Royal College of Pediatrics & child health: COVID-19 - guidance for neonatal settings

It is currently considered possible, but not proven, that SARS-CoV-2 can be transmitted vertically. The proportion of pregnancies affected and the significance for the child are yet to be determined. To date, viral RNA has not been detected in amniotic fluid, vaginal secretions or breast milk. In the individual reported cases of possible vertical transmission, viral RNA in the infant’s respiratory secretions was not demonstrated before 36 hours of life. Maternal admissions: Women with proven or suspected COVID-19 who require admission for midwifery care should be admitted to a dedicated room in the labour suite or directly to an obstetric theatre if immediate emergency management is required. The neonatal team should be informed as soon as possible of this admission and the resuscitaire and room equipment should be checked before the mother enters the room. Intubation of the mother for a GA Caesarean section is a significant aerosol generating procedure (AGP); the use of Entonox and maternal pushing during labour are not considered AGPs. Suctioning, bag mask ventilation and intubation of the newborn are AGPs, although the absolute risk to health care workers performing these manoeuvres on newborn infants is thought to be low. Commonly used equipment for neonatal resuscitation and stabilisation should be readily available (e.g. located in disposable grab bags) to avoid taking the full resuscitation trolley into the room unless required. Term or late preterm baby born in good condition: Well babies born to suspected/confirmed COVID-19 mothers and who do not require medical intervention should remain with their mother in their designated room. Current guidance is that well babies of COVID-19 positive mothers should only be routinely tested if unwell. If the mother needs assistance in caring for her baby this would usually be provided by the attending midwife – when a mother is acutely unwell, an alternative non-quarantined carer/relative should be identified to provide care for the baby at home or in a designated room not in the neonatal unit (NNU). In the latter case the baby should be isolated from their mother. Term or late preterm baby requiring additional care: Well babies born to suspected/confirmed COVID-19 mothers and who require additional care (e.g. intravenous antibiotics) should be assessed in the labour ward and a decision made as to whether additional care can safely be provided at the mother’s bedside. Avoid NNU admission if possible and safe. Babies requiring admission to the NNU should be assessed in a designated area in the NNU by an appropriately skilled neonatal team member wearing appropriate PPE. Management on NNU For babies born to suspected/confirmed COVID-19 positive mother who require to be admitted to the NNU, clinical investigations should be minimised while maintaining standards of care. Senior input is recommended when deferring routine investigations and in prioritisation of work. Consider ways to reduce unnecessary investigations – e.g. use of point of care testing. Although the risk of transmission from AGPs within the first 24 hours after birth is thought to be low, staff should follow guidance regarding use of appropriate PPE, even in an emergency. All babies requiring respiratory support should be nursed in an incubator. In-line suction with endotracheal tubes should be used when staff are familiar with this. Read complete guidance on-



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