AAP issues guidance for treating neonates born to Covid-19 positive moms

Giving birth is a special time for mothers and their infants — that first meeting and bonding helps establish a good, healthy start to a new life. But Covid-19 is changing all that.

While we don’t yet know a lot about Covid-19, a few case studies have suggested congenital and perinatal transmission of the virus from infected mothers, and the American Academy of Pediatrics (AAP) is erring on the side of caution by issuing preliminary guidance for those giving birth during the pandemic, as well as those who care for them.

The guidance, written by Karen M. Puopolo, MD, PhD, and colleagues on the American Academy of Pediatrics Committee on Fetus and Newborn, Section on Neonatal Perinatal Medicine, and the Committee on Infectious Diseases, and colleagues, noted that while there is uncertainty and a lack of data about vertical transmission of Covid-19, neonates born to women with confirmed Covid-19 or to women with suspected illness, “should be considered as persons under investigation (PUIs) for infection.”

The academy “recommends that infants born to mothers with Covid-19 should be temporarily separated to minimize the risk of the infant becoming infected, and that infants born to mothers suspected of having Covid-19 stay in an area separated from other unaffected infants.” They also noted that, if this is not possible or the mother insists on rooming in, the infant should be separated from her by at least 6 feet.

The guidance further recommends that newborns that are born at or near term and who appear healthy at birth “may be admitted to specific areas physically separate from newborns whose mothers are not confirmed of suspected of having Covid-19. The infants should be bathed as soon as possible, and clinical staff should abide by droplet and contact precautions until it is determined whether or not the infant has become infected with Covid-19.”

Breast milk is likely safe for infants, as so far, Puopolo and colleagues noted, no study has found the virus in breast milk. That said, the mothers should pump breast milk, with appropriate hygiene, “and this milk may be fed to the infant by designated caregivers.” Again, appropriate cleaning of all equipment must be undertaken, including cleaning it with disinfectant wipes and washing components in hot soapy water.

“In addition to the known benefits of breastfeeding, mothers’ milk may provide infant protective factors after maternal COVID-19. Promoting breast milk feeding and supporting establishment of maternal milk supply may offer additional benefits to well and sick newborns,” Puopolo and colleagues wrote.

For testing neonates for Covid-19, the AAP recommends:

  • Molecular assay testing at about 24 hours after birth.
  • Repeat the test at about 48 hours of age. If the baby is well and discharged within this time clinicians can opt to not do this test. However, Puopolo and colleagues noted that there have been reports of infants who were negative at first testing who later tested positive for Covid-19.
  • Along with swabs of the throat and nasopharynx, clinicians may consider a rectal swab test “if available at their center, particularly for sick infants requiring prolonged hospital care.”

During delivery, the AAP recommend that attending medical staff should be attired in gown, gloves, and “either an N95 respiratory masks and eye protection goggles or with an air-purifying respirator that provides eye protection.” When mother and baby are discharged, the mother who has Covid-19 should continue to stay at least 6 feet from the infant, and “when in closer proximity use a mask and hand-hygiene for newborn care until… she is afebrile for 72 hours without the use of antipyretics, and… at least 7 days have passed since symptoms first appeared. This also holds for mothers with the illness whose infants require ongoing care… with the addition of obtaining at least two negative tests for SARS-CoV-2 swab tests taken 24 hours apart.”

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The AAP noted that its guidance is only for neonates, and that it does not address the management of pregnant women with Covid-19, but refers clinicians to the American College of Obstetricians and Gynecologists’ Practice Advisory.

  1. Infants born to mothers with Covid-19 should be temporarily separated to minimize the risk of the infant becoming infected, and infants born to mothers suspected of having Covid-19 should stay in an area separated from other unaffected infants.

  2. While it does not appear that Covid-19 affects breast milk, mothers with Covid-19 should pump their milk and the baby fed by a designated caregiver.

Candace Hoffmann, Managing Editor, BreakingMED™

Puopolo disclosed no relevant relationships.

Cat ID: 41

Topic ID: 83,41,287,500,728,932,730,933,125,190,469,520,926,41,138,142,927,151,928