Perinatal-Neonatal Management of COVID-19 Infection — Guidelines of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum of India (NNF), and Indian Academy of Pediatrics (IAP)

Abstract

Justification: During the current rapidly evolving pandemic of COVID-19 infection, pregnant women with suspected or confirmed COVID-19 and their newborn infants form a special vulnerable group that needs immediate attention. Unlike other elective medical and surgical problems for which care can be deferred during the pandemic, pregnancies and childbirths continue. Perinatal period poses unique challenges and care of the mother-baby dyads requires special resources for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. Process: The GRADE approach recommended by the World Health Organization was used to develop the guideline. A Guideline Development Group (GDG) comprising of obstetricians, neonatologists and pediatricians was constituted. The GDG drafted a list of questions which are likely to be faced by clinicians involved in obstetric and neonatal care. An e-survey was carried out amongst a wider group of clinicians to invite more questions and prioritize. Literature search was carried out in PubMed and websites of relevant international and national professional organizations. Existing guidelines, systematic reviews, clinical trials, narrative reviews and other descriptive reports were reviewed. For the practice questions, the evidence was extracted into evidence profiles. The context, resources required, values and preferences were considered for developing the recommendations. Objectives: To provide recommendations for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. Recommendations: A set of twenty recommendations are provided under the following broad headings: 1) pregnant women with travel history, clinical suspicion or confirmed COVID-19 infection; 2) neonatal care; 3) prevention and infection control; 4) diagnosis; 5) general questions.

Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic

“…30 31 Facility-specific creation and distribution of guidelines for managing maternity patients is somewhat lagging behind despite frequent updates by Ministries of Health and professional associations. [32][33][34][35][36][37][38] Information sharing channels must be established to secure providers' timely access to accurate information. [39][40][41] Midwives supporting pregnant and labouring women during the pandemic, 42 43 particularly independent practitioners, need clear guidelines for providing home-based care.…”

Coronavirus Disease 2019 (COVID-19) in Children - What We Know So Far and What We Do Not

“…For neonatal management of COVID-19 infected mothers, it is recommended to have a separate room adjacent to the delivery room for neonatal resuscitation or for resuscitation staff to maintain atleast a 2 meter gap between the infected mother and newborn [34]. Only essential personnel should attend the delivery with full PPE, with the mother following meticulous hand hygiene and wearing a mask.…”

Clinical profile, viral load, management and outcome of neonates born to COVID 19 positive mothers: a tertiary care centre experience from India

“…The protocol for clinical management and investigation of neonates was based on national guidelines and recommendations as per the currently available evidence [31][32][33][34]. Neonates who tested positive for COVID 19 infection were not given any specific treatment against COVID 19 infection.…”

“…As per national guidelines by expert group consensus and unit policy, all neonates born to COVID 19 positive mothers were tested [31][32][33][34].…”