AAP Recommendations: L&D Guidance and Management of Infants Born to COVID-19 Positive Mothers
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
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
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 07/15/2020 through 07/15/2022, 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.
NOTE:Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date
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
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
Rooming-In vs Separation
Mother with confirmed or suspected COVID-19 and well newborns can room-in
Risk of newborn infection is low if proper precautions are taken
A mother who is accutely ill may not be able to care for her infant
May be appropriate to temporarily separate mother and newborn or have the newborn cared for by non-infected caregivers in mother’s room
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
Mothers and Partners Visiting the NICU
If fully vaccinated who have then had an exposure
Do not exclude unless they develop symptoms consistent with SARS-CoV-2 infection
Should not visit NICU infants while able to transmit SARS-CoV-2
Immunocompetent persons may be considered non-infectious if
Afebrile for 24 hours without use of antipyretics
At least 10 days have passed since symptoms first appeared (or, in the case of asymptomatic women identified only by obstetric screening tests, at least 10 days have passed since the positive test)
Symptoms have improved
Persons who are severely or critically ill with COVID-19
Should not enter the NICU until at least 20 days have passed since symptoms first appeared or first positive test
Severely immunocompromised and infected with SARS-CoV-2
Recommend consultation with your local infectious disease specialists for specific case management
Testing Newborns Prior to Discharge
Bathe newborns after birth to remove virus that may be on skin
Timing of testing for healthy newborns: At least once before discharge
24 hours of age
Repeat at 48 hours
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
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
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
she has been afebrile for 24 hours without use of antipyretics
at least 10 days have passed since her symptoms first appeared (or, in the case of asymptomatic women identified only by obstetric screening tests, at least 10 days have passed since the positive test), and
symptoms have improved.
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
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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