Caring for Neonates During the COVID-19 Pandemic
Brittany Perry, DO
Nemours/Alfred I. duPont Hospital for Children
Perry B. Caring for neonates during the COVID-19 pandemic. Published online April 9, 2020. Consultant360.
Puopolo KM, Hudak ML, Kimberlin DW, Cummings J. Initial guidance: management of infants born to mothers with COVID-19. Published April 2, 2020. Accessed April 6, 2020. https://downloads.aap.org/AAP/PDF/COVID%2019%20Initial%20Newborn%20Guidance.pdf
Physicians across the world have been faced with uncertainty while treating patients during the novel coronavirus disease 2019 (COVID-19) pandemic. Current evidence suggests children may have more mild symptoms than adults, but more information is needed to understand the impact of this virus on children. The pandemic is rapidly evolving, and we continue to learn about prevention and treatment. The American Academy of Pediatrics published a paper titled “Initial Guidance: Management of Infants Born to Mothers with COVID-19” to support physicians who care for mothers with COVID-19 and their newborns.
In the report, the authors summarize 6 published reports that examined viral detection in mothers with COVID-19 infection and their newborns during the peripartum period. Many of the reports found no evidence of mother-to-newborn transmission, whereas a few reports describe infants with symptomatic disease and positive viral testing. The authors acknowledge the limited data available as of March 30, 2020, used in creating these guidelines. The recommendations are summarized next.
What personal protective equipment (PPE) should you wear when caring for neonates born to mothers with COVID-19? The guidance promotes use of a gown, gloves, standard mask, and eye protection for encounters with exposed neonates. For neonates who require tracheal suctioning, respiratory support beyond 2 liters nasal cannula, bag-mask ventilation, or intubation, PPE should include a gown, gloves, and N95 mask with eye protection or respirator that includes eye protection.
When should providers attend deliveries? The guidance recommends following routine hospital policy for attendance at deliveries. Maternal COVID-19 alone is not an indication.
Should mothers with COVID-19 be separated from their neonates at birth? The guidance supports temporary separation to minimize postnatal infection. Length of time is not specified. Infants should be bathed as soon as possible and isolated in a single room. Alternative care is described in the guidance if the mother and neonate are not separated or if single-room isolation is not possible.
Is breast milk okay? Yes. The guidance supports feeding the neonate mother’s expressed breast milk. Reports to date have not found detection of the virus in breast milk. Additional guidance is provided in the report if breastfeeding is desired.
What about viral testing for neonates? Viral testing is recommended for neonates born to mothers with COVID-19 if testing is available with ideal timing 24 hours after birth, followed by a second test at 48 hours. If both tests are negative, the neonate may be placed on universal precautions.
What about hospital discharge planning? The guidance suggests close follow-up for asymptomatic neonates with COVID-19. Infants without COVID-19 should be discharged home with a healthy caregiver and maintain separation from mother until the mother is either afebrile for 72 hours and 7 days since symptoms appeared or had 2 negative tests at least 24 hours apart. Similarly, mothers should not visit their hospitalized neonate until afebrile for 72 hours, improvement in respiratory symptoms, and 2 negative tests 24 hours apart.
There are many uncertainties about COVID-19 and we will continue to expand our knowledge as more data are collected. There may be limitations to implementing these recommendations, as health care systems continue to face challenges with limited access to PPE and testing supplies. However, this interim guidance gives direction for providers who are caring for exposed mothers and their neonates.