Maternal Child Health & COVID-19

Updates on the latest information and articles on Maternal Child Health & COVID-19

The American Thoracic Society COVID-19 Scientific Advisory Board

The COVID-19 Scientific Advisory Board (C19SAB) is a distinguished group of volunteer anesthesiologists, epidemiologists and critical care physicians who, based on clinical acumen, have been nominated to participate by societies such as the International Anesthesia Research Society (IARS). The C19SAB meets daily to actively debate and review all published journal articles and DocMatter discussions concerning the COVID-19 pandemic. The publications and discussions below have been hand-selected by the C19SAB for their relevance to front-line providers treating this disease.

Highlighted Peer-Reviewed Publications:

Category: Infection Control
Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic

Canadian Journal of Anesthesia/Journal canadien d'anesthesie. Apr 23, 2020.
Shannon L. Lockhart; Laura V. Duggan; Randy S. Wax; Stephan Saad; et al


Opinion from SAB Member: Dr. W. Heinrich Wurm

A call to arms from several Canadian anesthesia departments stressing the fact that protecting health care personnel from infection is the most important factor determining the success of a prolonged campaign against COVID-19. Their exhaustive recommendations exceed WHO standards in the area of high risk aerosol generating medical procedures (AGMPs) like endotracheal intubation and include head, neck and wrist protection. A sobering table highlights the odds-ratio of transmission for a number of anesthesia related procedures including AGMPs, but a reminder to avoid self-contamination during the doffing procedure is of equal importance. This guide is a valuable reference for practitioners, students and instructors.

Category: Diagnosis of Infection or Immunity; Emerging Clinical Data and Guidelines
Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition)

World Journal of Pediatrics. Apr 24, 2020.
Kun-Ling Shen; Yong-Hong Yang; Rong-Meng Jiang; Tian-You Wang; et al


Opinion from SAB Member: Dr. Lydia Cassorla

This review provides guidance in the form of an updated consensus statement regarding COVID-19 in children. In the early February 2020, an expert committee with more than 30 Chinese experts from 11 academic medical organizations formulated the first edition of consensus statement on diagnosis, treatment and prevention of coronavirus disease 2019 (COVID-19) in children. According to the 28 February 2020 WHO COVID-19 situation report, pediatric cases in China accounted for 2.4% of 55,924 confirmed cases. Close contact with infected persons with or without symptoms is the main transmission route of SARS-CoV-2 to children, resulting in mostly clustered cases. "There is no direct evidence of vertical mother-to-child transmission, but newborns can be infected through close contact."
Risk factors, diagnosis, severity classifications, early warning indicators, differential diagnosis, and treatment are discussed. Risk factors for severe disease include underlying diseases, immunosuppressant Rx and age<3 months. Most manifestations and laboratory findings are similar to adults, with atypical symptoms such as GI manifestations and listlessness noted. The group recommends antipyretics such as ibuprofen and acetaminophen if T>38.5 degrees C, and nebulizer treatments to manage mucus plugs. "Antiviral drugs without clear evidences of safety and efficiency are not recommended to be used in pediatric patients. The revised antiviral drug therapy remains interferon-alpha (IFN-alpha) sprays and aerosol inhalation. We do not recommend using lopinavir/ritonavir, ribavirin or chloroquine phosphate in pediatric patients." Intubation and controlled ventilation is recommended if non-invasive mechanical ventilation does not result in clinical improvement after 2 hours. Plasma exchange to treat cytokine storm, immunoglobulin and anticoagulation are mentioned. 27 references provided, including the group's initial statement.

Category: Risk Factors / Demographics / Resource Requirements / Outcomes; Patients / Family
Determining risk factors for mortality in liver transplant patients with COVID-19

The Lancet Gastroenterology & Hepatology. Apr 24, 2020.
Gwilym J Webb; Andrew M Moon; Eleanor Barnes; A Sidney Barritt; et al


Opinion from SAB Member: Dr. Barry Perlman

A previous correspondence of liver transplant patients in Italy reported that 3 of their 111 long-term liver transplant survivors (on minimal immunosuppression) died from severe COVID-19, while 3 of 40 more recent liver transplant patients (on full immunosuppression) who had COVID-19 experienced an "uneventful course." The long-term survivors were older, and had significantly higher incidence of obesity, DM, HTN, kidney disease, cardiovascular disease, and hyperlipidemia. Asymptomatic patients were not tested, so the incidence of SARS-CoV-2 in each group was not known. To address whether co-morbidities contributed to the higher death rate in the long-term transplant patients, the current correspondence reports the outcome of 39 liver transplant recipients with COVID-19 submitted to the COVID-Hep and SECURE Cirrhosis international registries. 9 (23%) died of respiratory failure. Frequency of co-morbidities between fatal and non-fatal cases was not significantly different. A study with larger case numbers will be needed to identify risk factors for severe COVID-19 in liver transplant patients.

Category: Risk Factors / Demographics / Resource Requirements / Outcomes
SARS-Cov-2 (human) and COVID-19: Primer 2020

Hepatology International. Apr 24, 2020.
Gayatri Ramakrishna; Pradeep Kumar; Savera Aggarwal; Mojahidul Islam; et al


Opinion from SAB Member: Dr. J. Lance Lichtor

This is a pictoral original paper that illustrates basics concerning where the disease came from, what the virus looks like, how it enters the body, disease prognosis, how it replicates in the lung and the liver, and generally how replicates.

Category: Pulmonary Management
Management of COVID-19 Respiratory Distress

JAMA. Apr 24, 2020.
John J. Marini; Luciano Gattinoni


Opinion from SAB Member: Dr. Louis McNabb

Discusses the differences in the lung mechanics and approaches to treatment in the early vs. the late phase of lung injury in COVID-19. Primary goal is to prevent patient self-induced lung injury from increased transpulmonary pressures from patient's hypoxic drive.

Category: Multisystem Disease Management
Prevalence and Characteristics of Gastrointestinal Symptoms in Patients with SARS-CoV-2 Infection in the United States: A Multicenter Cohort Study

Gastroenterology. Apr 20, 2020.
Walker D. Redd; Joyce C. Zhou; Kelly E. Hathorn; Thomas R. McCarty; et al


Opinion from SAB Member: Dr. Jay Przybylo

A brief but substantial article constructing a link between SARS-CoV-2, angiotensin converting enzyme 2 receptors as the cellular entry portal, and the abundance of the receptor in the GI tract. GI symptoms were associated with taste and smell disorders but not associated with blood, liver or heart involvement.

Sensitivity to angiotensin II dose in patients with vasodilatory shock: a prespecified analysis of the ATHOS-3 trial

Annals of Intensive Care. Jun 3, 2019.
Kealy R. Ham; David W. Boldt; Michael T. McCurdy; Laurence W. Busse; et al


Opinion from SAB Member: Dr. Jay Przybylo

This extends beyond a case report in an 88y/o who died. Angiotensin II provided stabilization of blood pressure and allowed decrease of other vasopressors.