Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID‐19

Yeo, Kee Thai; Oei, Ju Lee; Luca, Danièle De; Schmölzer, Georg M.; Guaran, Robert; Palasanthiran, Pamela; Kenchappa, Kumar; Buonocore, Giuseppe; Cheong, Jeanie L.Y.; Owen, Louise; Kusuda, Satoshi; James, Jennifer; Lim, Gina; Sharma, Ankur; Uthaya, Sabita; Gale, Chris; Whittaker, Elizabeth; Battersby, Cheryl; Modi, Neena; Norman, Mikael; Navér, Lars; Giannoni, Éric; Diambomba, Yenge; Shah, Prakeshkumar S; Gagliardi, Luigi; Harrison, Michael J.; Pillay, Shakti; Alburaey, Abdullah; Yuan, Yuan; Zhang, Huayan

doi:10.1111/apa.15495

Cited by 66 publications

(83 citation statements)

References 54 publications

(94 reference statements)

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“…more commonly acquired postnatally, through environmental exposure. There are wide differences in this matter between the clinical guidelines issued by scientific societies and authorities worldwide 96 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ caring-for-newborns.html, https://www.rcog.org.uk/globalassets/ documents/guidelines/2020-06-04-coronavirus-covid-19-infectionin-pregnancy.pdf) and these have been recently highlighted 97 . Thus, we believe that a correct and complete counselling should be given to families in order to allow a well-informed choice.…”

Section: Discussionmentioning

confidence: 99%

“…If rooming-in is chosen, appropriate hygiene advice and personal protective equipment should be given, as these may significantly reduce the risk of transmission 99 . Hygiene measures during mother-neonate contact were described inconsistently and only in a minority of articles 23,24,34,39,64,67,75 , and, given the differences in guidelines worldwide 97 , dedicated studies are warranted to understand what would be the ideal equipment and policy to be applied.…”

Section: Discussionmentioning

confidence: 99%

“…However, not all these NICU-admitted babies may have actually needed critical care and this is not possible to be extrapolated with this type of analysis. The NICU-admission may be influenced by many factors such as local setting, logistics, and isolation policy, since the NICU could represent the only area to isolate infected babies and guidelines are extremely dissimilar between different countries and settings 97 . This should be avoided if NICU care is not actually needed, in order to avoid the shortage of NICU beds during the pandemic 102 .…”

Section: Discussionmentioning

confidence: 99%

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Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

et al. 2020

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A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. Here, we aim to clarify the transmission route, clinical features and outcomes of these infections. We present a meta-analysis of 176 published cases of neonatal SARS-CoV-2 infections that were defined by at least one positive nasopharyngeal swab and/or the presence of specific IgM. We report that 70% and 30% of infections are due to environmental and vertical transmission, respectively. Our analysis shows that 55% of infected neonates developed COVID-19; the most common symptoms were fever (44%), gastrointestinal (36%), respiratory (52%) and neurological manifestations (18%), and lung imaging was abnormal in 64% of cases. A lack of mother–neonate separation from birth is associated with late SARS-CoV-2 infection (OR 4.94 (95% CI: 1.98–13.08), p = 0.0002; adjusted OR 6.6 (95% CI: 2.6–16), p < 0.0001), while breastfeeding is not (OR 0.35 (95% CI: 0.09–1.18), p = 0.10; adjusted OR 2.2 (95% CI: 0.7–6.5), p = 0.148). Our findings add to the literature on neonatal SARS-CoV-2 infections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

et al. 2020

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“…Since the start of the pandemic, there has been an exponential increase in publications describing the measures that need to be taken in specific patient groups and this has resulted in various, and often diverse, proposals for guidelines [8]. Unfortunately, at the time of writing, there is no universally applicable, evidence-based guideline for the prevention and management of COVID-19 infection in the paediatric population,.…”

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confidence: 99%

COVID-19 surveillance for all newborns at the NICU; conditio sine qua non?

2020

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Previous studies have reported fewer cases of Coronavirus disease 2019 (COVID-19) in children than in adults, and to date there is limited literature about the clinical course and outcomes in neonates [1, 2]. Not inappropriately the focus of COVID-19 therapies has been in adults, especially the aged. However, it is clear that an immature immune system makes neonates, especially those in the NICU, highly vulnerable to infections generally [3, 4], and thus probably also for COVID-19. One case series has suggested that the younger the child, the higher risk of severe COVID-19 disease [5]. The first report of a neonate with COVID-19 infection was a 17 days old boy who recovered [6]. At the time of writing, complete data 1 on 35 neonates have been included in the database EPICENTRE [7]. Vertical risk was present in 33 neonates, and only two infants were reported to have community exposure. As more neonates are included in well-designed databases, the more we understand the risks, clinical spectrum, severity and complications in this patient population. Moreover, we can focus on ways to prevent COVID-19 infections in neonates born from an infected mother, or neonates that are infected in the community, whether at home, in hospital, by health care workers or families, especially during any potential new pandemic waves.

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“…These studies found that the recommendations formulated within the CPGs were lacking evidence and that the overall quality of CPGs was poor and variable [11][12][13]. However, these studies are limited in that they assessed CPGs published very soon after the rst con rmed case of COVID-19 [11], CPGs addressing very speci c interventions [12], or CPGs with very speci c populations [13]. To our knowledge, this study will be the rst to assess the quality of evidence-based CPGs focused on the use of TIs and/or management of COVID-19.…”

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confidence: 99%

Critical Appraisal of Clinical Practice Guidelines for the Management of COVID-19: Protocol for a Systematic Review

Dhivagaran

Abbas

Butt

et al. 2020

Preprint

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BackgroundIn December 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 was identified as the cause of an acute respiratory disease, coronavirus disease 2019 (COVID-19). Given the lack of validated treatments, there is an urgent need for the high-quality management of COVID-19. Clinical practice guidelines (CPGs) are one tool that healthcare providers may use to enhance patient care. As such, it is necessary that they have access to high-quality evidence-based CPGs upon which they may base decisions regarding the management and use of therapeutic interventions (TI) for COVID-19. The purpose of the proposed study is to assess the quality of CPGs that make management or TI recommendations for COVID-19 using the AGREE II instrument. Methods‌The proposed systematic review will identify CPGs for TI use and/or the management of COVID-19. MEDLINE, EMBASE, CINAHL and Web of Science will be searched from December 2019 up to December 2020. The primary outcome of this study is the assessed quality of the CPGs. The quality of eligible CPGs will be assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Descriptive statistics will be used to quantify the quality of the CPGs. The secondary outcomes of this study are the types of management and/or TI recommendations made. Inconsistent and duplicate TI and/or management recommendations made between CPGs will be compared across guidelines. DiscussionThe results of this study will be of utmost importance to enhancing clinical decision-making among healthcare providers caring for patients with COVID-19. Moreover, the results of this study will be relevant to guideline developers in the creation of CPGs or improvement of existing ones, researchers who want to identify gaps in knowledge, and policy-makers looking to encourage and endorse the adoption of CPGs into clinical practice. The results of this review will be published in a peer-reviewed journal and presented at conferences. Systematic Review ‌Registration‌ ‌International‌ ‌Prospective‌ ‌Register‌ ‌for‌ ‌Systematic‌ ‌Reviews‌ ‌(PROSPERO)‌ ‌—‌ ‌CRD42020219944

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Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID‐19

Cited by 66 publications

References 54 publications

Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

COVID-19 surveillance for all newborns at the NICU; conditio sine qua non?

Critical Appraisal of Clinical Practice Guidelines for the Management of COVID-19: Protocol for a Systematic Review

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