Generally:
- Assign a specific neonate resuscitation team to attend deliveries to minimize health care providers and non-infected mothers and infants’ exposure;
- Owing to an immature immune system, neonates, especially premature ones, could be at more risk of being infected postnatally;
- Predicting which infant will require intubation or deep suctioning is hard; consider airborne PPE for every delivery
- 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;
- 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:
- The most experienced resuscitator should perform it and take precautions by wearing fit-tested N95 masks, double gloves, face shield, goggles and gown;
- In the United States, usual American Academy of Pediatrics (AAP) and Neonatal Resuscitation Program (NRP) recommendations should be followed;
- Laryngeal mask airway might reduce aerosol generation and could be an alternative to face masks.
About post resuscitation stabilization:
- If possible, transport newborns in a negative pressure room;
- Babies should stay in the closed isolette;
- Consider early bath to minimize exposure in stable babies.
About nutritional support:
- Optimal mode of nutrition is unknown;
- Although no reports demonstrate transmission of SARS-CoV-2 through breast milk, benefits of breastfeeding should be weighed against the risks of transmission;
- 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