Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Describe the AAP recommended PPE for staff attending a delivery of woman with confirmed COVID-19 infection
2. Discuss discharge planning for a newborn whose mother has COVID-19 infection

Estimated time to complete activity: 0.5 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.5 contact hours.

Read Disclaimer & Fine Print

NOTE: Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date

SUMMARY:

The AAP provides guidance on clinical issues related to the newborn when a mother has confirmed or suspected COVID-19. Neonates born to women with confirmed or pending COVID-19 results at delivery should be considered as persons under investigation (PUIs) for infection. The guideline also addresses particular areas of concern to healthcare professionals, such as PPE requirements for delivery

• PPE Precautions if Mother has COVID-19
• Rooming-In vs Separation
• NICU Care of Exposed Infant
• Testing Newborns Prior to Discharge
• Hospital Discharge
• Discharge Planning Based on Newborn Test Results

PPE Precautions if Mother has COVID-19

• AAP specifically addresses the aerosolization of SARS-CoV-2 viral particles during delivery and states that, in addition to gown and gloves, N95 respiratory masks or air-purifying respirators that provide eye protection should be used

Due to the likelihood of maternal virus aerosols and the potential need to perform newborn resuscitation that can generate aerosols

Rooming-In vs Separation

• The guidance does state that “temporary separation minimizes the risk of postnatal infant infection from maternal respiratory secretions”
• However, if a separate area is not available or the mother chooses to have baby room-in
  • Infant should be ≥6 feet from mother
  • Use curtain or isolette

NICU Care of Exposed Infant

• Admit to single-patient room
  • Ideal: Potential for negative pressure or air filtration system
  • If negative pressure unavailable or if individual space unavailable: Space by ≥6 feet and/or use air temperature-controlled isolettes
• Intubation is an aerosol-generating procedure and therefore use either an N95 respiratory mask and eye protection goggles or an air-purifying respirator that provides eye protection
• Visiting the newborn while in the NICU
  • Mothers who have COVID-19 should not visit their infants in NICUs until the following conditions are met
    • Resolution of fever without the use of antipyretics for at least 72 hours and improvement (but not full resolution) in respiratory symptoms, and
    • Negative results of a COVID-19 test from at least two consecutive specimens collected 24 or more hours apart
  • Non-maternal parents who are PUIs or who develop symptoms of disease with confirmed COVID-19
    • Should not visit infants requiring ongoing hospital care until they are determined to be uninfected by molecular testing and/or clinical criteria

Testing Newborns Prior to Discharge

• Bathe newborns after birth to remove virus that may be on skin
• Timing of testing
  • 24 hours of age
  • Repeat at 48 hours
• Procedure
  • Use one swab: Swab throat and then nasopharynx
• If infant is positive
  • Test using combined throat/nasopharynx specimens every 48 to 72 hour intervals until there are 2 consecutive negative tests

KEY POINTS:

Hospital Discharge

• Base discharge on a center’s normal criteria

Discharge Planning Based on Newborn Test Results

• If infant can’t be tested
  • Treat as if positive for the virus for the 14-day observation period
  • Mother should maintain precautions until she meets the criteria for non-infectivity (see ‘Related ObG Topics’ below)
• Positive test results
  • No symptoms: Plan for frequent outpatient follow-up (phone, telemedicine or in-office) through 14 days after birth
  • Follow CDC precautions to prevent household spread from infant to caregivers (see ‘Primary Sources – Learn More’ below)
• Negative test results
  • Ideally, discharge to designated healthy caregiver
  • Mother should
    • Maintain ≥6 foot distance when possible
    • Use a mask and hand hygiene when directly caring for the infant  
  • The above transmission precautions should be used until
    • Mother afebrile for 72 hours without use of antipyretics and at least seven days have passed since her symptoms first appeared or
    • Mother has at least 2 negative COVID-19 test results from at least two consecutive specimens collected 24 or more hours apart
• Other caregivers in the home who are have confirmed or suspected COVID-19
  • Should use standard procedural masks and hand hygiene when within 6 feet of the newborn until their own status is resolved

Learn More – Primary Sources:

AAP INITIAL GUIDANCE: Management of Infants Born to Mothers with COVID-19

CDC: If You Are Sick or Caring for Someone

Related ObG Topics:

COVID-19, PPE and Second Stage of Labor: Current US Guidance

ACOG COVID-19 FAQs for Obstetrical Care

Coronavirus and Pregnancy: CDC Guidance and Professional Recommendations