AAP issues guidance for managing infants born to mothers with COVID-19

There are many questions about COVID-19 that remain unanswered, and many involve keeping both pregnant women and newborns safe during the hospital stay for birth. The American Academy of Pediatrics (AAP) has released new guidance for this situation.¹

The guidance states that the disease does not appear to be as severe as influenza or other serious coronavirus diseases such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which often caused severe or fatal disease in pregnant women. Young children also continue to appear less likely to experience severe disease, but it is still possible. Limited case studies have shown that congenital or perinatal infections also are possible.

The important points in the guidance include:

·      During delivery of women who have COVID-19, airborne, droplet, and contact precautions should be used because of an increased likelihood of maternal viral aerosols and the possibility of administering newborn resuscitation to infants with COVID-19.

·      When possible, newborns should be separated following birth when the mother has COVID-19. If the family wants the infant to room in with the mother, they should be told about the potential risk of the child developing COVID-19.

·      According to evidence available on March 30, 2020, SARS-CoV-2, the virus that causes COVID-19, has not been found in breast milk. Mothers with COVID-19 who have chosen to breastfeed their child can express the milk to be fed to the infant by uninfected caregivers.

·      Infants born to mothers with COVID-19 should be tested for SARS-CoV-2 at 24 hours after birth and 48 hours after birth, if the child is still at the hospital. In care centers with limited testing abilities, individual risk/benefit decisions should be made to determine if testing is to be performed.

·      Newborns who either have a documented SARS-CoV-2 infection or are at risk of postnatal acquisition of COVID-19 should get frequent outpatient follow-up for 14 days after discharge.

·      If a newborn requires ongoing hospital care, the mother with COVID-19 should remain separate from the child until she has been afebrile for 72 hours without the use of antipyretics; improvement has been seen in respiratory symptoms; and negative results from 2 consecutive SARS-CoV-2 nasopharyngeal swab tests collected 24 hours apart or later have occurred.

·      Following discharge, a mother with COVID-19 should maintain a distance of at least 6 feet and when in closer proximity use mask and hand hygiene until the mother has been afebrile for 72 hours without the use of antipyretics and at least 7 days have passed since the first symptom appeared.

The guidance will be changed as more information on SARS-CoV-2 and COVID-19 becomes available.

References:

1. 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 7, 2020. https://downloads.aap.org/AAP/PDF/COVID%2019%20Initial%20Newborn%20Guidance.pdf