DECISION-MAKING TOOL FOR TERM STABLE BABIES BORN OF SUSPECT/PROBABLE/CONFIRMED COVID-19 MOTHERS

(July 9, 2020)


DELIVERY OF A STABLE TERM SUSPECT COVID SUSPECT COVID BABY IN COVID WARD

BABY TRANSPORT OF STABLE TERM or MOTHER”S ROOM

SUSPECT COVID BABY • Routine newborn care and Hepatitis B vaccine shall be given.
Bathe the baby on or after the 6th HOL.
**Prior to delivery or immediately post-partum, an OB or Pediatric team member shall •
offer to the mother the option of rooming in the baby, even if her COVID status is
• Once stabilized, baby shall be placed and transported

suspect/probable/confirmed or awaiting results. The possible risks of transmission,
inside a transport isolette and at times, earlier than • At the NICU Annex, the baby shall remain inside the isolette or
precautions to be taken, advantage of rooming-in and breastfeeding shall be explained bassinet with shield.
to the mother. Anytime the mother worsens or the infant becomes symptomatic,
the mother.
On the way out of the DR complex, transport • Feeding: The baby shall be fed the mother’s EBM or pasteurized
rooming-in shall be deferred and the baby shall be transferred to the designated COVID • breastmilk by cup/syringe by the HCW.
personnel shall change into new PPEs
areas.
• Security personnel shall be part of the transport
• Mother can pump her breastmilk manually or by using her own
• All deliveries by NSD or CS shall be at a designated delivery room for breast pump. All milk shall be properly labelled and stored.
suspect/probable/COVID positive mothers. team.
• Stable suspect COVID newborn shall be transferred to • Parents shall be updated through phone calls.
• Mother shall wear surgical facemask at all times especially at the DR.
the NICU annex located at the maternity unit or
• *COVID Delivery Team attending the delivery shall wear double gloves and roomed in with the mother*. • If the baby is roomed-in, he shall be placed inside the isolette or
PPE**/bunny suits maintained at a distance of 6 ft. from the mother. Mother shall

• Pediatric team shall stay at a designated area inside the delivery room *If an isolette is not available, the baby will be wear a facemask at all times and practice hand hygiene before and
separated by a plastic barrier. The resuscitation shield shall be placed on top transported in a bassinet with an aerosol shield. after breastfeeding or touching the baby. The mother shall be the
of the radiant warmer. sole caregiver of the baby. No other caregivers or visitors are
• Upon delivery, immediate drying and properly timed cord clamping shall be allowed except HCW.
performed. Baby shall be brought to the radiant warmer by one of the pediatric
team for assessment and thermoregulation. • The HCW shall wear complete PPE at all times.
• The baby shall be placed on prone position to facilitate drainage of secretions. • Strict hand hygiene before and after handling the baby and
Unnecessary oral and nasal suctioning shall be avoided. equipment should be observed.
*COVID Delivery Team – Obstetrician (1-2); Pediatrician (1-2); • Pediatric resident/consultant shall bathe immediately after
Anesthesiologist (1); Nurse (1-2) making rounds on these babies and before handling non-COVID
*Pediatric Delivery Team – Pediatric Consultant and Senior Resident babies. The nurse in charge shall bathe once she goes on break
**APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT (PPE) and after her shift.
1. Well-fitting N95 mask (fit-tested) • Airborne and contact precautions shall be observed at all
2. Eye protection (goggles or face shield) times.
3. Impermeable gown
4. Hair cap
1. Facilitate COVID-19 Test on or after the 24th HOL
5. Surgical gloves
2. Coordinate with Infection Control Service and Microbiology
local 4139 for COVID-19 test 6. Shoe cover
NOTES:
3. Physician to collect specimen and fill-up CASE
INVESTIGATION FORM (CIF) 2019 CORONAVIRUS DISEASE • COVID suspect/probable/confirmed mothers give birth to
(COVID-19). COVID suspect babies
th
4. Refer to a Pediatric Infectious Disease Specialist Abbreviations: IMCU – intermediate care unit; EBM – expressed breast milk; HCW – healthcare • AAP recommends another COVID test on the 48 HOL if baby
worker; NSD – normal spontaneous delivery; CS – cesarean section; DR – Delivery room; HOL – is still in the hospital
hour of life

 DECISION-MAKING TOOL FOR COVID POSITIVE NEWBORNS (July 9, 2020)
COVID POSITIVE NEWBORNS*
• COVID naso-oropharyngeal swab test shall be done ideally on
the 24th HOL, and if still admitted, on the 48th HOL.
• Refer to Pediatric Infectious Disease service
• Mother’s EBM or pasteurized milk may be given to the baby.
• Routine newborn care and pre-discharge screening
procedures shall be provided at the appropriate time.
*Newborns who tested positive for SARS COV2 by RT-PCR •
STABLE COVID POSITIVE NEWBORNS
• If asymptomatic, may be discharged with mother anytime.
• If continues to be asymptomatic, patient may be retested on the 7th day
from the last positive test OR just quarantine with mother for 10 days
• Readmit baby if newborn develops symptoms of COVID (e.g. fever, cough,
colds etc.)
• Close follow-up of newborns through telemedicine or face-to-face once
non-communicable
UNSTABLE COVID POSITIVE NEWBORNS
• Refer to a neonatologist
• Admit the baby to the NICU COVID Isolation room.
• All babies shall be placed inside an isolette, whether intubated or not.
For intubated patients, may use an endotracheal aspirate (ETA) specimen for
COVID RT PCR test
• Repeat COVID swab once the symptoms improved or on the 7th day after the
first positive test.
• If baby remains in the NICU COVID isolation room, transmission-based precautions
shall be discontinued 10 days after the onset of symptoms plus at least 3 days
without symptoms (e.g. fever and respiratory symptoms) OR 2 negative COVID
swab results.
• The baby shall only be transferred out of the COVID Isolation room once they have
at least 2 negative COVID swab tests done at least 24-48 hours apart.
• Parents shall be updated daily.
 DECISION-MAKING TOOL FOR TERM BABIES BORN OF SUSPECT/PROBABLE/CONFIRMED COVID-19 MOTHERS (July 9, 2020)

DISCHARGE OF A SUSPECT/PROBABLE/ HOME INSTRUCTIONS AND FOLLOW-UP OF A SUSPECT/PROBABLE/CONFIRMED
CONFIRMED COVID BABY COVID BABY

• Recommend early discharge of mother and baby • SLMC Cellular Immunology will email family of COVID test results once available. RESU/LGU are also informed of results
• Give BCG vaccine, do ENBS and CCHD prior to discharge. • If COVID results are not yet known for both, mother and infant are isolated separately at home or with a minimum distance of 6 feet if they will
• OAE screening is done once baby is COVID (-) stay in one room until COVID test results are known
• For bilirubin screening, may do serum bilirubin or transcutaneous • Mother and caregiver should wear facemasks at all times and follow strict hand hygiene before and after handling the baby and the baby’s
bilirubin whichever is available things.
• If COVID test results are not yet known, HCW who will bring down baby for • Feeding:
discharge should be on PPE. Mother should wear facemask when in close − EBM from mother or donated/pasteurized breast milk. Another caregiver will feed the baby via cup or dropper.
proximity to the neonate, in the car and at home. − If mother prefers to directly breastfeed, advise to wear facemask at all times and observe strict hand hygiene.
• Baby will be transported inside an incubator upon discharge. • When to stop isolation/ separation of mother and baby:
• Incubator should be disinfected prior to leaving the room and after A. If mother is COVID positive and baby is COVID negative:
discharge of infant i. Continue to separate mom and baby until mother’s COVID test is negative OR mother has quarantined for 10 days from onset of illness
and with no symptoms for at least 3 days. If mother opted otherwise, mother to wear face mask and do frequent hand hygine
B. If BOTH mother and baby are COVID negative:
i. Mother and baby can stay together. Mother may do direct breastfeeding.
ii. Continue home quarantine until government lifts the community quarantine.
iii. Avoid crowded places since infant may contract other infections
C. If BOTH mother and baby are COVID positive:
i. Mother and baby can stay together but separate from other household members. May do direct breastfeeding.
Abbreviations: HCW – healthcare worker; ENBS – expanded newborn screening; OAE – ii. The soiled diaper of the infant should be placed in a securely tied plastic bag and thrown in a dedicated trash bin.
otoacoustic emission; CCHD – critical congenital heart disease; ICS – infection control D. If mother is COVID negative and baby is COVID positive:
service; RESU – regional epidemiology and surveillance unit; EBM – expressed breast milk i. Mother and baby to stay together. Mother can directly breastfeed. Mother to wear facemask at all times when caring for baby.




ADDITIONAL CARE OF THE BABY
• Bathe the baby daily
• Make sure the umbilical cord is dry at all times
• Put the diaper inside a plastic bag which is securely tied until the baby’s COVID test result returns negative

• All household members should:
− Wear facemasks at all times
− Practice social distancing as much as possible (3 feet away from each other)
− Strict hand hygiene
• Follow-up of baby and consultations will be through phone or teleconference with pediatrician. Face to face consultation once
mother and baby are considered non- communicable
• Vaccinations will be updated once baby is considered non communicable by AMD. Baby may receive multiple vaccines

 DECISION-MAKING TOOL FOR PRETERM/ UNSTABLE BABIES BORN OF SUSPECT/PROBABLE/CONFIRMED COVID-19 MOTHERS
(July 9, 2020)


PRETERM/UNSTABLE TERM SUSPECT
DELIVERY OF A PRETERM/UNSTABLE TERM
COVID BABY IN NICU ISOLATION ROOM
SUSPECT COVID BABY
• ALL babies shall be placed inside an isolette especially
• Delivery by NSD or CS at designated delivery room for suspect/probable/COVID TRANSPORT OF PRETERM/ those requiring respiratory support.
(+) mothers.
UNSTABLE TERM SUSPECT • ALL HCWs taking care of these babies should be on PPE.
• Mother should wear facemask at all times especially at the DR
• *COVID Delivery Team attending the delivery should wear double gloves and COVID BABY • Strict hand hygiene before and after touching the baby and
equipment should be observed.
PPE**/bunny suits • Nurse assigned to handle these babies should not be
• Pediatric team with neonatologist will stay at a designated area inside the • Place inside a transport incubator during assigned to non-COVID babies in the nursery
delivery room separated by a plastic barrier. Place the resuscitation shield transfer to NICU ISOLATION ROOM • Pediatric resident/consultant should bathe immediately
on top of the radiant warmer. Upon delivery, perform immediate drying • Transport personnel shall wear appropriate after making rounds on these babies, before handling non-
and early cord clamping. Baby shall be brought to the radiant warmer by one PPE COVID babies.
member of the pediatric team for assessment and resuscitation. • Disinfect outer casing of the transport • Airborne and contact precautions
• Place baby on prone position to facilitate drainage of secretions. Avoid incubator prior to transport. Full disinfection • Feeding: EBM from mother or pasteurized donor milk.
unnecessary oral and nasal suctioning. of incubator after transport to NICU. • Mother can pump her milk using her own breast pump or by
• When doing bag and mask ventilation, attach a viral filter and ensure that hand expression. Store milk securely and properly labeled.
the procedure is done under a resuscitation shield.
• COVID positive mother will be cleared to visit baby once her
• All resuscitation shall be performed under the shield.
repeat COVID test is negative OR 10 days of quarantine and
at least 3 days with no symptoms
• Give Hepatitis B vaccine
• Repeat COVID test at the 48th HOL




1. Facilitate COVID-19 Test on or after the 24th HOL
2. Coordinate with Infection Control Service and
Microbiology local 4139 for COVID-19 test
3. Physician to collect specimen and fill-up CASE *COVID Delivery Team – Obstetrician (1-2); Pediatrician (1-2);
INVESTIGATION FORM (CIF) 2019 CORONAVIRUS
Anesthesiologist (1); Nurse (1-2)
DISEASE (COVID-19).
*Pediatric Delivery Team – Pediatric Consultant and Senior Resident

4. Refer to a Pediatric Infectious Disease Specialist **APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT (PPE)
Abbreviations: NICU – neonatal intensive care unit; EBM – expressed breast milk; HCW – 1. Well-fitting N95 mask (fit-tested)

healthcare worker; NSD – normal spontaneous delivery; CS – cesarean section; DR – delivery 2. Eye protection (goggles or face shield)
3. Impermeable gown
room; HOL – hour of life
4. Hair cap
5. Surgical gloves
6. Shoe cover

SCREENING OF MOTHERS PRIOR TO DELIVERY: RT-PCR COVID SWAB (as of July 9,
2020)
A. COVID test results available BEFORE delivery:

NEGATIVE COVID test ± chest x-ray
Asymptomatic for 14 days Room in baby with mother in a regular private room
No exposure to COVID for past 14
days

− Do COVID swab test on baby. Separate mother and baby unless mother
prefers otherwise
POSITIVE COVID test − Suggest to do COVID swab on father if able

**Follow algorithm for babies of suspect/ probable/confirmed COVID mothers
B. COVID test results NOT yet available AT TIME of delivery:

NORMAL chest x-ray − Temporary separation of mother and baby while waiting for mother’s COVID
Asymptomatic for past 14 days swab result unless mother prefers otherwise.
No exposure to COVID for the past 14 − Baby will not be swabbed and will just wait for mother’s result unless baby
days has symptoms pertaining to COVID


− Separate mother and baby unless mother prefers otherwise.
ABNORMAL chest x-ray OR − DO COVID test on baby
Symptomatic OR − Stable babies: admit to NICU annex at the maternity unit
With significant exposure to COVID − Unstable babies: admit to NICU isolation room
for the past 14 days
**Follow algorithm for babies of suspect/ probable/confirmed COVID mothers
NOTES: Recommended COVID test: RT-PCR through naso-oropharyngeal swab.
Newborns can be discharged after 24 hours of life if stable even without the result of COVID test




Case Definition of SUSPECT COVID:
Mother with SYMPTOMS which include but not limited to: fever, cough, colds, headache, arthralgia, myalgia, diarrhea, shortness of breath, sore throat
OR
Mother with CHEST X-RAY showing signs of pneumonia
AND
RISK OF EXPOSURE to COVID 19 case. Any of the following:
Traveled abroad in the last 14 days
Travel to or resided in communities with local transmission of COVID 19
Exposure to a person with COVID 19
Exposure to a person with symptoms of COVID 19
Exposure to a traveler with symptoms of COVID 19
OR
Newborns from a suspect/probable/ confirmed COVID 19 mother

Case Definition of PROBABLE COVID:
Mother/ newborn has inconclusive test for COVID or COVID positive test but testing center is not accredited by DOH as a testing center

Case Definition of CONFIRMED COVID:
Mother/newborn POSITIVE for SARS-COV2 through a naso-oropharyngeal swab done in a DOH accredited testing center


References:

FAQs/ Management of Infants Born to Mothers with Suspected or Confirmed COVID-19


WHO-2019-nCoV-clinical-2020.5-eng.pdf
1591879323896505.pdf (DOH Interim Guidelines on Expanded Testing May 29, 2020)

Interim Guidelines for Clinical Specimens for COVID-19 | CDC


Caring for Newborns | COVID-19 | CDC
FAQs/ Management of Infants Born to Mothers with Suspected or Confirmed COVID-19

Coronavirus disease 2019 (COVID-19) – UpToDate
PsNbM Guidelines on Care of Newborns of Suspected/Confirmed COVID 19 Mothers