Perinatal aspects on the covid-19 pandemic: a practical resource for perinatal-neonatal specialists

Abstract

Background: Little is known about the perinatal aspects of COVID-19.

Objective: To summarize available evidence and provide perinatologists/neonatologists with tools for managing their patients.

Methods: Analysis of available literature on COVID-19 using Medline and Google scholar.

Results: From scant data: vertical transmission from maternal infection during the third trimester probably does not occur or likely it occurs very rarely. Consequences of COVID-19 infection among women during early pregnancy remain unknown. We cannot conclude if pregnancy is a risk factor for more severe disease in women with COVID-19. Little is known about disease severity in neonates, and from very few samples, the presence of SARS-CoV-2 has not been documented in human milk. Links to websites of organizations with updated COVID-19 information are provided. Infographics summarize an approach to the pregnant woman or neonate with suspected or confirmed COVID-19.

Conclusions: As the pandemic continues, more data will be available that could lead to changes in current knowledge and recommendations.

Fig. 1. Infographic showing maternal clinical features, possible modes of spread to the neonate and neonatal management of suspected or confirmed COVID-19.

There is a wide range of illness among mothers from asymptomatic to pneumonia to severe acute respiratory distress syndrome (ARDS). Term neonates born to COVID-19 mothers are usually asymptomatic. PPE personal protective equipment, CPAP continuous positive airway pressure, HFNC high flow nasal cannula, PAPR powered air purifying respirator.

Fig. 2. Current recommended management of suspected pregnant woman with influenza-like illness with suspected novel 2019 coronavirus infection (COVID-19).

If maternal tests are positive, mothers should wear a mask for source containment. Minimum number of providers should be in the delivery/operating room to reduce exposure risk. Additional providers can be on standby outside the room to reduce personal protective equipment (PPE) burnout. Neonatal providers performing infant stabilization should attend delivery with PPE to provide airborne precautions and infant is immediately isolated from the mother after delivery and cared in a separate room pending testing. Recommended testing is nasopharyngeal and throat swabs at 24 h after birth and repeated 48 h after birth. If these tests are negative and baby is asymptomatic, he/she can be discharged to be cared for by a noninfected, asymptomatic caretaker pending negative repeat tests and resolution of symptoms in the mother. If infant is positive but asymptomatic, baby can be discharged but may need to be quarantined at home. If possible, uninfected individuals >60 years of age or with comorbid conditions should not care for these infants. If symptomatic, baby needs NICU care. These guidelines are subject to change with emerging evidence.