Neonatal Resuscitation and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection

Abstract

The first case of novel coronavirus disease of 2019 (COVID-19) caused by severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) was reported in November2019. The rapid progression to a global pandemic of COVID-19 has had profound medical, social, and economic consequences. Pregnant women and newborns represent a vulnerable population. However, the precise impact of this novel virus on the fetus and neonate remains uncertain. Appropriate protection of health care workers and newly born infants during and after delivery by a COVID-19 mother is essential. There is some disagreement among expert organizations on an optimal approach based on resource availability, surge volume, and potential risk of transmission. The manuscript outlines the precautions and steps to be taken before, during, and after resuscitation of a newborn born to a COVID-19 mother, including three optional variations of current standards involving shared-decision making with parents for perinatal management, resuscitation of the newborn, disposition, nutrition, and postdischarge care. The availability of resources may also drive the application of these guidelines. More evidence and research are needed to assess the risk of vertical and horizontal transmission of SARS-CoV-2 and its impact on fetal and neonatal outcomes.

Key Points

• The risk of vertical transmission is unclear; transmission from family members/providers to neonates is possible.

• Optimal personal-protective-equipment (airborne vs. droplet/contact precautions) for providers is crucial to prevent transmission.

• Parents should be engaged in shared decision-making with options for rooming in, skin-to-skin contact, and breastfeeding.

Keywords

neonatal resuscitation - COVID-19 - novel coronavirus - SARS-CoV-2

Note

D.T., P.C., and S.L. are scientific experts associated with ILCOR and S.L. is a member of the steering committee of the American Academy of Pediatrics Neonatal Resuscitation Program. M.V. is the Chairman of the European Board of Neonatology (European Society for Pediatric Research) and the Chairman of the Spanish Maternal, Neonatal, and Developmental Network SAMID (Instituto de Investigación Sanitaria Carlos III, Ministry of Science and Innovation, Kingdom of Spain). However, the views expressed in this article are individual opinions of the authors and do not reflect official recommendations of these organizations.

• References

• 1 World Health Organization. Coronavirus disease 2019 (COVID-19). Situation Report-74. Updated March 20, 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200321-sitrep-61-covid-19.pdf?sfvrsn=6aa18912_2 . Accessed April 6, 2020
• 2 Coronaviridae Study Group of the International Committee on Taxonomy of V . The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020; 5: 536-544
• 3 The Gurdian. First Covid-19 case happened in November, China government records show - report. Available at: https://www.theguardian.com/world/2020/mar/13/first-covid-19-case-happened-in-november-china-government-records-show-report . Accessed April 2, 2020
• 4 Holshue ML, DeBolt C, Lindquist S. , et al; Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382 (10) 929-936
• 5 –Peristats. United States. Quick Facts: Population. Available at: https://www.marchofdimes.org/Peristats/ViewTopic.aspx?reg=99&top=14&lev=0&slev=1 . Accessed April 2, 2020
• 6 Centers for Diasase Control and Presention Pregnancy & breastfeeding information about coronavirus disease 2019. Available at: https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html . Accessed April 2, 2020
• 7 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
• 8 Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020
• 9 Centers for Diasase Control and Presention. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html . Accessed April 2, 2020
• 10 Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020; S0163-4453 (20)30109-2
• 11 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020; ciaa200
• 12 Zhu H, Wang L, Fang C. , et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9 (01) 51-60
• 13 Avery CM. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants, by G. C. Liggins, MB, PhD, FRCOG, and R. N. Howie, MB, MRACP, Pediatrics, 1972;50:515-525. Pediatrics 1998; 102 (1, Pt 2): 250-251
• 14 Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50 (04) 515-525
• 15 Klein K, McClure EM, Colaci D. , et al. The antenatal corticosteroids trial (ACT): a secondary analysis to explore site differences in a multi-country trial. Reprod Health 2016; 13 (01) 64
• 16 Dubler S, Zimmermann S, Fischer M. , et al. Bacterial and viral contamination of breathing circuits after extended use - an aspect of patient safety?. Acta Anaesthesiol Scand 2016; 60 (09) 1251-1260
• 17 World Health Organizations. Clinical management of severe acute respiratory infection when COVID-19 disease is suspected. Available at: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected . Accessed April 2, 2020
• 18 Wang L, Shi Y, Xiao T. , et al. Chinese expert consensus on the perinatal and neonatal management for the prevention and control of the 2019 novel coronavirus infection (first edition). Ann Transl Med 2020; 8 (03) 47
• 19 Spanish Ministry of Health. Documento técnico Manejo de la mujer embarazada y el recién nacido con COVID-19. Available at: https://www.mscbs.gob.es/en/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/Documento_manejo_embarazo_recien_nacido.pdf . Accessed April 2, 2020
• 20 Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med 2020; (e-pub ahead of print) DOI: 10.5858/arpa.2020-0901-SA.
• 21 Dong L, Tian J, He S. , et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020
• 22 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero?: more definitive evidence is needed. JAMA 2020; DOI: 10.1001/jama.2020.4868.
• 23 Zeng H, Xu C, Fan J. , et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020
• 24 World Health Organization. Guidelines on Basic Newborn Resuscitation. Geneva, Switzerland: World Health Organization; 2012
• 25 Pisacane A. Neonatal prevention of iron deficiency. BMJ 1996; 312 (7024): 136-137
• 26 Sanberg PR, Park DH, Borlongan CV. Stem cell transplants at childbirth. Stem Cell Review Report 2010; 6: 27-30
• 27 Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr 2015; 169 (07) 631-638
• 28 American Academy of Pediatrics and American Heart Association; Weiner GM, Zaichkin J. , eds. Textbook of Neonatal Resuscitation (NRP). 7th ed. Grove Village, IL: American Academy of Pediatrics; 2016: 326
• 29 Schmölzer GM, Dawson JA, Kamlin CO, O'Donnell CP, Morley CJ, Davis PG. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed 2011; 96 (04) F254-F257
• 30 Cheung JC, Ho LT, Cheng JV, Cham EYK, Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. Lancet Respir Med 2020; S2213-2600 (20)30084-9
• 31 Anderson PO. Breastfeeding and respiratory antivirals: coronavirus and influenza. Breastfeed Med 2020; 15 (03) 128
• 32 Zeng L, Xia S, Yuan W. , et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020
• 33 Centers for Diasase Control and Presention. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html#take_precautions . Accessed April 2, 2020
• 34 Lippi G, Simundic A-M, Plebani M. Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). Clin Chem Lab Med 2020; (e-pub ahead of print) DOI: 10.1515/cclm-2020-0285.
• 35 Li D, Wang D, Dong J. , et al. False-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2: role of deep-learning-based CT diagnosis and insights from two cases. Korean J Radiol 2020; 21 (04) 505-508
• 36 Bi Q, Wu Y, Mei S. , et al. Epidemiology and transmission of COVID-19 in Shenzhen China: analysis of 391 cases and 1,286 of their close contacts. medRxiv 2020; DOI: 10.1101/2020.03.03.20028423.
• 37 Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA 2020
• 38 Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA 2020; 323 (13) 1313-1314
• 39 COVID-19 in children: initial characterization of the pediatric disease. Pediatrics 2020; (e-pub ahead of print) DOI: 10.1542/peds.2020-0834.
• 40 Dong Y, Mo X, Hu Y. , et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; (e-pub ahead of print) DOI: 10.1542/peds.2020-0702.
• 41 Wu Y, Guo C, Tang L. , et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol 2020; (e-pub ahead of print) DOI: 10.1016/S2468-1253(20)30083-2.
• 42 Bauchner H, Golub RM, Zylke J. Editorial concern-possible reporting of the same patients with covid-19 in different reports. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.3980.