Anna Lavizzari1, Claus Klingenberg2,3, Jochen Profit4,5, John A F Zupancic6,7, Alexis S Davis4, Fabio Mosca8,9, Eleanor J Molloy10,11,12,13, Charles C Roehr14,15. 1. NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. anna.lavizzari@policlinico.mi.it. 2. Department of Paediatric and Adolescent Medicine, University Hospital of North Norway, Tromso, Norway. 3. Paediatric Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromso, Norway. 4. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. 5. California Perinatal Quality Care Collaborative, Palo Alto, CA, USA. 6. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 7. Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA. 8. NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 9. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 10. Paediatrics, Academic Centre, Children's Hospital Ireland (CHI) at Tallaght, Trinity College, the University of Dublin, Dublin, Ireland. 11. Trinity Translational Medicine Institute, St James' Hospital, Dublin, Ireland. 12. Neonatology, Coombe Women and Infants' University Hospital, Dublin, Ireland. 13. Neonatology, CHI at Crumlin, Dublin, Ireland. 14. Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 15. National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Abstract
BACKGROUND: The COVID-19 pandemic threatens global newborn health. We describe the current state of national and local protocols for managing neonates born to SARS-CoV-2-positive mothers. METHODS: Care providers from neonatal intensive care units on six continents exchanged and compared protocols on the management of neonates born to SARS-CoV-2-positive mothers. Data collection was between March 14 and 21, 2020. We focused on central protocol components, including triaging, hygiene precautions, management at delivery, feeding protocols, and visiting policies. RESULTS: Data from 20 countries were available. Disease burden varied between countries at the time of analysis. In most countries, asymptomatic infants were allowed to stay with the mother and breastfeed with hygiene precautions. We detected discrepancies between national guidance in particular regarding triaging, use of personal protection equipment, viral testing, and visitor policies. Local protocols deviated from national guidance. CONCLUSIONS: At the start of the pandemic, lack of evidence-based guidance on the management of neonates born to SARS-CoV-2-positive mothers has led to ad hoc creation of national and local guidance. Compliance between collaborators to share and discuss protocols was excellent and may lead to more consensus on management, but future guidance should be built on high-level evidence, rather than expert consensus. IMPACT: At the rapid onset of the COVID19 pandemic, all countries presented protocols in place for managing infants at risk of COVID19, with a certain degree of variations among regions. A detailed review of ad hoc guidelines is presented, similarities and differences are highlighted. We provide a broad overview of currently applied recommendations highlighting the need for international context-relevant coordination.
BACKGROUND: The COVID-19 pandemic threatens global newborn health. We describe the current state of national and local protocols for managing neonates born to SARS-CoV-2-positive mothers. METHODS: Care providers from neonatal intensive care units on six continents exchanged and compared protocols on the management of neonates born to SARS-CoV-2-positive mothers. Data collection was between March 14 and 21, 2020. We focused on central protocol components, including triaging, hygiene precautions, management at delivery, feeding protocols, and visiting policies. RESULTS: Data from 20 countries were available. Disease burden varied between countries at the time of analysis. In most countries, asymptomatic infants were allowed to stay with the mother and breastfeed with hygiene precautions. We detected discrepancies between national guidance in particular regarding triaging, use of personal protection equipment, viral testing, and visitor policies. Local protocols deviated from national guidance. CONCLUSIONS: At the start of the pandemic, lack of evidence-based guidance on the management of neonates born to SARS-CoV-2-positive mothers has led to ad hoc creation of national and local guidance. Compliance between collaborators to share and discuss protocols was excellent and may lead to more consensus on management, but future guidance should be built on high-level evidence, rather than expert consensus. IMPACT: At the rapid onset of the COVID19 pandemic, all countries presented protocols in place for managing infants at risk of COVID19, with a certain degree of variations among regions. A detailed review of ad hoc guidelines is presented, similarities and differences are highlighted. We provide a broad overview of currently applied recommendations highlighting the need for international context-relevant coordination.
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