COVID-19 - Guidance for

Newborn infants

AFAF KORRAA

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 Clinical presentation
• At present, expert opinion is that the fetus is
unlikely to be exposed during pregnancy.
• Only one case of possible vertical transmission
caused by intrauterine infection has been
identified.

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 Transmission of the virus is therefore most
likely to occur post birth

• We are strongly encouraged to conduct a

risk/benefit discussion with families to
individualise care in babies that may be more
susceptible to COVID-19 infection.

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 Antenatal
• Mode of birth should be individualized based
on obstetric indications and the woman’s
preferences.
• WHO recommends that caesarean section
should ideally be undertaken only when
medically justified
• Steroids should be given to mothers
anticipating preterm delivery where
indicated and urgent delivery should not be
delayedfor their administration (as normal
practice).
• MgSO4 should be given for neuroprotection of
infants < 30 weeks’ gestation as per current
guidance

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 Antenatal
• All women with confirmed or
suspected COVID-19 should have
continuous cardiotocography
monitoring in labour.
• The appropriate Personal Protective
Equipment determined locally must
be worn by any person entering the
room.

• Only essential staff should be

present in the delivery
room/theatre.
RCPCH 2020

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 MANAGEMENT AT THE
DELIVERY ROOM
• Delivery shall take place in a dedicated isolation room .
• All Infant Resuscitation/ Assessment will occur in the
location where the infant is born – AVOID TRANSFER

• Resuscitation will be carried out as per NRP protocol.

• Clinical staff should use Droplet and Contact Precautions.

• N95, and eye proteciton goggle is needed when

performing newborn resuscitation that can generate
aerosols:

– bag-mask ventilation, intubation, suctioning, oxygen at a flow >2

LPM/kg, continuous positive airway pressure and/or positive
pressure ventilation.

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 MANAGEMENT AT THE
DELIVERY ROOM
• Once baby is stable ,should be
bathed by water and soap after
birth before transfere to NICU.
• Delayed cord clamping is not
recommended
• Queensland 2020

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• Mother –infant contact is not ADVISABLE
• In preterm baby, standard thermoregulatory
measures including the use of a plastic bag.
AAP 2020

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 MANAGEMENT POST DELIVERY

1- Assessment
High index of suspicion for signs of sepsis/unwell baby

1-Both stable and unstable infants should be moved immediately after

resuscitation to a dedicated Isolation Room in the NICU.

2- Babies born to suspected/confirmed mothers with COVID-19 should have a

throat or nasopharyngeal pharyngeal swab for COVID-19 PCR at 12/ or 24
Hr of age. and repeat at around 48 hours by special procedure (*)

AAP 2020

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 Rooming-in for mothers and well
newborns
• Temporary separation minimizes the risk of postnatal
infant infection from maternal respiratory secretions. If
possible, admit the infant to an area separate from
unaffected infants, and wear gowns, gloves, eye
protection goggles and standard procedural masks for
newborn care.
• If the center cannot place the infant in a separate area
— or the mother chooses rooming-in despite
recommendations
• — ensure the infant is at least 6 feet from the mother.
A curtain or an isolette can help facilitate separation
AAP2020

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 Feeding
Mother should be assisted to initiate breast milk feeding
OR / expression after delivery if her condition allows.

This should be done after proper hand hygiene and while

wearing a face mask.

AAP 2020

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Well near-term or term rooming with
their mothers

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Mother should:
• wear a long-sleeved gown and surgical mask
• Clean her hands properly and often with soap
and water or alcohol rub - before and after
interacting with your baby.

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 Neonatal Nursery
• COVID-19 positive mother alone (i.e. no other
neonatal criteria), is not itself an indication for
admission to a neonatal nursery
• Perform clinical assessment after birth as per
usual protocols
• Assess if required care can safely be provided
during co-location with mother.

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 In-hospital neonatal transport

• Guidance is available on safe transfers

between departments, but neonates should
be transferred in a closed incubator.
• Where possible, all procedures and
investigations should be carried out in the
single room with a minimal number of staff
present.

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 In-hospital neonatal transport

• There Must be a pathways for transport to the

post-partum wards and the NICU if an infant born
to a COVID-positive mother is symptomatic.
• An infant on respiratory support should be
transported to the NICU using a designated
route in a closed isolette to minimize the
possibility of unfiltered expiratory gases exposing
anyone not wearing airborne precautions.

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 Outborn transport of infant born to
COVID-positive mother
• There is currently no data to guide the
practice of outborn transport of an infant born
to a COVID-positive mother.
• In centers where staff who perform aerosol
generating medical procedures (AGMP) use
N95 respirators regardless of time after birth,
to be consistent, all transport team members
should have access to the same precautions

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 NICU
• 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 the center must cohort multiple COVID-

exposed infants, there should be at least 6 feet between
infants.

• Consider ways to reduce unnecessary investigations

Intubation/LISA are particularly high risk and must involve
use of appropriate PPE, even in an emergency.

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 NICU
• In-line suction with endotracheal tubes should
be used if possible.

• Where possible use of a video-laryngoscope

should be considered for intubation (if
available), and the baby kept within the
incubator.

• AAP 2020

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 NICU
• CPAP and high flow therapies are associated
with significant aerolisation and must
therefore be also be considered high risk.

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 Testing and discharge
Infants who cannot be tested should be treated
as if they are positive for the virus for the 14-
day observation period.
Infants Positive test results:
• If an infant tests positive for COVID-19 but
does not display symptoms, plan for frequent
outpatient follow-up (phone, telemedicine or
in-office) through 14 days after birth.
• Follow precautions (including stools) to
prevent household spread from infant to
caregivers

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 Testing and discharge

Negative test results:

• Discharge the infant, ideally, to the care of a designated healthy
caregiver.
• The mother should maintain a 6-foot distance when possible and
use a mask and hand hygiene when directly caring for the infant
until either a) she meets the criteria for non-infectivity ***.

***.
(a) she has been afebrile for 72 hours without use of antipyretics, and
(b) at least 7 days have passed since her symptoms first appeared;
OR she has negative results of a SARS-CoV-2 test from at least two
consecutive specimens collected ≥24 hours apart

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 Visit Protocol if the baby is in
the NICU?
• Mothers with COVID-19 should not visit infants requiring
neonatal intensive care until she met the criteria of non-
infectivity***

• COVID-19 positive parents should not be able to visit their

baby on the NNU.

• No other visitors (including siblings) should be allowed to

visit infants in NNUs (all areas), except under exceptional
circumstances, to be discussed with local infection control.

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 Parents and visitors
• COVID-19 positive parents should not be able to visit their
baby on the NNU.
• Parents who have been screened for COVID-19, for
whatever reason, should not be permitted to visit their
baby until they have been confirmed negative .
• No other visitors (including siblings) should be allowed to
visit infants in NNUs (all areas), except under exceptional
circumstances, to be discussed with local infection control.
• Visits from other NHS staff and personnel to the NNU
should be kept to a minimum – consider opportunities for
remote meetings.
• Units should seek to mitigate loss of family contact with
video techniques

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Thank you

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