Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID-19

Kee Thai Yeo^{1

2}, Ju Lee Oei^{3

4}, Daniele De Luca^{5

6}, Georg M Schmölzer⁷, Robert Guaran⁸, Pamela Palasanthiran⁹, Kishore Kumar¹⁰, Giuseppe Buonocore¹¹, Jeanie Cheong^{12

13

14}, Louise S Owen^{12

13

14}, Satoshi Kusuda¹⁵, Jennifer James¹⁶, Gina Lim¹⁷, Ankur Sharma⁴, Sabita Uthaya^{18

19}, Christopher Gale^{18

19}, Elizabeth Whittaker^{19

20}, Cheryl Battersby^{18

19}, Neena Modi^{18

19}, Mikael Norman²¹, Lars Naver²¹, Eric Giannoni²², Yenge Diambomba²³, Prakeshkumar S Shah²³, Luigi Gagliardi²⁴, Michael Harrison²⁵, Shakti Pillay²⁵, Abdullah Alburaey²⁶, Yuan Yuan²⁷, Huayan Zhang^{16

27

28}

Affiliations

¹ KK Women's & Children's Hospital, Singapore, Singapore.
² Duke-NUS Medical School, Singapore, Singapore.
³ School of Women's and Children's Health, University of New South Wales, Australia.
⁴ Royal Hospital for Women, Randwick, NSW, Australia.
⁵ Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospitals, APHP, Paris, France.
⁶ Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay, Paris, France.
⁷ University of Alberta, Edmonton, AB, Canada.
⁸ NSW Perinatal Services Network, Sydney, NSW, Australia.
⁹ Sydney Children's Hospital Network, Randwick, NSW, Australia.
¹⁰ Cloudnine Hospitals, Bangalore, India.
¹¹ Azienda Ospedaliera Universitaria Senese, Siena, Italy.
¹² Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia.
¹³ Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.
¹⁴ Royal Women's Hospital, Melbourne, VIC, Australia.
¹⁵ Kyorin University, Tokyo, Japan.
¹⁶ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁷ Ulsan University Hospital, Ulsan, South Korea.
¹⁸ Imperial College London and Chelsea and Westminster NHS Foundation Trust, London, UK.
¹⁹ Imperial College Healthcare NHS Trust, London, UK.
²⁰ Imperial College London, London, UK.
²¹ Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
²² Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
²³ Mount Sinai Hospital, Toronto, ON, Canada.
²⁴ Ospedale Versilia, Lido di Camaiore, AUSL Toscana Nord Ovest, Pisa, Italy.
²⁵ University of Cape Town, Cape Town, South Africa.
²⁶ Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
²⁷ Guangzhou Women and Children's Medical Center, Guangzhou, China.
²⁸ University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

PMID: 32716579
DOI: 10.1111/apa.15495

Review

Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID-19

Kee Thai Yeo et al. Acta Paediatr. 2020 Nov.

. 2020 Nov;109(11):2192-2207.

doi: 10.1111/apa.15495. Epub 2020 Aug 20.

Authors

Affiliations

¹ KK Women's & Children's Hospital, Singapore, Singapore.
² Duke-NUS Medical School, Singapore, Singapore.
³ School of Women's and Children's Health, University of New South Wales, Australia.
⁴ Royal Hospital for Women, Randwick, NSW, Australia.
⁵ Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospitals, APHP, Paris, France.
⁶ Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay, Paris, France.
⁷ University of Alberta, Edmonton, AB, Canada.
⁸ NSW Perinatal Services Network, Sydney, NSW, Australia.
⁹ Sydney Children's Hospital Network, Randwick, NSW, Australia.
¹⁰ Cloudnine Hospitals, Bangalore, India.
¹¹ Azienda Ospedaliera Universitaria Senese, Siena, Italy.
¹² Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia.
¹³ Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.
¹⁴ Royal Women's Hospital, Melbourne, VIC, Australia.
¹⁵ Kyorin University, Tokyo, Japan.
¹⁶ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁷ Ulsan University Hospital, Ulsan, South Korea.
¹⁸ Imperial College London and Chelsea and Westminster NHS Foundation Trust, London, UK.
¹⁹ Imperial College Healthcare NHS Trust, London, UK.
²⁰ Imperial College London, London, UK.
²¹ Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
²² Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
²³ Mount Sinai Hospital, Toronto, ON, Canada.
²⁴ Ospedale Versilia, Lido di Camaiore, AUSL Toscana Nord Ovest, Pisa, Italy.
²⁵ University of Cape Town, Cape Town, South Africa.
²⁶ Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
²⁷ Guangzhou Women and Children's Medical Center, Guangzhou, China.
²⁸ University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

PMID: 32716579
DOI: 10.1111/apa.15495

Abstract

Aim: This review examined how applicable national and regional clinical practice guidelines and recommendations for managing neonates born to mothers with COVID-19 mothers were to the evolving pandemic.

Methods: A systematic search and review identified 20 guidelines and recommendations that had been published by May 25, 2020. We analysed documents from 17 countries: Australia, Brazil, Canada, China, France, India, Italy, Japan, Saudi Arabia, Singapore, South Africa, South Korea, Spain, Sweden, Switzerland, the UK and the United States.

Results: The documents were based on expert consensus with limited evidence and were of variable, low methodological rigour. Most did not provide recommendations for delivery methods or managing symptomatic infants. None provided recommendations for post-discharge assimilation of potentially infected infants into the community. The majority encouraged keeping mothers and infants together, subject to infection control measures, but one-third recommended separation. Although breastfeeding or using breastmilk was widely encouraged, two countries specifically prohibited this.

Conclusion: The guidelines and recommendations for managing infants affected by COVID-19 were of low, variable quality and may be unsustainable. It is important that transmission risks are not increased when new information is incorporated into clinical recommendations. Practice guidelines should emphasise the extent of uncertainty and clearly define gaps in the evidence.

Keywords: COVID-19; neonate; perinatal care; practice guidelines; transmission.

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References

REFERENCES

1. World Health Organization. Coronavirus disease (COVID-2019) situation reports. 2020.
1. Wang D, Hu BO, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061.
1. Collin J, Bystrom E, Carnahan A, Ahrne M. Pregnant and postpartum women with SARS-CoV-2 infection in intensive care in Sweden. Acta Obstet Gynecol Scand. 2020;99:819-822.
1. Vivanti A, Vauloup-Fellous C, Prevot S, et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020;11:3572.
1. Savasi VM, Parisi F, Patanè L, et al. Clinical Findings and Disease Severity in Hospitalized Pregnant Women With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol. 2020;136(2):252-258.

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Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID-19

Affiliations

Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID-19

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical