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: