pregnancy

AAP Releases New Guidelines for Infants Born to Women With COVID-19

The American Academy of Pediatrics has released new guidance on the management of infants born to women with COVID-19.

“Based on current limited evidence as of 3/30/2020, this report provides interim guidance for the management of infants born to mothers with confirmed and suspected COVID-19,” they wrote.

While at this time, COVID-19 infection does not appear to have as negative an impact on pregnant women as does SARS, MERS, and influenza, some evidence for increased risk of severe or critical illness in infants does exist, they explained.

Among the recommendations:

Neonates born to women with COVID-19 or who are being tested for COVID-19 should be considered as persons under investigation (PUIs) as well.

  • Standard procedural mask and eye protection, gown, and gloves should be used in encounters with infants born to mothers with COVID-19.
  • Attendance by the neonatal team in the delivery room should be based upon normal center-specific policies, but this could be reevaluated by hospitals and physicians based on the circumstances.
  • Temporary separation of mother and newborn will minimize the risk of postnatal infection.
  • Infants born to mothers with COVID-19 infection, who are well appearing, can be admitted to physically separate areas from newborns with uninfected mothers.
  • Infants should be bathed as soon as possible following birth to remove viruses on the skin.  
  • Clinicians should use droplet and contact precautions until virologic status is known.
  • Breast milk from the mother may be fed to the infant by designated caregivers.
  • Infants should be tested where tests are available.
  • Healthy infants should be discharged with a healthy caregiver, with the infected mother maintaining a distance for as much time as possible until she has been afebrile for 72 hours without antipyretics and 7 days have passed since symptoms first appear, or until the mother has negative results of a molecular assay for detection of SARS-CoV-2 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart.

The authors cautioned that the interim guidance from the American Academy of Pediatrics is based on the current, quite limited evidence as of March 30, 2020…” and that it “may not be applicable to every clinical environment, where availability of testing and PPE may require individualized risk/benefit assessment and different decision-making in the management of specific cases. The clinician should anticipate that this guidance will be revised when further evidence is available to inform newborn management.”

—Michael Potts

Reference:
Puopolo KM, Hudak ML, Kimberlin DW, Cummings J. Initial guidance: management of infants born to mothers with COVID-19. Published April 2, 2020. Accessed April 6, 2020. https://downloads.aap.org/AAP/PDF/COVID%2019%20Initial%20Newborn%20Guidance.pdf.