COVID-19 NEWS MATERNAL FETAL MEDICINE
A Vulnerable Population
ENDOCRINOLOGY
The Centers for Disease Control and Prevention reports that individuals with diabetes are at high risk for severe illness and poorer health outcomes with COVID-19 . Research suggests this might be due to poor glycemic control or chronic hyperglycemia , yet information on clinical outcomes specifically for patients with type 1 diabetes who have confirmed cases of COVID-19 is limited .
So the Barbara Davis Center for Childhood Diabetes at the University of Colorado , the primary type 1 diabetes service provider for Children ’ s Hospital Colorado , helped rapidly form a national COVID-19 registry . “ In partnership with other U . S . pediatric and adult diabetes clinics , the registry helps pinpoint factors associated with poorer outcomes ,” says pediatric endocrinologist Todd Alonso , MD .
An early publication ( 1 ) from the registry last August demonstrated poor outcomes and symptoms in patients with type 1 diabetes . A third of patients in the study developed diabetic ketoacidosis , or DKA , a life-threatening illness often precipitated by other illnesses . Subsequent studies ( 2 )( 3 ) showed clear inequities in those who were hospitalized and developed DKA , particularly Black and Hispanic patients , mirroring observations in other patient populations . The registry has also studied new onset diabetes ( 4 ) during the COVID-19 pandemic . It found that patients were very sick at onset , suggesting healthcare access has significantly suffered .
“ These papers show that DKA is a big risk for this patient population ,” Dr . Alonso says . “ It ’ s more important than ever to optimize blood sugar management .” •
1 . Ebekozien OA , et al . Type 1 Diabetes and COVID-19 : Preliminary Findings From a Multicenter Surveillance Study in the U . S . Diabetes Care . Jun 2020 .
2 . O ’ Malley G , et al . COVID-19 Hospitalization in Adults with Type 1 Diabetes : Results from the T1D Exchange Multi-Center Surveillance Study . J Clin Endocrinol Metab . 2020 .
3 . Ebekozien OA et al . Inequities in diabetic ketoacidosis among patients with type 1 diabetes and COVID-19 : Data from 52 US clinical centers . JCEM . 2020 .
4 . Beliard K , et al . Increased DKA at Presentation Among Newly Diagnosed Type 1 Diabetes Patients with or without COVID-19 ; Data from a Multi-Site Surveillance Registry . J Diabetes . 2020 Dec 7 .
Prime the Pump
Can wound infusion pumps help reduce opioid use after cesarean delivery ?
According to the CDC ’ s National Center for Health Statistics , cesarean delivery is one of the most common surgical procedures in the U . S ., accounting for 32 % of all deliveries . As one of only a few freestanding children ’ s hospitals in the nation with a dedicated labor and delivery unit for high-risk pregnancies , the Colorado Fetal Care Center at Children ’ s Hospital Colorado performs its fair share .
“ These are moms who are going through so much already . We want to do everything we can to help them care for and interact with their baby , while providing optimum pain control ,” says obstetric anesthesiologist Cristina Wood , MD , Medical Director of Obstetric Anesthesia at the Colorado Fetal Care Center .
Historically , care providers at the Colorado Fetal Care Center at Children ’ s Colorado used a multimodal pain management regimen for patients that typically included the use of opioids . For some patients , the regimen also included a wound infusion pump . Dr . Wood likens it to a little garden hose that sits underneath the incision for a 48-hour continuous infusion of the local anesthetic bupivacaine .
“ Our use of the pump was sporadic ,” she says . “ And there ’ s conflicting literature on whether the pump can improve care , due to the heterogeneity of the studies . So , we saw an opportunity for improvement .”
DOES IT WORK ?
Lead OB-GYN Hospitalist Frank Chow , MD , and a team of Children ’ s Colorado specialists completed a retrospective review of cesarean deliveries at the Colorado Fetal Care Center from January 2015 through March 2016 . The team , which included Michael Zaretsky , MD , Medical Director of the Colorado Fetal Care Center , alongside clinical manager Marilyn Hernandez , RN , pediatric anesthesiologist Melissa Masaracchia , MD , and Dr . Wood , compared postoperative opioid use between patients who received the standard multimodal pain management and those who received the same regimen with the continuous infusion of bupivacaine .
4 | CHILDREN ’ S HOSPITAL COLORADO