Management of newborns exposed to mothers with confirmed or suspected COVID-19

Abstract

There is limited information about newborns with confirmed or suspected COVID-19. Particularly in the hospital after delivery, clinicians have refined practices in order to prevent secondary infection. While guidance from international associations is continuously being updated, all facets of care of neonates born to women with confirmed or suspected COVID-19 are centerspecific, given local customs, building infrastructure constraints, and availability of protective equipment. Based on anecdotal reports from institutions in the epicenter of the COVID-19 pandemic close to our hospital, together with our limited experience, in anticipation of increasing numbers of exposed newborns, we have developed a triage algorithm at the Penn State Hospital at Milton S. Hershey Medical Center that may be useful for other centers anticipating a similar surge. We discuss several care practices that have changed in the COVID-19 era including the use of antenatal steroids, delayed cord clamping (DCC), mother-newborn separation, and breastfeeding. Moreover, this paper provides comprehensive guidance on the most suitable respiratory support for newborns during the COVID-19 pandemic. We also present detailed recommendations about the discharge process and beyond, including providing scales and home phototherapy to families, parental teaching via telehealth and in-person education at the doors of the hospital, and telehealth newborn follow-up.

A case report of neonatal coronavirus disease-19 infection in South India

“…The majority of the data was not suggestive the same. Considering the advantages of breastfeeding and insufficient data to suggest the transmission of COVID-19 through breast milk, suspected or confirmed COVID-19 is not a contraindication to breastfeeding [10]. This is very reassuring, however, continuous monitoring of such neonates is essential to look for potentially serious complications as well as to prevent horizontal transmission.…”

Perioperative care of the newborns with CHDs in the time of COVID-19

“…Physiologic and management considerations for the patient Although postnatal transmission to newborns is most likely, current evidence is inconclusive regarding in utero transmission. 14 According to recent data, SARS-CoV-2 virus has not been detected in amniotic fluid, cord blood, or breast milk of pregnant women infected with SARS-CoV-2. The incidence of the disease is lower in neonates than in adults possibly related to the difficulty of vertical transmission of coronavirus, proper handling at birth, and timely isolation of the newborn following the birth.…”

“…36 The newborn patients born to mother with COVID-19 can be fed with breastmilk (bottle or nasogastric tube) by an uninfected caregiver. 2,14,53 During the SARS-CoV-2 pandemic, for the health and safety of the patients, parental visiting should be limited. Of course, visitor restrictions may vary at different centres depending on local and regional COVID-19 infection rates in the community.…”

Obstetrics and gynaecology in the era of COVID-19

“…Neonates born to pregnant women with confirmed COVID-19 or with test-pending at the time of delivery should be considered as persons under investigation. 28…”

“…If the baby is still in the postnatal ward, then the test should be done at 48 hours after birth. 28…”