Management of newborns exposed to mothers with confirmed or suspected COVID-19

• Published in: Journal of perinatology Vol. 40; no. 7; pp. 987 - 996
• Main Authors: Amatya, Shaili, Corr, Tammy E., Gandhi, Chintan K., Glass, Kristen M., Kresch, Mitchell J., Mujsce, Dennis J., Oji-Mmuo, Christiana N., Mola, Sara J., Murray, Yuanyi L., Palmer, Timothy W., Singh, Meenakshi, Fricchione, Ashley, Arnold, Jill, Prentice, Danielle, Bridgeman, Colin R., Smith, Brandon M., Gavigan, Patrick J., Ericson, Jessica E., Miller, Jennifer R., Pauli, Jaimey M., Williams, Duane C., McSherry, George D., Legro, Richard S., Iriana, Sarah M., Kaiser, Jeffrey R.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-07-2020; Nature Publishing Group
• Subjects: 692/699/255; 692/699/255/2514; Algorithms; Betacoronavirus - isolation & purification; Breast feeding; China; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; Coronaviruses; COVID-19; Customs; Development and progression; Earthquakes; Evidence-Based Practice; Female; Health care facilities; Humans; Infant Care - methods; Infant Care - organization & administration; Infant, Newborn; Infants (Newborn); Infection; Infection control; Infectious Disease Transmission, Vertical; Medicine; Medicine & Public Health; Neonates; Newborn babies; Pandemics; Pediatric Surgery; Pediatrics; Phototherapy; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Postnatal Care - organization & administration; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - virology; Protective equipment; Review; Review Article; SARS-CoV-2; Secondary infection; Steroid hormones; Steroids; Telemedicine; Triage - methods; Triage - organization & administration; China
• ISSN: 0743-8346; 1476-5543; 1476-5543
• DOI: 10.1038/s41372-020-0695-0

There is limited information about newborns with confirmed or suspected COVID-19. Particularly in the hospital after delivery, clinicians have refined practices in order to prevent secondary infection. While guidance from international associations is continuously being updated, all facets of care of neonates born to women with confirmed or suspected COVID-19 are center-specific, given local customs, building infrastructure constraints, and availability of protective equipment. Based on anecdotal reports from institutions in the epicenter of the COVID-19 pandemic close to our hospital, together with our limited experience, in anticipation of increasing numbers of exposed newborns, we have developed a triage algorithm at the Penn State Hospital at Milton S. Hershey Medical Center that may be useful for other centers anticipating a similar surge. We discuss several care practices that have changed in the COVID-19 era including the use of antenatal steroids, delayed cord clamping (DCC), mother–newborn separation, and breastfeeding. Moreover, this paper provides comprehensive guidance on the most suitable respiratory support for newborns during the COVID-19 pandemic. We also present detailed recommendations about the discharge process and beyond, including providing scales and home phototherapy to families, parental teaching via telehealth and in-person education at the doors of the hospital, and telehealth newborn follow-up.