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home/Knowledge Base/Pediatrics

Carefully Resuscitating Newborns from Suspected or Confirmed Mothers

12 views 0 05/04/2020 Marc-Antoine Tremblay

Generally:

  1. Assign a specific neonate resuscitation team to attend deliveries to minimize health care providers and non-infected mothers and infants’ exposure;
  2. Owing to an immature immune system, neonates, especially premature ones, could be at more risk of being infected postnatally;
  3. Predicting which infant will require intubation or deep suctioning is hard; consider airborne PPE for every delivery
  4. All newborns, disregarding gestational age, should lay in an isolette. The ones with a hood that can elevate to provide warmth or lower for transport are preferred;
  5. If resuscitation is performed in the delivery room, it should be done 6 feet/2m away from the mother with a physical barrier in between.

About airway management:

  1. The most experienced resuscitator should perform it and take precautions by wearing fit-tested N95 masks, double gloves, face shield, goggles and gown;
  2. In the United States, usual American Academy of Pediatrics (AAP) and Neonatal Resuscitation Program (NRP) recommendations should be followed;
  3. Laryngeal mask airway might reduce aerosol generation and could be an alternative to face masks.

About post resuscitation stabilization:

  1. If possible, transport newborns in a negative pressure room;
  2. Babies should stay in the closed isolette;
  3. Consider early bath to minimize exposure in stable babies.

About nutritional support:

  1. Optimal mode of nutrition is unknown;
  2. Although no reports demonstrate transmission of SARS-CoV-2 through breast milk, benefits of breastfeeding should be weighed against the risks of transmission;
  3. If wanted, breastfeeding should be done after the breasts are washed with soap and water with the mother wearing a mask.

 

This manuscript by Chandrasekharan’s team outlines useful steps to manage the resuscitation of infant born to a mother infected or suspected with COVID-19. The authors acknowledge the paucity of literature guiding perinatal management of infant born to a mother who is suspected or has confirmed COVID-19. It also includes variations on how to take care of the newborns involving shared-decision making with parents. For more information about these shared-decision process and options, see the original article below or our other topic Shared Decisions in Managing Neonates available in the pediatrics section

Source:

Chandrasekharan and al. (April 8, 2020). Neonatal Resuscitation and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection. American Journal of Perinatology. doi: 10.1055/s-0040-1709688

Tags:precautionsairway managementNeonateresuscitation

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