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home/Knowledge Base/Pediatrics

Shared Decisions in Managing Neonates

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

Neonatal resuscitation:

  1. Could be performed either in a separate room or in the delivery room;
  2. If done in the delivery room, should at least be 6 feet/2m away from the mother.

Infant placement:

  1. Can be placed either in a separate negative pressure room or in the same room;
  2. If mother wants to visit, she should be wearing a mask and proceed to rigorous hand hygiene;
  3. If mother wants the infant in the same room, should be in an isolette 6 feet away, with mother wearing a mask and washing her hands at all time.

Neonatal testing:

  1. Can range from six swabs (nasopharyngeal, oropharyngeal and rectal swabs 24 and 48 hours after birth) to no testing if the newborn is asymptomatic.

Nutritional support:

  1. Formula or donor milk;
  2. Expressed breastmilk after mother’s breasts cleaning, given by a healthy caretaker, can be acceptable;
  3. Mothers could also breastfeed wearing PPE and after cleaning her breasts.

Visitation policy for baby:

  1. No visit except video visits until mother is asymptomatic and two specimens from the baby are negative is the safest option;
  2. Mother could always visit the infant if wanted, with precautions;
  3. If needed, only one other visitor who has been tested could visit.

 

In the current situation, delivering babies can be complicated in terms of infection prevention. Parents want to be with their newborns while clinicians try to reduce exposure to the virus. To facilitate this, Chandrasekharan and al. proposed options (A, B or C) based on shared-decision making with parents to manage an infant born to a suspected or confirmed with COVID-19 for various scenarios. With option A being the most conservative and ‘’secure‘’ approach and option C the most accommodative one for the parents, this can help balance parental-infant bonding and viral transmission risks to give the best care we can. Here are some highlights; to view full options for each scenario, see the original article below.

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:patient managementNeonatePrevention

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