Universal screening of high-risk neonates, parents, and staff at a neonatal intensive care unit during the SARS-CoV-2 pandemic

Abstract

Since February 21, 2020, SARS-CoV-2 has spread exponentially worldwide. Neonatal patients needing intensive care are considered a vulnerable population. To report the results of a policy based on multi-timepoint surveillance for SARS-CoV-2 of all neonates admitted to the neonatal intensive care unit (NICU), their parents, and all healthcare providers in a part of Italy with a high prevalence of the infection. Observational study conducted from 21 February to 21 April 2020. Intervention consisted of (a) parental triage on arrival at the neonatal ward; (b) universal testing with nasopharyngeal swabs and blood testing for SARS-CoV-2 IgM and IgG antibodies; (c) use of continuous personal protective equipment at the NICU by parents and staff. A total of 6726 triage procedures were performed on 114 parents, and 954 nasopharyngeal swabs were collected from 226 individuals. Five (2.2%) asymptomatic individuals (2 parents and 3 healthcare providers) tested positive on nasopharyngeal swabs and were kept isolated for 14 days. Of 75 admitted newborn, no one tested positive on nasopharyngeal swabs or antibody tests. Three parents presented with fever or flu-like symptoms at triage; they tested negative on swabs. Conclusion: With universal screening of neonates, parents, and staff, there were no cases of SARS-CoV-2 infection among the neonates admitted to a NICU in an area with a high incidence of SARS-CoV-2. Our experience could be usefully compared with other strategies with a view to developing future evidence-based guidelines for managing high-risk neonates in case of new epidemics. What is Known: • The novel coronavirus named SARS-CoV-2 has since spread worldwide at a remarkable rate, with more than 2.5 million confirmed cases. • Pediatric population may be less affected from COVID-19 than adult population but infants and newborn babies seem to be more vulnerable to SARS-CoV-2 infection. What is New: • Using an approach based on triage; testing with nasopharyngeal swabs and serology; and use of personal protective equipment, there were no cases of SARS-CoV-2 infection among neonates in a NICU in a high incidence of SARS-CoV-2 area. • Positive and asymptomatic individuals were identified and isolated early allowing the containment of infection's spread among healthcare providers and parents.

The Collateral Impact of COVID-19 Emergency on Neonatal Intensive Care Units and Family-Centered Care: Challenges and Opportunities

“…In many cases, the needed restrictions and containment measures (Cavicchiolo et al, 2020a , b ; De Rose et al, 2020 ) that are in place to deal with the COVID-19 emergency are exacerbating the problems associated with meager adoption of family-centered care principles in NICUs. During these months, it has been common to hear colleagues say that “COVID has made us go back decades in the quality of family support we provide.” This is a serious negative development because care should be all the more humane and person-centered during the COVID-19 pandemic; a goal that becomes fully achievable only through a strengthened involvement of patients' families (Coulter and Richards, 2020 ) and the support and empowerment of frontline healthcare workers.…”

Italian neonatologists and SARS-CoV-2: lessons learned to face coming new waves

“…37 As the months went by, the increasing evidence suggested to perform universal screening with nasopharyngeal swabs to all pregnant women; this practice is now recognized in almost all Italian hospitals. 9,11,31,53 A woman's partner was allowed to attend the labor and delivery if his SARS-CoV-2 status was known but was not allowed to stay on the postpartum ward or it was permitted with time restrictions. 37 Studies suggested concentrating COVID-19 cases, procedures, and medical devices in chosen third-level hub referral hospitals with a NICU.…”

“…39 Most studies suggested a dedicated, specialized team caring for newborns born from COVID-19 mothers to minimize the transmission and spread of the SARS-CoV-2 among healthcare workers. 8,21,53 If the mother was positive for SARS-CoV-2, the infant should have been tested at or beyond 24 hours after birth. Separate swabs of the nasopharynx, oropharynx, and rectum were recommended depending on the availability and turnaround time of testing facilities.…”

“…8,21 Screening at NICU admission was assessed by authors from Padova and Rome. 31,32,53 Although the prevalence of COVID-19positive infants was low, both NICUs opted for a universal screening of newborns admitted to the Unit, their parents, and staff in order to avoid the spread of the virus in a high-risk ward. This policy allowed to identify early positive asymptomatic individuals, which were 2.2% of screened, 53 and it has been demonstrated as the best approach to reduce SARS-CoV-2-related costs.…”

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

“…For the time being, we have to assemble reasonable experience based guidelines to prevent COVID-19 within the NICU. In this issue of European Journal of Pediatrics, we publish an intriguing study performed in a 3 rd level Italian NICU located in one of the regions most affected by the pandemic [9]. The authors present a method to care for these vulnerable neonates.…”