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1. Maternity services' responses to the COVID-19 pandemic: how Public Health England guidance was implemented in practice

Author

Hanley, S., Raybould, G., Baxter, E., Gray, J., Sharkey, D., and Walker, K. F.

Subjects
Microbiology (medical), Infectious Diseases, Pregnancy, SARS-CoV-2, Health Personnel, Humans, COVID-19, Female, Public Health, General Medicine, Pandemics, Personal Protective Equipment
Abstract

Introduction: The rapidly evolving COVID-19 pandemic required systemic change in how healthcare was delivered to minimize virus transmission whilst maintaining safe service delivery. Deemed at ‘moderate-high risk’, maternity patients are an important patient group that require consideration. Public Health England (PHE) issued national guidance on how to adjust these services. Aim: To explore how maternity units in England implemented PHE guidance. Methods: An online survey of 22 items was distributed to individuals that had worked on an England-based maternity unit during the COVID-19 pandemic. The questionnaire was designed and tested by the multidisciplinary research team. Data was collected from November 2020 to July 2021. Findings: Forty-four participants across 33 maternity units responded. Ninety-three percent were able to test all women requiring an overnight stay for COVID-19. Only 27% reported birth partners were tested for COVID-19. Only 73% reported they were able to isolate all COVID-19-positive patients in single rooms. Eighty-four percent stated they were aware of current PHE guidance on personal protective equipment (PPE) and 82% felt ‘confident’ in donning/doffing of PPE. Priorities for the future include rapid testing and a focus on community service provision. Conclusions: PHE COVID-19 guidance was implemented differently in maternity units across England due to the varying resources available at each trust leading to variable ability to test and isolate patients as recommended. More specific, tailored guidance for infection control measures against COVID-19 is needed for maternity settings due to their unique position.

Published
2022

6. The newborn delivery room of tomorrow: emerging and future technologies.

Author

Batey, N, Henry, C, Garg, S, Wagner, M, Malhotra, A, Valstar, M, Smith, T, Sharkey, D, European Society for Paediatric Research (ESPR) Neonatal Resuscitation Section Writing Group, Batey, N, Henry, C, Garg, S, Wagner, M, Malhotra, A, Valstar, M, Smith, T, Sharkey, D, and European Society for Paediatric Research (ESPR) Neonatal Resuscitation Section Writing Group

Abstract

Advances in neonatal care have resulted in improved outcomes for high-risk newborns with technologies playing a significant part although many were developed for the neonatal intensive care unit. The care provided in the delivery room (DR) during the first few minutes of life can impact short- and long-term neonatal outcomes. Increasingly, technologies have a critical role to play in the DR particularly with monitoring and information provision. However, the DR is a unique environment and has major challenges around the period of foetal to neonatal transition that need to be overcome when developing new technologies. This review focuses on current DR technologies as well as those just emerging and further over the horizon. We identify what key opinion leaders in DR care think of current technologies, what the important DR measures are to them, and which technologies might be useful in the future. We link these with key technologies including respiratory function monitors, electoral impedance tomography, videolaryngoscopy, augmented reality, video recording, eye tracking, artificial intelligence, and contactless monitoring. Encouraging funders and industry to address the unique technological challenges of newborn care in the DR will allow the continued improvement of outcomes of high-risk infants from the moment of birth. IMPACT: Technological advances for newborn delivery room care require consideration of the unique environment, the variable patient characteristics, and disease states, as well as human factor challenges. Neonatology as a speciality has embraced technology, allowing its rapid progression and improved outcomes for infants, although innovation in the delivery room often lags behind that in the intensive care unit. Investing in new and emerging technologies can support healthcare providers when optimising care and could improve training, safety, and neonatal outcomes.

Published
2022

8. National active surveillance to understand and inform neonatal care in COVID-19

Author

Gale, C, Knight, M, Ladhani, S, Draper, ES, Sharkey, D, Doherty, C, Mactier, H, Kurinczuk, JJ, Group, Members of Neonatal Complications of COVID-19 Surveillance, and National Institute of Health Research Policy Research Programme

Subjects
medicine.medical_specialty, Pediatrics, Population, Pneumonia, Viral, Disease, neonatology, 03 medical and health sciences, Betacoronavirus, Viewpoint, 0302 clinical medicine, 030225 pediatrics, Obstetrics and Gynaecology, Epidemiology, medicine, Humans, Pediatrics, Perinatology, and Child Health, 030212 general & internal medicine, Neonatology, education, Pandemics, Pregnancy, education.field_of_study, Infection Control, SARS-CoV-2, business.industry, Transmission (medicine), Infant, Newborn, COVID-19, Obstetrics and Gynecology, General Medicine, medicine.disease, United Kingdom, Neonatal infection, Perinatal Care, Pediatrics, Perinatology and Child Health, Epidemiological Monitoring, Infant Care, Members of Neonatal Complications of COVID-19 Surveillance Group, 1114 Paediatrics and Reproductive Medicine, epidemiology, business, Coronavirus Infections, Horizontal transmission
Abstract

The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and has spread rapidly. COVID-19 was declared a pandemic by the WHO on 12 March 2020. Robust, population-based data describing COVID-19 during pregnancy and the neonatal period are critical to understand and manage this global threat in these groups. There are three key ways that SARS-CoV-2 could affect neonates: 1. Vertical transmission of SARS-CoV-2 from mother to infant, which may lead to neonatal COVID-19. 2. Horizontal transmission of SARS-CoV-2 in the neonatal period, potentially leading to neonatal COVID-19; this may occur from family contacts or nosocomial transmission in healthcare settings, such as neonatal units. 3. Indirect effects on the newborn following maternal COVID-19 that impact pregnancy or labour and birth, leading to complications, such as preterm birth. This will include situations where the neonate is affected by, but does not contract, SARS-CoV-2. The impact of COVID-19 on neonates, as well as the importance of these different potential mechanisms of exposure, remains unclear. Vertical transmission of SARS-CoV-2 has yet to be definitively established; neonatal infection with the virus has been detected in the first days after birth to mothers with COVID-191; however, this could represent early horizontal transmission. Support for vertical transmission comes from serological testing following maternal COVID-19, which found SARS-CoV-2 IgM in umbilical cord blood2; however, SARS-CoV-2 viral RNA was not detected in these newborns, and the validity of current serological tests remains to be established.3 Nevertheless, neonates can be symptomatic with COVID-19 regardless of the mechanism of transmission. Although initial data indicated that the disease was less severe in children,4 approximately 10% of neonates and infants with COVID-19 develop severe or critical disease, a higher proportion than that in …

Published
2020

11. Neonatal stroke surveillance study protocol in the United Kingdom and Republic of Ireland

Author

Kwok T’ng Chang, Dineen Robert A., Whitehouse William, Lynn Richard M., McSweeney Niamh, and Sharkey Don

Subjects
infant, neonatal stroke, population surveillance, perinatal stroke, Medicine
Abstract

Neonatal stroke is a devastating condition that causes brain injury in babies and often leads to lifelong neurological impairment. Recent prospective population studies of neonatal stroke are lacking. Neonatal strokes are different from those in older children and adults. A better understanding of its aetiology, current management, and outcomes could reduce the burden of this rare condition. The study aims to explore the incidence and 2 year outcomes of neonatal stroke across an entire population in the UK and Republic of Ireland. This is an active national surveillance study using a purpose-built integrated case notification-data collection online platform. Over a 13 month period, with a potential 6 month extension, clinicians will notify neonatal stroke cases presenting in the first 90 days of life electronically via the online platform monthly. Clinicians will complete a primary questionnaire via the platform detailing clinical information, including neuroimaging, for analysis and classification. An outcome questionnaire will be sent at 2 years of age via the platform. Appropriate ethics and regulatory approvals have been received. The neonatal stroke study represents the first multinational population surveillance study delivered via a purpose-built integrated case notification-data collection online platform and data safe haven, overcoming the challenges of setting up the study.

Published
2022
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38. Identification and characterization of podocalyxin--the major sialoprotein of the renal glomerular epithelial cell.

Author

Kerjaschki, D, Sharkey, D J, and Farquhar, M G

Abstract

The glomerular epithelial polyanion is a specialized cell surface component found on renal glomerular epithelial cells (podocytes) that is rich in sialoprotein(s), as detected by staining with cationic dyes (colloidal iron, alcian blue) and wheat germ agglutinin (WGA). We have isolated rat glomeruli and analyzed their protein composition by SDS PAGE in 5-10% gradient gels. When the gels were stained with alcian blue or "Stains All," a single band with an apparent Mr of 140,000 was detected that also stained very prominently with silver, but not with Coomassie Blue. This band predominated in fluorograms of gels of isolated glomeruli that had been labeled in their sialic acid residues by periodate-[3H]borohydride. In lectin overlays, the 140-kilodalton (kd) band was virtually the only one that bound [125I]wheat germ agglutinin, and this binding could be prevented by predigestion with neuraminidase. [125I]Peanut lectin bound exclusively to the 140-kd band after neuraminidase treatment. An antibody was prepared that specifically recognizes only the 140-kd band by immunoprecipitation and immuneoverlay. By immunoperoxidase and immunogold techniques, it was localized to the surface coat of the glomerular epithelium and, less extensively, to that of endothelial cells. When analyzed (after electroelution from preparative SDS gels), the 140-kd band was found to contain approximately 20% hexose and approximately 4.5% sialic acid. These findings indicate that the 140-kd protein is the major sialoprotein of the glomerulus, and it is the only component of glomerular lysates with an affinity for cationic dyes and lectins identical to that defined histochemically for the epithelial polyanion in situ. Since this molecule is a major component of the cell coat or glycocalyx of the podocytes, we have called it "podocalyxin."

Published
1984
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39. Development of a procedure for autoradiographic localization of carbonic anhydrase at the electron microscope level.

Author

Gay, C V, Shanabrook, V M, and Sharkey, D J

Abstract

A method for preparing tissue suitable for electron microscope autoradiographic localization of carbonic anhydrase is described. Radioactivity is in the form of 3H-acetazolamide, a specific inhibitor of carbonic anhydrase. Tissues fixed in glutaraldehyde, dehydrated in ethylene glycol followed by cellosolve as a transition fluid, and embedded in epoxy resin, were found to retain most (74%) of the label. Electron micrographs of avian gastric mucosa prepared in this manner are shown. Other methods of preparation were explored and resulted in considerable losses of label or in inadequately preserved tissue. Light microscope autoradiographic localization of gastric mucosa, shell gland, chorioallantoic membrane, and skeletal muscle compare well with previous localizations.

Published
1981
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40. Identification of an N-Acetylglucosaminyltransferase in Dictyostelium discoideumThat Transfers an “Intersecting” N-Acetylglucosamine Residue to High Mannose Oligosaccharides

Author

Sharkey, D J and Kornfeld, R

Abstract

Glycoproteins synthesized by the cellular slime mold Dictyostelium discoideumhave been shown to contain asparagine-linked high-mannose oligosaccharides which have an N-acetylglucosamine group in a novel intersecting position (attached β1–4 to the mannose linked α1–6 to the core mannose). We have used crude membrane preparations from vegetative D. discoideum(strain M4) to characterize the enzyme activity responsible for catalyzing the transfer of GlcNAc to the intersecting position of high-mannose oligosaccharides. UDP-GlcNAc:oligosaccharide β-N-acetylglucosaminyltransferase activity in these preparations attaches GlcNAc to the mannose residue-linked α1–6 to the β-linked core mannose of the following Man9GlcNAc oligosaccharide as shown by the arrow.

Published
1989
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50. Comparing peripheral limb and forehead vital sign monitoring in newborn infants at birth.

Author

Swamy SKN, Stockwell SJ, Liu C, Henry C, Shipley L, Ward C, Mirahmadi S, Correia R, Morgan SP, Crowe JA, Sharkey D, and Hayes-Gill BR

Abstract

Background: To study the feasibility of measuring heart rate (HR) and oxygen saturation (SpO 2 ) on the forehead, during newborn transition at birth, and to compare these measurements with those obtained from the wrist., Methods: Vital signs were measured and compared between forehead-mounted reflectance (remittance) photoplethysmography sensor (fhPPG) and a wrist-mounted pulse oximeter sensor (wrPO), from 20 enrolled term newborns born via elective caesarean section, during the first 10 min of life., Results: From the datasets available (n = 13), the median (IQR) sensor placement times for fhPPG, ECG and wrPO were 129 (70) s, 143 (68) s, and 159 (76) s, respectively, with data recorded for up to 10 min after birth. The success rate (percentage of total possible HR values reported once sited) of fhPPG (median = 100%) was higher compared to wrPO (median = 69%) during the first 6 min of life (P < 0.005). Both devices exhibited good HR agreement with ECG, achieving >95% agreement by 3 (fhPPG) and 4 (wrPO) min. SpO 2 for fhPPG correlated with wrPO (r = 0.88), but there were significant differences in SpO 2 between the two devices between 3 and 8 min (P < 0.005), with less variance observed with fhPPG SpO 2 ., Conclusion: In the period of newborn transition at birth in healthy term infants, forehead measurement of vital signs was feasible and exhibited greater HR accuracy and higher estimated SpO 2 values compared to wrist-sited pulse oximetry. Further investigation of forehead monitoring based on the potential benefits over peripheral monitoring is warranted., Impact: This study demonstrates the feasibility of continuously monitoring heart rate and oxygen saturation from an infant's forehead in the delivery room immediately after birth. Significantly higher SpO 2 measurements were observed from the forehead than the wrist during the transition from foetal to newborn life. Continuous monitoring of vital signs from the forehead could become a valuable tool to improve the delivery of optimal care provided for newborns at birth., (© 2024. The Author(s).)

Published
2024
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