Guidelines for Managing Care of Infants Born to Mothers with COVID-19

The American Academy of Pediatrics has issued recommendations for physicians managing the care of newborns whose mothers are suspected or confirmed as having COVID-19.

The report, “Initial Guidance: Management of Infants Born to Mothers with COVID-19,” covers precautions for birth attendants, rooming-in, breastfeeding, testing, neonatal intensive care, visitation and hospital discharge. 

“We know that parents want to keep their babies as safe and healthy as possible during this unusual and stressful time,” said Mark Hudak, MD, FAAP, one of the authors of the guidance. “We make these recommendations out of an abundance of caution as we learn more from new research on the coronavirus.”

The AAP 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.

Other recommendations include:

• If the center cannot place the infant in a separate area — or the mother chooses rooming-in despite recommendations — ensure the infant is at least 6 feet from the mother. 
• Studies to date have not detected the virus in breast milk, and so mothers may express breast milk after appropriate breast and hand hygiene. Caregivers who are not infected may feed the breast milk to the infant. Mothers who request direct breastfeeding should adhere to strict preventive precautions that include use of a mask and meticulous breast and hand hygiene.
• Medical staff attending a birth when the mother has COVID-19 should use gown and gloves, with either an N95 respiratory mask and eye protection goggles or with an air-purifying respirator that provides eye protection. 
• Infants requiring neonatal intensive care ideally should be admitted to a single-patient room with the potential for negative room pressure or other air filtration system. If unavailable, or if multiple COVID-exposed infants must share a room, there should be at least 6 feet between infants and/or they should be placed in air temperature-controlled isolettes.
• If testing is available, well newborns born to mothers with COVID-19 should be tested for COVID-19 at 24 hours of age, and the test should be repeated around 48 hours of age. Infants who cannot be tested should be treated as if they are positive for the virus for the 14-day observation period. The mother should continue to maintain precautions until she meets the criteria for non-infectivity.

The AAP guidance also covers care of an infant who tests positive for COVID-19, as well as follow-up care for those who are discharged from the hospital. A mother who tested positive for the coronavirus is instructed to maintain a 6-foot distance from the infant when possible until she has gone 72 hours without a fever without use of antibiotics or meets other criteria discussed in the report.

Source: AAP