Neonatal Resuscitation and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection

Abstract

The first case of novel coronavirus disease of 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was reported in November2019. The rapid progression to a global pandemic of COVID-19 has had profound medical, social, and economic consequences. Pregnant women and newborns represent a vulnerable population. However, the precise impact of this novel virus on the fetus and neonate remains uncertain. Appropriate protection of health care workers and newly born infants during and after delivery by a COVID-19 mother is essential. There is some disagreement among expert organizations on an optimal approach based on resource availability, surge volume, and potential risk of transmission. The manuscript outlines the precautions and steps to be taken before, during, and after resuscitation of a newborn born to a COVID-19 mother, including three optional variations of current standards involving shared-decision making with parents for perinatal management, resuscitation of the newborn, disposition, nutrition, and postdischarge care. The availability of resources may also drive the application of these guidelines. More evidence and research are needed to assess the risk of vertical and horizontal transmission of SARS-CoV-2 and its impact on fetal and neonatal outcomes. KEY POINTS: · The risk of vertical transmission is unclear; transmission from family members/providers to neonates is possible.. · Optimal personal-protective-equipment (airborne vs. droplet/contact precautions) for providers is crucial to prevent transmission.. · Parents should be engaged in shared decision-making with options for rooming in, skin-to-skin contact, and breastfeeding..

Fig. 1

Setting up of a birthing room for a patient with suspected or confirmed COVID-19 undergoing labor and delivery. A negative pressure room is preferred with limited number of providers in the room to limit exposure. Additional personnel may be outside the room and be available if extensive neonatal resuscitation is needed. COVID-19, novel coronavirus disease 2019; PAPR, powered air-purifying respirator. Image Courtesy: Satyan Lakshminrusimha .

Fig. 2

Infographic showing the approach to neonates born to mothers with suspected or confirmed COVID-19 including a combination of options A, B, and C ( Table 1 ) based on decisions made with parental involvement, at the University of California at Davis Medical Center. The pink panel reflects a conservative approach with strict isolation methods to limit viral transmission to the neonate at the cost of maternal-infant bonding. The green panel shows strategies to minimize transmission while accommodating maternal-infant bonding and breastfeeding. The risk of infection with such an approach must be emphasized during discussion with parents. Please see text and Table 1 for details. DR, delivery room; EBM, expressed breast milk; OR, operating room; PAPR, powered air-purifying respirator; PPE, personal protective equipment; SARS-CoV-2, severe acute respiratory syndrome–coronavirus 2. Image Courtesy: Satyan Lakshminrusimha .

Fig. 3

Resuscitation in the delivery room with precautions to minimize risk to the infant. Appropriate PPE and maintaining at least 6-feet or 2-m distance from the mother with a barrier (curtain) in between is important. Alternatively, infant may be resuscitated in a separate room. AAP, American Academy of Pediatrics; NRP, Neonatal Resuscitation Program; PAPR, powered air-purifying respirator. Image Courtesy: Satyan Lakshminrusimha .

Fig. 4

Exposure to COVID-19 during the perinatal period and the possible clinical signs and symptoms along with laboratory changes in a newborn. The disease may be classified into early onset or late-onset. COVID-19, novel coronavirus disease 2019; Ig, immunoglobulin; RT-PCR, real-time polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome–coronavirus 2. Image Courtesy: Satyan Lakshminrusimha .