Maternal-Neonatal COVID-19 General Guideline

Full guideline document available at https://www.pcmch.on.ca/wp-content/uploads/2020/05/MatNeo-COVID-19-Guide_V4.pdf

New provincial guidelines that aim to keep mothers and newborns safe during the pandemic were released May 1, 2020 by the Provincial Council for Maternal and Child Health (PCMCH) Maternal Neonatal COVID-19 Task Force, PCMCH Maternal-Newborn Committee

The guidelines are made up of 13 recommendations, and include, among others:

  • Mothers who are COVID-positive, have symptoms of the virus or have been in close contact with a COVID-positive person will wear a surgical mask during all stages of labour.
  • Infants who are born to COVID-positive mothers should be tested for the virus within the first 24 hours of delivery, even if they don’t have symptoms.
  • Mothers who are COVID-positive can safely do skin-to-skin with their newborn and breastfeed their baby using proper precautions, which include wearing a surgical mask and washing their breasts, chest and hands before breastfeeding or pumping breast-milk.

Babies born to COVID-positive mothers are being tracked by BORN Ontario, or the Better Outcomes Registry & Network. So far, between 10 and 20 COVID-positive mothers have delivered babies in the province.

Birthing and newborn recommendations will be updated and refined as more data is collected in Ontario, Canada and from international registries.

One of the points made was that for a pregnant person, the most important thing is to be aware that childbirth is going to be a different experience than they were expecting when they first got pregnant, before the pandemic.

Here’s the summary of recommendations:

A. Use of Personal Protective Equipment (PPE) by Providers and Patients during Labour & Delivery

Use of Droplet-Contact PPE

1. A point of care risks assessment should be done by health care workers (HCWs) for risk of droplet and contact transmission during labour, delivery, and newborn care. Suitable precautions may include: gloves, gown, a surgical/procedure mask, and eye protection (goggles or face shield).

Droplet-contact precautions is recommended for all health care providers at all births in Ontario.

2. Pregnant patients who screen positive for signs/symptoms of COVID-19 should be treated as suspected for COVID-19, should be given a surgical/procedure mask for all stages of labour  (if tolerated) and be advised to perform hand hygiene.

Use of Airborne PPE/N95 Respirator

3. Only essential OR staff should be in the room for administration of general anesthesia for a caesarian section, such staff should follow Airborne precautions (including appropriately fitted N95 mask). Once intubation is complete, other HCWs may enter the room and use Droplet/Contact precautions.

4. All staff present in the operating room for caesarean section under regional anesthesia should use Droplet/Contact precautions. In the event that regional anesthesia is not sufficient and the procedure needs to be converted to general anesthesia, only necessary HCWs should be in the room for intubation and Contact/Droplet and Airborne precautions should be used. Once intubation is complete and ventilation initiated, other HCWs may enter the room and use Droplet/Contact precautions.

B. Support People for Pregnant Patients during a Labour & Delivery

Admission

5. A single support person who should remain unchanged during labour and birth and was screened negative for symptoms of COVID-19, be allowed to accompany the birthing mother as long as the institution has the following:

i. Sufficient PPE for support person;

ii. Adequate spacing and care environment in which support people can be appropriately physically distanced from other patients and support people; and

iii. The ability to ensure that the support person remains compliant with physical distancing and infection control instructions.

C. Care of Babies born to Suspected and Confirmed COVID-19 Mothers

6. Given the low risk of vertical transmission and the low risk of aerosol exposure from neonatal resuscitation, Droplet/Contact precautions are suitable for the initial resuscitation of newborns, even those born to suspected or confirmed COVID-19 mothers.

7. This group recommends early discharge of well babies, after proper risk assessment has occurred.

D. Infant Testing

8. Infants born to mothers with confirmed COVID-19 at the time of birth should be tested for COVID19 within 24 hours of delivery, regardless of symptoms.

9. If maternal testing is pending at the time of mother-baby dyad discharge then follow-up must be ensured such that if maternal testing is positive the baby is tested in a timely manner. If bringing the baby back for testing is impractical, the baby should be tested prior to discharge.

E. Care and Testing of Babies in NICU/SCN

10. HCWs providing care for babies requiring ongoing, potentially aerosolizing respiratory support in the NICU or SCN should use Airborne and Droplet/Contact precautions.

11. If any visitor to NICU or HCW is determined to be a suspected or confirmed COVID case, the baby becomes a possible contact and should be isolated with appropriate additional precautions instituted. Hospital IPAC should be notified to institute proper follow-up. Any infant who is a postnatal contact of a confirmed COVID positive caregiver or HCW should remain isolated with appropriate additional precautions for 14 days according to MOH or local guidelines.

12. Infants born to COVID-19 positive mothers should be tested within the first 24 hours of life and, if the initial test is negative, again at 48 hours of life, regardless of symptoms. Infants should be maintained on Droplet/Contact precautions with or without Airborne precautions as appropriate until results are reported.

i. Infants who have a 24 or 48 hour COVID test positive should be discussed with a pediatric infectious disease specialist.

ii. Infants who have a negative test at 48 hours should be discussed with local IPAC to determine appropriate ongoing care measures.

F. Monitoring/Surveillance Recommendations

13. The task force feels it imperative that prospective surveillance of the mother-baby dyad be performed postpartum until 2 weeks to ensure the safety of this recommendation.

Full guideline document available at https://www.pcmch.on.ca/wp-content/uploads/2020/05/MatNeo-COVID-19-Guide_V4.pdf