- 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
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