Among the many aftermaths that the pandemic is leaving, that of vaccination hesitation is certainly the most dangerous. Failure to cover also causes premature births to grow
An alarm signal: Most of the pregnant mothers we see, to date, are not vaccinated against Covid. worried about the Professor Fabio Mosca, director of the Woman-Child-Newborn Department at the Polyclinic of Milan and past president of the Italian Society of Neonatology. And send a message: You have to get vaccinated. There are our indications, indications of the Ministry of Health and of the scientific societies that they say of get vaccinated safely during pregnancy. The ministry, as a precaution, advised them to be carried out in the second-third trimester of gestation. The scientific societies had also given the green light in the first quarter. All right, as long as we go ahead. We make all the vaccines we need, even the one against the flu at this stage of the season.
Population at risk
Among the many aftermaths that the pandemic is leaving, that of vaccination hesitation is certainly the most dangerous. The population of unvaccinated mothers is at risk. We know that the mother who is not immunized if she contracts Covid runs greater risks, because anyway develops a number of complications that are certainly more serious. For some mothers, those who have diabetes for example, Covid in pregnancy greatly worsens the prognosis, increases the risk of hospitalization in intensive care by three times compared to a mother who does not have Covid, explains Mosca. Not to mention complications such as eclampsia, a pregnancy syndrome that can be very dangerous for the mother and baby. To this is added another problem – says Mosca -: the prematurity rate in the mother who contracted Covid during pregnancy increases. It goes from 6.7 percent in the non-Covid population to arrive, in our series of 3,300 cases collected by the Sin registry, to over 11 percent. Therefore there is an increase also often linked to the fact that the birth is induced before the time because it is necessary to treat the mother who is obviously not in the best conditions to continue the pregnancy.
The outcome for children
But what is the outcome for the children? Most infants who are born to a positive mother have not contracted Covid. About 2.5 per cent of it is affected, a little more after discharge but not more than 4-5 per cent in total. And in most cases, these were asymptomatic or paucisymptomatic infections. The newborn, thanks to its innate immunity, defends itself well The pandemic has taught a series of lessons. The first that a nice injection of money is needed to structurally adapt the departments of both Neonatology and Neonatal Intensive Care. We were not ready to face an infectious disease that required increasing the isolation spaces, dedicated paths, negative pressure rooms. As has already been done in some intensive therapies in Italy but also and more abroad, you have to think about switching to single-room intensive care and not open space which, on the one hand, allow for easier isolation but also to respect more privacy, comfort of parents and a context that favors their staying 24 hours a day next to their child. Structures also means machinery. We have learned that the same thing is true for the puerperium and for the nursery, there was also a shortage of negative pressure rooms and we had to implement measures in a short time to cope with them. The second lesson that in health care we must not skimp on doctors and nurses. We really had to jump through hoops at isorisorse. Therefore we need an investment vision from this point of view and to have an organic endowment of doctors and nurses that allows us to cope with emergencies.
The positive teachings
Ma Covid has also given positive lessons. Our health has responded in a very important way. In addition, a number of opportunities have arisen. Starting from training: we learned how to use digital tools and if we look at the number of people trained in the pre-Covid era and those in the last year, it has increased dramatically. The ways of interacting with the afternoon webinars and were born we have trained more than 16 thousand members in 2021 alone. So it was a very beautiful and extraordinary job that allowed us to implement a whole series of other activities. We have created the Research White Paper in which we have research photography. In 2020 there was an increase in neonatological scientific production of 46-47%, in terms of both the impact factor (the score that measures the value and prestige of each scientific journal, ed), and the number of publications. On the Covid topic alone, 70 articles have been published in the neonatology field, concludes Mosca.
In this way, it is possible to guarantee fair and quality care throughout Europe
Ensure fair and high quality neonatal care. Not a mission impossible but the goal of the European standards of care for infant health
. The Italian Society of Neonatology has recently taken care of the translation into Italian, coordinated by Gina Ancora, together with the coordination of parents’ associations Living Onlus, making ours the first European country to make this important document available in its national language. The project was carried out by a international and interdisciplinary working group of 220 experts from more than 30 countries; supported by 108 health care societies and associations and 50 parenting organizations. This is an initiative shared by various European scientific societies including Espnic (European society for pediatric and neonatal intensive care), Efcni (European foundation for the care of newborn infants) and national scientific societies including the Italian Society of neonatology itself, explains the Professor Daniele De Luca, president of Espnic.
What are they for
To indicate some standards that should be considered in ensuring quality resuscitation care for infants who need it. The hope that they can be useful in drafting guidelines and documents with national legal value, in order to improve the organization of neonatal intensive care. Healthcare, as we know, is the responsibility of the individual member states of the European Union, therefore the Standards have no legal value, but they can be useful as a reference to the national authorities working on the organization of the sector. What topics are covered? Those typical of resuscitation and intensive care of the newborn including for example procedures, data collection, monitoring, how the departments should be designed of neonatal intensive care. It is a major effort to update these issues on the basis of the latest scientific evidence that can change even rapidly. How can they be used? Neonatology units, as well as hospital management, should be aware of these standards and consider them in the periodic reflection necessary to improve their internal practices. however, it is extremely important to remember that these standards must be seen in the light of the most advanced scientific literature and with the filter of local realities, and can therefore be improved. In fact, not all neonatology departments are the same, not all deal with the same type of patients and with the same background. The Standards, therefore, cannot be something fixed and obligatory but a reference to be considered and adapted to the local reality.
Reduce the gap between Northern and Southern Italy
Not only European models but also Italian ones. The Italian Society of Neonatology has drawn up and presented to the Minister of Health, Roberto Speranza, the manual on Organizational Standards for perinatal care, coordinated by Rinaldo Zanini, which saw the participation of the main scientific societies in the maternal-infant area. Standards represent the starting point for building the future of Italian Neonatology, aim to reduce the disparities currently existing in the organization and care of neonatal care and the North-South divide as well as increasing the safety of mother and newborn. An important project that comes 22 years after the last edition of the Requirements and recommendations for perinatal care. Since then, however, the care scenario of pregnancy, childbirth and birth has undergone important changes, which concerned not only the more purely technical aspects, but also the psychological, social and economic ones, thus requiring a new organizational approach. The Standards defined for the reorganization and improvement concern various areas: the Hub and spoke model in the perinatal setting; human resources and tools for assessing the needs of mother and child; the volumes of activities and resources of the 1st and 2nd level birth points, including staff sizing and their specific functions; the care, with the tools for taking charge of the newborn and his family and the Neonatal (Sten) and maternal assisted (Stam) emergency transport system.
November 27, 2021 (change November 27, 2021 | 22:17)
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