Guidelines for continued newborn healthcare during the COVID-19 pandemic: Compiled programmatic information for implementers and project managers

About

The World Health Organization (WHO) declared COVID-19 a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to the most recent research, the virus is mainly spread during close contact with infected people via small droplets and, to a certain extent, the aerosol produced through coughing, sneezing, talking or breathing in exertion. The symptoms include fever, tiredness and dry cough, and one out of every six infected persons can develop severe breathing problems. The “infodemic” regarding Coronaviruses and COVID-19 has caused both fear and confusion regarding newborn health guidelines and their implementation. We don’t know yet the full extent of the pandemic impact on service delivery.

This document compiled programmatic information for implementers and project managers, per WHO and key global health institutions interim guidance, to ensure the continuity of newborn healthcare services in communities and in healthcare institutions during the COVID-19 pandemic.

It must be noted that even during a pandemic:

Women and babies should not die from preventable causes

  1. Maternal and newborn health care continue to be essential services.
  2. Standard Maternal Newborn Health (MNH) care should be provided by the health system and sought by families.
  3. Pregnant women and families should take the same precautions to avoid COVID-19 infection as other people.

Frequently Asked Questions (FAQs)

Prevention

How to prevent the spread of the COVID 19 Coronavirus among newborns?

In healthcare facilities:

  • Hand hygiene and social distancing must be practiced in institutions by caregivers, mothers, and family members.
  • Transmission after birth via contact with infectious respiratory secretions is a concern. The WHO states that currently it is not known if the virus is transmitted from mother to newborn during pregnancy or delivery. However, to reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, CDC suggests that facilities should consider temporarily separating (e.g. separate rooms) the mother who has COVID-19 or suspected SARS-CoV-2 infection from her baby until the mother is cleared. The risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team.

The decision to discontinue temporary separation of the mother from her baby should be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. The decision should take into account disease severity, illness signs and symptoms, and results of laboratory testing for SARS-CoV-2.

Guidelines:

In communities:

Correct practices for hygiene and social distancing must be communicated to caregivers, mothers and family members. Disinfecting surfaces is also recommended for shared spaces and surfaces. Home quarantine if is an effective way of managing the COVID-19 infection with minor symptoms.

Guidelines: WHO advice for the public can be found here. Home care guidance, if advised by the healthcare provider, can be found here for the mother, here for the caregiver, and here for all other household members

Testing

Should all newborns be tested for COVID-19 Coronavirus?

WHO currently recommends that pregnant women with symptoms of COVID-19 should be prioritized for testing. If they have COVID-19, they may need specialized care.

Guidelines:

Treatment

What is the treatment for COVID-19 among newborns?

There is no available cure for COVID-19 disease. Treatment and care for COVID19 patients is primarily supportive to relieve the patient off signs and symptoms. with focus also on prevention of spread.

Guidelines:

Delivery Type

Should deliveries be done via Caesarean section for all women suspected of or who have tested positive for Coronavirus during the COVID-19 pandemic?

No. WHO advises, that Caesarean sections should only be performed when medically justified. The mode of birth should be individualized and based on a woman’s preferences alongside obstetric indications.

Guidelines:

Breastfeeding

Can mothers continue to breastfeed their newborns during the pandemic?

Yes. Women with COVID-19 can breastfeed if they wish to do so. They should:

  • Practice respiratory hygiene during feeding, wearing a mask where available.
  • Wash hands before and after touching the baby.
  • Routinely clean and disinfect surfaces they have touched.

Guidelines: Recommendations for breastfeeding can be found below:

Skin to Skin

Can a mother/parent give skin to skincare/kangaroo care to a newborn during the COVID-19 pandemic?

  • Close contact and early, exclusive breastfeeding helps a baby to thrive.
  • Kangaroo care is a method of care of preterm and low birthweight infants.
  • Community health care workers and hospital staff must encourage women to always take care of their babies safely, with good respiratory hygiene.
  • They must be encouraged to wash their hands before and after touching their baby and keep all surfaces clean and sanitized.
  • If mothers have a cough, in addition to hand hygiene, they must be encouraged to use a mask.

Guidelines:

Immunization

Should newborns be immunized as per schedule during the COVID-19 pandemic?

Immunization must be continued during the pandemic.

  • Program managers must develop catch-up action plans for missed immunizations in case staff is diverted to COVID-19 response and/ or immunization turnout was low.

Guidelines: Interim guidelines by WHO for conducting mass immunizations can be found here.

Antenatal and Postnatal Care

Should hospitals, birth centers continue with normal antenatal care ANC, PNC, and NBH initiatives during the COVID-19 pandemic?

  • Program Managers must develop action plans for following up on postnatal women in the communities in case of increased workload on health workers due to the COVID-19 response.

Guidelines: WHO recommends a continued high standard of care for pregnant and lactating women.

Community Healthcare Workers

Should community healthcare workers (CHWs), continue to make home visits to expectant mothers for antenatal care (ANC), and new mothers and newborns for postnatal care (PNC) and newborn healthcare (NBH) initiatives in the community?

  • CHWs are among the frontline workers in the response against COVID-19 and are exposed to hazards including pathogen exposure, stress and fatigue, occupational burnout, stigma, and physical and psychological violence.

Guidelines:

  • WHO guidelines for community workers and volunteers can be found here.
  • Unicef also includes some useful communication guidance for CHW’s to avoid mistrust, community backlash or other mistreatments which can be found here.

Stigma

How can institutional and community healthcare workers stop the mothers and newborn babies from getting stigmatized if they tested positive for COVID-19 and have now recovered?

  • Any new disease brings with it the associated risk of social stigma and vulnerable populations are at risk of being subjected to it. Community awareness activities including radio messaging, sharing positive and sympathetic stories and curbing misconceptions can go a long way in managing stigma associated with COVID-19 successfully treated mother-baby dyad.

Guidelines: The joint guidance by the Red Cross Federation, UNICEF and WHO for stigma management can be found here.

Questions for WHO

Birth Partners

Should hospitals and birthing centers continue to allow “birth partners” with women who are in labor/delivery, during the COVID-19 pandemic?

  • Currently, there is no recommendation by WHO to avoid birth partners. However, the CDC recommends that, if the mother wishes to be accompanied by a birth partner, the partner should practice hand hygiene, wear appropriate Personal Protective Equipment (PPE) including masks and gloves, and use sanitizers correctly and strictly follow all other guidance provided by the birthing facility.

Guidelines:

Visitors

Should visitors be allowed to visit mother and baby at birth centers or hospitals during the COVID-19 pandemic?

  • Managing visitors: Healthcare facilities should consider limiting visitors, except for a healthy parent or caregiver. COVID-19 screening should be in place for any visitor going to the labor ward (or maternity ward)
  • Visitors must be encouraged to practice correct hand washing techniques before and after coming in contact with the baby.
  • Visitors should be instructed to wear appropriate Personal Protective Equipment (PPE), including gown, gloves, face mask, and eye protection. If another healthy family or staff member is present to provide care (e.g. diapering or bathing) and feeding for the newborn, they should use appropriate PPE.
  • For healthy family members, appropriate PPE includes gown, gloves, face mask, and eye protection.

Guidelines:

Postpartum Family Planning

Continuation of practicing child-spacing for the survival of both women and newborns must be messaged in communities and healthcare institutions. Mothers need to counseled and offered postpartum family planning, and family planning services in general should be maintained.

Additional Resources


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