For expectant and new mothers, please allow me to summarize the latest guidelines from the American Academy of Pediatrics regarding in hospital care for your newborn:
- We recommend that skin to skin contact between mother/baby immediately after birth is still optimal, even if mother is COVID positive.
- For COVID positive mothers, newborns should be tested at 24 and 48 hours (baby may be negative first test). Continue close monitoring for babies who come up negative, of course.
- For COVID positive mothers, “rooming in” is not recommended. Ideally, the mother should be isolated from the baby, but we realize that that presents many other problems and may not be feasible. Mother should don all appropriate protective wear–gown, glove, eye/face shield with N-95 mask for ALL contacts with her baby, however.
- Breast feeding should definitely continue. Best practice is for mother to express her milk for another uninfected caregiver to feed to the baby. However, if mother desires to nurse directly she can do so as long as she is wearing all PPE as (3) above.
- For mothers testing negative, early discharge is not recommended. There is no demonstrated health benefit; newborn testing (eg PKU) must wait until > 24 hours of life so leaving early can render those tests less than accurate. It can also place extra access and care burdens on new families.
- Newborns who test positive for COVID but are symptom free can be discharged normally but must be closely monitored until they test negative twice consecutively. Sick babies, obviously, must be cared for in hospital in an NICU.
- COVID positive parents should NOT visit in an NICU. They must be 3 days symptom free, at least 10 days since first onset of infection in order to enter the unit.
Obviously, we are dealing with a new and fluid situation, so we doctors are making the best judgements we can with the data available at this time. Careful collection and assessment of new clinical info, both as it affects individuals infected as well as from the standpoint of public health needs, are ongoing. Adjustments to these approaches would be made as later and likely better information becomes available. What we must NOT do is make decisions with potentially profound impact on the wellbeing of the youngest and most vulnerable children based on the utterances of politicians, pundits, press conferences, or public opinion polls. As Joe Friday actually never said, “Just the facts, Ma’am.”
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