe bronchopulmonary dysplasia needs additional investigation.

This clinical trial was performed to study the effects of intravenously (IV) administered recombinant human (rh) erythropoietin (EPO) at escalating doses (150, 300, and 450 U/kg, administered as an IV bolus injection, twice weekly, for 6, 4, and 4 weeks, respectively) in five patients with low-grade non-Hodgkin's lymphoma (Ig NHL) and bone marrow involvement and one patient with multiple myeloma (MM). All patients were anemic due to underlying disease. None of the patients had a history of bleeding, hemolysis, renal insufficiency, or other disorders causing anemia in addition to bone marrow infiltrating malignancy. Endogenous EPO serum levels were significantly increased in all patients (74 to 202 mU/mL). Five patients (one MM, four small-cell lymphocytic [SCLC] NHL) showed a dramatic increase of hemoglobin (Hb), hematocrit (Hk) and RBC count becoming obvious on the second EPO dose level. Initial ferritin serum values, which were high mostly due to polytransfusion, were significantly reduced in responding patients. Erythropoiesis of one patient with extensive follicular mixed (fm) NHL did not respond to EPO treatment. Platelet (PLT) count increase (greater than 75% above starting levels) during and following EPO therapy was observed in one patient with MM. Adverse events due to EPO therapy have not been recorded. These findings point out a previously unrecognized capacity of EPO given at pharmacologic doses to stimulate erythropoiesis in patients with anemia due to bone marrow infiltration by neoplastic lymphocytes in spite of enhanced endogenous EPO expression.

Sir, Despite a global pandemic, there are so far, few reports on pregnant women with Coronavirus disease 2019 (COVID-19), testing strategies vary substantially and management guidelines are not uniform.1, 2 A 34-year-old primipara with a dichorionic twin pregnancy was referred to our hospital at 36+2/7 weeks due to hypertension and proteinuria. Her body mass index (BMI) at the first antenatal visit was 38 kg/m2 and she was diagnosed with gestational diabetes at 29 weeks. Fetal growth was normal, and both fetuses were in cephalic presentation. She presented with mild headache, hoarseness and increasing malaise for 3 days but no cough or dyspnea. Her heart rate was 85 beats/min, respiration rate 11/min, oxygen saturation 96%, blood pressure (BP) 170/100 mm Hg and body temperature 38.0°C. Creatinine was 89 µmol/L (reference <90 µmol/L) and uric acid 510 µmol/L (reference 155-350 µmol/L). Other lab results including C-reactive protein (CRP), hemoglobin, leukocytes, platelets and liver enzymes were unremarkable. A nasopharyngeal COVID-19 RNA test was taken. She was admitted to an isolation room and treated with paracetamol, labetalol and nifedipine. The staff caring for her used personal protective equipment. Seven hours later, her BP remained high despite antihypertensive treatment, she complained of severe headache and photophobia, and her patellar reflexes were brisk. Intravenous magnesium sulphate infusion was started. An emergency cesarean was performed under spinal anesthesia and antibiotic prophylaxis (cefuroxime 1.5 g intravenously) was administered. The estimated blood loss was 200 mL. Two female babies were delivered in good condition. Three hours later, the mother´s COVID-19 test result was reported to be positive. Her BP remained stable and the temperature normalized after the first postoperative day. On the third day, her oxygen saturation dropped to 87%, which was managed successfully with oxygen, 1-3 L/min via a nasal cannula. A computerized tomography scan of the chest ruled out pulmonary embolism but showed typical signs of COVID-19 pneumonia. The CRP reached 88 mg/L on the fourth day but fell to 38 mg/L on the sixth day. Oxygen therapy was discontinued on the fifth postoperative day and she was discharged on the sixth day fully mobilized, without dyspnea, and with well-controlled BP. The twin baby girls were assessed by a pediatrician immediately after birth and could be roomed-in with their mother after 10 minutes. Because of maternal gestational diabetes, both twins were formula-fed from the start and breastfeeding was initiated simultaneously. Twin 1 had a birthweight of 2680 g, with Apgar scores of 9, 10 and 10 at 1, 5 and 10 minutes, respectively. At 22 minutes after delivery she developed breathing problems and continuous positive airway pressure was administered for 40 minutes. On the second day, she had a cyanotic attack while feeding, which was interpreted as secondary to vomiting/gastrointestinal reflux. Oxygen saturation directly after the event was normal. Twin 2 was smaller with a birthweight of 2160 g, and Apgar scores of 9, 10 and 10. Both twins had negative nasopharyngeal Covid-19 tests taken at 34 hours and 4½ days of age. Covid-19 tests performed on breastmilk and maternal vaginal secretion on the fifth day were also negative. This case of a twin pregnancy with severe preeclampsia that was complicated by Covid-19 illustrates the potential difficulties in discriminating common complications encountered in high-risk pregnancies with comorbidities, such as pulmonary edema/embolism, from COVID-19. Therefore, liberal testing for COVID-19 should be considered in women with high-risk pregnancies.