Management of neonates after postpartum discharge and all children in the ambulatory setting during the coronavirus disease 2019 (COVID-19) pandemic

Abstract

Purpose of review The present coronavirus disease 2019 (COVID-19) pandemic has created additional challenges with an increased number of presumed healthy, full-term newborns being discharged at 24 h after delivery. Short lengths of stay raise the possibility of mother–infant dyads being less ready for discharge, defined as at least one of the three informants (i.e., mother, pediatrician, and obstetrician) believing that either the mother and/or infant should stay longer than the proposed time of discharge. This public health crisis has reduced the number of in-person well child visits, negatively impacting vaccine receipt, and anticipatory guidance. Recent findings Extra precautions should be taken during the transition period between postpartum discharge and follow-up in the ambulatory setting to ensure the safety of all patients and practice team members. This should include restructuring office flow by visit type and location, limiting in-person visits during well infant exams, instituting proper procedures for personal protective equipment and for cleaning of the office, expanding telehealth capabilities for care and education, and prioritizing universal vaccinations and routine well child screenings. Summary Based on current limited evidence, this report provides guidance for the postdischarge management of newborns born to mothers with confirmed or suspected disease in the ambulatory setting as well as prioritizing universal immunizations and routine well child screenings during the COVID-19 pandemic.

Birth Hospital Length of Stay and Rehospitalization During COVID-19

“…The lack of an association between the increased proportion of short birth hospitalization LOS and infant rehospitalization may suggest improved discharge planning (e.g., shorter time to first pediatrician appointment, telehealth support) and/or a change in thresholds for rehospitalization. 29 Notably, early discharge was not randomized in this study and our findings likely reflect family self-selection and clinician decision making and thus, are unlikely to apply to all hospital births. Additionally, our secondary analysis cautions consideration of discharge on the day of birth or after a one-night stay following cesarean birth.…”

“…Outpatient care also changed with rapid adoption and expansion of telehealth. 29,30 While it is not known how thresholds to seek care and criteria for admission changed during the pandemic, telehealth may decrease emergency department utilization and lead to changes in rehospitalization rates. 30 Shorter hospitalizations may have led to decreased access and support from ancillary services, including lactation support.…”

Integralidade e Saúde: experiências, desafios e possibilidades no contexto pandêmico brasileiro

“…Reforça-se as puérperas a importância de estender as orientações recebidas ao seu ambiente familiar, sendo necessário que as pessoas que fazem parte do seu convívio tomem todos os cuidados para coibir a aquisição e transmissão da infecção. Deve-se considerar a necessidade de garantir que todas as famílias, independentemente do status COVID-19 da mãe e do bebê, tenham os meios para prevenir a contração e/ou disseminação deste vírus após a alta (HARRIEL et al, 2020).…”

“…Incentiva-se que a higiene adequada das mãos seja praticada por todos os membros da casa e isso inclui lavar as mãos com água e sabão por pelo menos 20 segundos, ou usar um desinfetante para as mãos à base de álcool que contenha pelo menos 60% de álcool, quando água e sabão não estiverem disponíveis (BRASIL, 2020ª;HARRIEL et al, 2020).…”

Restructuring maternal services during the covid-19 pandemic: Early results of a scoping review for non-infected women

“…Considering the novelty of the pandemic, an implicit variability has to be accepted concerning what is advisable for monitoring early neonatal stages. A largely shared opinion considers essential the involvement of professionals with in-person visits either at home or within the health facilities and supports this mode in order to implement neonatal jaundice assessment by the mother and to plan for vaccinations ( Harriel et al., 2020 ; Royal College of Obstetricians and Gynaecologists, 2020b ; Sachdeva et al., 2020 ; Tscherning et al., 2020 ). On the other hand, a recent study supports the idea that maternal and child monitoring may be performed exploiting emerging virtual technologies in up to 87.3% of overall postpartum consultations whenever videoconferencing is available between institutions and homes.…”