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Guidelines for Neonate Born to COVID Pos PUI or PUM

JDH and NICU West Guidelines for Neonate Born to a COVID-19 Positive Mother or

COVID-19 Person Under Investigation (PUI, symptomatic and being tested) or

COVID-19 Person Under Monitoring (PUM, asymptomatic but exposed to COVID-19 case)

  • OB will communicate to NICU when COVID +, PUI, or PUM patient is admitted to L&D
  • In all of these cases, the pregnant patient will be placed in an isolation room with HEPA filter
  • OB team will have Panda set up in separate L&D room for the neonate
  • Currently it appears unlikely that SARS-CoV-19 is transmitted from mother to fetus before birth, however newborns are at some risk of infection from mother’s respiratory secretions after birth
  • If NICU team called to a vaginal delivery on L&D:
    • PPE cart will be available outside the mother’s room
    • In cases where intubation is likely, the team should wear N95 respirator mask along with eye protection, gown and gloves.
    • In cases where need for intubation is unlikely, teams are encouraged to use standard face mask with eye protection, gown and gloves. If intubation becomes necessary, team should quickly transition to N95 respirator masks for the intubation procedure.
    • Minimum necessary NICU team members in the room, call for additional people if needed
    • Perinatal exposure to neonate may be possible after vaginal delivery based on viral detection in urine and stool.
    • Upon delivery, an OB nurse will bring baby to baby’s room and place on Panda warmer
    • Proceed with NRP as indicated
  • If NICU team not called to vaginal delivery, OB nursing team will move baby to the separate baby room with Panda warmer for initial steps of care.
  • If C-Section delivery
    • COVID-19 positive testing is NOT by itself an indication for C-Section delivery
    • If intubation likely, team should wear N95 respirator, eye protection, gown and gloves, if intubation unlikely, use standard face mask instead of N95, as above, with minimum necessary NICU team members in the resuscitation room
    • Upon delivery, an OB nurse will bring the baby from the OR to the warmer
    • Proceed with NRP as indicated
  • Prefer mask CPAP over nasal prong CPAP if needed in DR for these COVID-risk babies until in isolette
  • If ongoing NICU care required:
    • Move baby in appropriate closed isolette to Room 2 – continue to wear PPE during transfer
    • In Room 2 admit to bed space with as much distance as feasible from other infants in room
    • Prefer ongoing NICU care with baby in isolette as feasible until mother confirmed negative or baby confirmed negative by testing
    • Cohorting of providers is preferred for these Room 2 babies
    • Droplet precautions should be used – gown, gloves, standard face mask and eye protection
    • If non-emergent intubation required after NICU admission, prefer to have this procedure performed in the Procedure Room as feasible, followed by terminal cleaning of that room
    • Infants should move out of Room 2 if testing is negative (see below regarding testing)
  • Visitation to NICU patients
    • These guidelines must be viewed in context of both CT Children’s and JDH Visitation Policies which, if they become in conflict, hospital policies would overrule this guideline document
    • COVID + and PUI and PUM (includes non-maternal parent if mother COVID +) should not visit the NICU due to risk of spread to other NICU patients, parents and staff
    • For babies remaining in the NICU, COVID + parents will be allowed to visit only after they meet all of the CDC recommendations for suspending precautions:
      • At least 72 hours since last fever (without use of fever medications), and
      • Improvement in respiratory symptoms, and
      • At least 7 days have passed since symptoms first began
    • Clinical team should discuss cases in consultation with infection control / ID at CT Children’s regarding preparing such families for a safe discharge of the newborn
  • If NICU care not required – Well Nursery Care:
    • OB team will transfer baby to postpartum room via isolette
    • Discuss risks and benefits of rooming in with baby’s parents and document such discussions
    • If parents choose rooming in, baby should generally remain at least 6 feet away from parents, with a screen between mother’s bed and baby, and an isolette may be preferable for the baby, as available and on a case-by-case basis.
    • Such parents should be instructed to perform infant care only after practicing careful hand hygiene and with standard face mask in place
    • Droplet precautions should be used by healthcare team for infant care – gown, gloves, standard face mask and eye protection while baby is a COVID-19 risk
  • Early bathing is preferred as able, as might theoretically lower risk of transmission
  • If the mother tests Positive for COVID-19, the baby should be tested for perinatal acquisition of the virus:
    • Current proposed recommendations are for testing 2 times, at least 24 hours apart, with first test done ~ 24 hours of age.
    • Nasopharyngeal swab samples should be obtained after consultation with infection control and lab for appropriate process and testing supplies
    • Neonates will be considered negative if both tests have returned negative
  • Mothers intending to breastfeed but infant in NICU or otherwise preferring not to put baby to breast should express breastmilk (with good hand hygiene) with bottles wiped down, bagged and transferred to baby’s room using gloves, per lactation protocols.
  • In Well Nursery, if mother prefers to feed at breast, she should wear a face mask and practice hand hygiene prior to each feed.
  • Discharge of the neonate may occur when:
    • The baby is otherwise medically appropriate for discharge, and
    • There are healthy/capable caregivers in the home
    • Such decisions should be made on a case by case basis
    • CDC website provides guidance for implementing care and preventing spread at home in cases of possible or confirmed COVID-19