In this early pilot study, we sought to determine if the alteration in these physiologic effects in premature infants in response to ambient noise in the NICU could be assessed evaluating cerebral blood saturation. Three premature infants, on high flow nasal cannula oxygen support (HFNC), at less than 34 weeks of gestation were included in the study. Three variables were used to evaluate sound levels due to AAP and EPA guidelines; Leq,1h, L10,1h and Lmax,1min. All of the patients studied were found to be exposed to statistically significant noise levels (above recommendation) throughout all of the time periods measured. Noise levels were found to be similarly elevated during the 1 am and 3 pm time periods as well, though not as much as compared to the 7 am measure. A statistically significant difference was found within every patient's rSO2 levels in both hemispheres, but also in the absolute differences of rSO2. Positive significant statistical correlations were found between the average rSO2 and Leq,1h (ρ=0.14), Lmax,1min (ρ=0.18), L10,1h (ρ=0.15). Significant negative correlations were found between the absolute difference levels and Lmax,1min (ρ=-0.3), and L10,1h (ρ=-0.18) This data highlights the need for further study as to the potential impact of noise on the cerebral physiology of premature infants. Further research is needed to assess the potential long-term side effects of environmental noise on the premature in-fant's brain.

Introduction While the COVID-19 pandemic continues to have a significant global health impact, rates of maternal to infant vertical transmission remain low (<5%). Parenchymal changes of placentas from COVID-19 infected mothers have been reported by several groups, but the localization and relative abundance of SARS-CoV-2 viral proteins and cellular entry machinery has not been fully characterized within larger placental tissue cohorts. Methods An extended placental tissue cohort including samples from 15 COVID-19 positive maternal-fetal dyads (with n = 5 cases with evidence of fetal transmission) in comparison with 10 contemporary COVID-19 negative controls. Using comparative immunofluorescence, we examined the localization and relative tissue abundance of SARS-CoV2 spike glycoprotein (CoV2 SP) along with the co-localization of two SARS-CoV2 viral entry proteins angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). Results/conclusions CoV2 SP was present within the villous placenta in COVID-19 positive pregnancies with and without evidence of fetal transmission. We further identified the predominance of ACE2 expression in comparison with TMPRSS2. Importantly, both CoV2 SP and ACE2 expression consistently localized primarily within the outer syncytiotrophoblast layer placental villi, a key physiologic interface between mother and fetus. Overall this study provides an important basis for the ongoing evaluation of SARS-CoV-2 physiology in pregnancy and highlights the importance of the placenta as a key source of primary human tissue for ongoing diagnostic and therapeutic research efforts to reduce the global burden of COVID-19.

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A comprehensive QI program focused on non-pharmacologic care, function-based assessments, and methadone resulted in significant sustained improvements in NAS outcomes. These findings have important implications for establishing potentially better practices for opioid-exposed newborns.