Feature

AAP recommends temporarily separating newborns from mothers with COVID-19

Mark L. Hudak

The AAP issued guidance for physicians managing the care of newborns whose mothers are suspected or confirmed to have COVID-19, including a recommendation to temporarily separate infants born to mothers with COVID-19 to minimize the risk for infection.

“This recommendation was offered out of an abundance of caution considering the lack of evidence about the risks of vertical transmission before and during delivery, the risk of transmission from mother to baby after birth and the natural history of COVID-19 infection in the newborn,” Mark L. Hudak, MD, chair of the AAP Section on Neonatal-Perinatal Medicine and a co-author of the guidelines, told Healio. “This guidance is very similar to existing recommendations about mother-baby care when the mother has active influenza.”

The APP offered best-practice protective recommendations for mothers who decline separation, or in cases where a hospital cannot accommodate a separation. In these cases, “If the center cannot place the infant in a separate area — or if the mother chooses to stay in the same room, despite recommendations — make sure the infant is at least 6 feet away,” the AAP said.

It also recommended that infants born to mothers suspected of having COVID-19 stay in an area separated from other unaffected infants.

“There remains much that we will learn about the natural history of perinatally acquired COVID-19 infections in newborns. As more information develops, it is possible, in fact probable, that some of these initial recommendations will be modified,” Hudak said. “The AAP has developed a national registry to which hospitals and providers may submit de-identified data that could be of tremendous assistance in making evidence-based updates.”

Other recommendations, as summarized by the AAP, include:

  • Studies to date have not detected the virus in breast milk. Therefore, mothers can give breast milk after ensuring breast and hand hygiene. Caregivers who are not infected may feed the breast milk to the infant. Mothers who insist on direct breastfeeding should adhere to preventive precautions that include a mask and meticulous breast and hand hygiene.
  • Medical staff attending a birth when a mother has COVID-19 should use gowns and gloves, with either an N95 respiratory mask and eye protection goggles or with an air-purifying respirator that provides eye protection.
  • Infants requiring neonatal intensive care ideally should be admitted to a single-patient room with the potential for negative room pressure or other air filtration system. If unavailable, or if multiple COVID-19 exposed infants must share a room, there should be at least 6 feet between all infants. If possible, infants should be placed in air temperature-controlled isolettes.
  • If testing is available, well newborns born to mothers with COVID-19 should be tested for COVID-19 at 24 hours of age. The test should be repeated at 48 hours of age. Infants who are not tested should be treated as if they tested positive for the virus for the 14-day observational period. The mother should remember to maintain precautions until she meets the criteria for non-infectivity.

The recommendations also cover care for infants who tests positive for COVID-19, and follow-up care for those who are discharged from the hospital, the AAP noted. A mother who tests positive for COVID-19, should maintain a 6-foot distance from the infant until she has gone 72 hours without a fever, use of antibiotics or meets criteria in the recommendations. – by Ken Downey Jr.

Reference:

Puopolo KM, et al. Initial guidance: Management of infants born to mothers with COVID-19. https://downloads.aap.org/AAP/PDF/COVID%2019%20Initial%20Newborn%20Guidance.pdf. Accessed April 8, 2020.

Disclosures: The authors report no relevant financial disclosures.

Mark L. Hudak

The AAP issued guidance for physicians managing the care of newborns whose mothers are suspected or confirmed to have COVID-19, including a recommendation to temporarily separate infants born to mothers with COVID-19 to minimize the risk for infection.

“This recommendation was offered out of an abundance of caution considering the lack of evidence about the risks of vertical transmission before and during delivery, the risk of transmission from mother to baby after birth and the natural history of COVID-19 infection in the newborn,” Mark L. Hudak, MD, chair of the AAP Section on Neonatal-Perinatal Medicine and a co-author of the guidelines, told Healio. “This guidance is very similar to existing recommendations about mother-baby care when the mother has active influenza.”

The APP offered best-practice protective recommendations for mothers who decline separation, or in cases where a hospital cannot accommodate a separation. In these cases, “If the center cannot place the infant in a separate area — or if the mother chooses to stay in the same room, despite recommendations — make sure the infant is at least 6 feet away,” the AAP said.

It also recommended that infants born to mothers suspected of having COVID-19 stay in an area separated from other unaffected infants.

“There remains much that we will learn about the natural history of perinatally acquired COVID-19 infections in newborns. As more information develops, it is possible, in fact probable, that some of these initial recommendations will be modified,” Hudak said. “The AAP has developed a national registry to which hospitals and providers may submit de-identified data that could be of tremendous assistance in making evidence-based updates.”

Other recommendations, as summarized by the AAP, include:

  • Studies to date have not detected the virus in breast milk. Therefore, mothers can give breast milk after ensuring breast and hand hygiene. Caregivers who are not infected may feed the breast milk to the infant. Mothers who insist on direct breastfeeding should adhere to preventive precautions that include a mask and meticulous breast and hand hygiene.
  • Medical staff attending a birth when a mother has COVID-19 should use gowns and gloves, with either an N95 respiratory mask and eye protection goggles or with an air-purifying respirator that provides eye protection.
  • Infants requiring neonatal intensive care ideally should be admitted to a single-patient room with the potential for negative room pressure or other air filtration system. If unavailable, or if multiple COVID-19 exposed infants must share a room, there should be at least 6 feet between all infants. If possible, infants should be placed in air temperature-controlled isolettes.
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  • If testing is available, well newborns born to mothers with COVID-19 should be tested for COVID-19 at 24 hours of age. The test should be repeated at 48 hours of age. Infants who are not tested should be treated as if they tested positive for the virus for the 14-day observational period. The mother should remember to maintain precautions until she meets the criteria for non-infectivity.

The recommendations also cover care for infants who tests positive for COVID-19, and follow-up care for those who are discharged from the hospital, the AAP noted. A mother who tests positive for COVID-19, should maintain a 6-foot distance from the infant until she has gone 72 hours without a fever, use of antibiotics or meets criteria in the recommendations. – by Ken Downey Jr.

Reference:

Puopolo KM, et al. Initial guidance: Management of infants born to mothers with COVID-19. https://downloads.aap.org/AAP/PDF/COVID%2019%20Initial%20Newborn%20Guidance.pdf. Accessed April 8, 2020.

Disclosures: The authors report no relevant financial disclosures.

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