Guidance for the clinical management of infants born to mothers with suspected/confirmed COVID-19 in Singapore

Abstract

In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.

Protecting Breastfeeding during the COVID-19 Pandemic: A Scoping Review of Perinatal Care Recommendations in the Context of Maternal and Child Well-Being

“…Universally testing visitors for SASR-COV-2 infection was recommended in seven publications [ 25 , 28 , 48 , 56 , 61 , 63 , 65 ]. Four papers proposed using video and teleconferences as an alternative to direct visits to labor and delivery units [ 64 , 65 , 70 , 71 ].…”

“…Only 4 of 56 papers [ 18 , 55 , 64 , 72 ] addressed SSC specifically for mothers with confirmed infection ( Figure 4 ). In general, we observed that 70% (39 out of the 56) of analysed publications concluded that SSC should be allowed or recommended [ 17 , 18 , 27 , 32 , 36 , 42 , 44 , 47 , 49 , 51 , 54 , 55 , 57 , 59 , 60 , 65 , 66 , 69 , 70 , 71 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ]. In 19% (7 papers) it was directly indicated that, regarding SSC, pre-pandemic recommendations should not be changed and routine care should be provided [ 18 , 42 , 47 , 69 , 82 , 86 , 87 ].…”

“…Most common recommendations allowed SSC with precautions like wearing a surgical mask by the mother as well as hands and surfaces disinfection. This was recommended in 39% (22 out of 56) papers [ 17 , 18 , 27 , 32 , 36 , 49 , 51 , 54 , 57 , 59 , 60 , 66 , 69 , 71 , 73 , 74 , 75 , 76 , 79 , 80 , 85 , 86 ]. However, in one paper [ 86 ] washing the mothers’ chest before contact with the child was specifically excluded from recommended precautions.…”

“…Nine papers suggested that the possibility of practicing SSC should depend on clinical and organizational conditions, meaning that the decision should be individualized in each case [ 29 , 36 , 44 , 54 , 60 , 71 , 79 , 92 ], and especially reconsidered when the mother’s condition is critical [ 74 ]. About one-fifth of the papers highlighted the importance of a shared decision-making model and informed choice made by parents and indicated that decisions on applying SSC should be discussed with the mother [ 29 , 35 , 47 , 54 , 55 , 63 , 71 , 72 , 81 , 84 , 92 ] ( Figure 4 ).…”

Being Prepared During the Evolving COVID-19 Pandemic: A Neonatal Experience in Training and Simulation

“…Pregnant women and infants are especially vulnerable to COVID-19, due to the higher risk of morbidities and mortality in infected mothers, in addition to the early uncertainties regarding vertical and perinatal transmissions to their newborns (8). Implementing training on management of the mothernewborn dyad affected by COVID-19 was complicated due to the varied recommendations, and the need for inter-disciplinary inter-specialty collaboration (9)(10)(11)(12)(13)(14). This article describes the combined approach of 3 restructured hospitals in Singapore: (a) KK Women's and Children's Hospital, (b) National University Hospital, and (c) Singapore General Hospital; in preparing and training neonatal HCWs during the COVID-19 pandemic, as well as lessons learnt during this process.…”