Neonatal Resuscitation and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection

Abstract

The first case of novel coronavirus disease of 2019 caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was reported in November2019. The rapid progression to a global pandemic of COVID-19 has had profound medical, social, and economic consequences. Pregnant women and newborns represent a vulnerable population. However, the precise impact of this novel virus on the fetus and neonate remains uncertain. Appropriate protection of health care workers and newly born infants during and after delivery by a COVID-19 mother is essential. There is some disagreement among expert organizations on an optimal approach based on resource availability, surge volume, and potential risk of transmission. The manuscript outlines the precautions and steps to be taken before, during, and after resuscitation of a newborn born to a COVID-19 mother, including three optional variations of current standards involving shared-decision making with parents for perinatal management, resuscitation of the newborn, disposition, nutrition, and postdischarge care. The availability of resources may also drive the application of these guidelines. More evidence and research are needed to assess the risk of vertical and horizontal transmission of SARS-CoV-2 and its impact on fetal and neonatal outcomes. Key Points• The risk of vertical transmission is unclear; transmission from family members/providers to neonates is possible.• Optimal personal-protective-equipment (airborne vs. droplet/contact precautions) for providers is crucial to prevent transmission. • Parents should be engaged in shared decision-making with options for rooming in, skin-to-skin contact, and breastfeeding.

Interim Guidance for Basic and Advanced Life Support in Children and Neonates With Suspected or Confirmed COVID-19

“…The mother is a potential source of aerosolization for the neonatal team. 18 • Initial steps: Routine neonatal care and the initial steps of neonatal resuscitation are unlikely to be aerosol-generating; they include drying, tactile stimulation, placement into a plastic bag or wrap, assessment of heart rate, placement of pulse oximetry and electrocardiograph leads. • Suction: Suction of the airway after delivery should not be performed routinely for clear or meconium-stained amniotic fluid.…”

COVID-19 Preparedness in a Neonatal Unit at a Tertiary Hospital in Johannesburg, South Africa

“…In order to minimize staff exposure, and therefore infection, only essential staff should be present in the delivery room/theatre. (20,21) From the neonatal team, only a senior registrar or consultant should attend deliveries of suspected or confirmed COVID-19 mothers in order to limit the number of staff involved. (21,22) Routinely, there used to be a "bottom up" approach where an intern would attend first and call for a registrar or consultant's help if required.…”

“…(21) As attendance at birth may involve resuscitation of the newborn, the appropriate PPE should include an N95 mask (or equivalent), gowns, gloves, eye protection and an apron. (8,17,(19)(20)(21)23) No transmission events have been reported in doctors and midwives who were wearing a full set of PPE during delivery procedures of COVID-19 mothers. (11)…”

“…These newborns should be carefully examined by neonatologists and monitored closely, and careful attention should be paid to prevent infection in these newborns. (4,(6)(7)(8)10,13) Newborns should be transferred in a closed transport incubator, (20,22,24) and all procedures and investigations should be carried out in a single room with a minimal number of staff present. (6,22,25) Potentially aerosol generating procedures (such as taking nasal swabs, intubating or suctioning) should be accompanied by full PPE and the necessary precautions.…”

“…(24) Mothers should be advised regarding hand washing and wearing a mask while handling the newborn. (20,21,24,26) If the newborn is admitted, then the newborn should not have any visitors but feeding is encouraged with expressed breastmilk with precautions. (21,24) Guidelines may be further updated as new evidence emerges.…”