AAP Recommendations: L&D Guidance and Management of Infants Born to COVID-19 Positive Mothers

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
• Mothers and Partners Visiting the NICU
• 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

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
• Confirmed COVID-19
  • 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
• 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
    • 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

Learn More – Primary Sources:

AAP FAQs: Management of Infants Born to Mothers with Suspected or Confirmed COVID-19

CDC: If You Are Sick or Caring for Someone