Clinical Practice Guidelines (AAP, 2020)

What your doctor is reading on Medscape.com:

APRIL 24, 2020 —In April 2020, the American Academy of Pediatrics (AAP) released initial clinical practice guidelines on the management of infants born to mothers with confirmed or suspected coronavirus disease 2019 (COVID-19). Key points are listed below.^[1]

Owing to the increased likelihood of maternal virus aerosols and the potential need to administer newborn resuscitation to infants with COVID-19 infection, use airborne, droplet, and contact precautions when attending deliveries from women with COVID-19.

When the physical environment permits, separate newborns at birth from mothers with COVID-19. If the family chooses to have the infant in the mother’s room, they should be educated on the potential risk of COVID-19 development in the newborn.

To date, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been found in breast milk. Milk expressed by mothers with COVID-19 can, until specific maternal criteria are met, be fed to their infants by uninfected caregivers.

Infants born to mothers with COVID-19 should, as resources permit, undergo testing for SARS-CoV-2 at 24 hours and, if they are still in the birth facility, 48 hours following birth.

A newborn with documented SARS-CoV-2 infection (or one at risk for postnatal infection, due to an inability to test the infant) requires frequent outpatient follow-up assessments via telephone or telemedicine or in person, through 14 days postdischarge.

After hospital discharge, a mother with COVID-19 is advised to stay at least 6 feet from her newborn. If she comes closer, a mask and hand hygiene must be used for newborn care until (a) the mother is afebrile for 72 hours without the use of antipyretics, and (b) at least 7 days have passed since the initial appearance of symptoms.

A mother with COVID-19 should remain separated from a newborn requiring ongoing hospital care until (a) she is afebrile for 72 hours without the use of antipyretics, (b) her respiratory symptoms have improved, and (c) at least two consecutive SARS-CoV-2 nasopharyngeal swab tests, collected 24 hours or more apart, are negative.