Foreword: Neonatal intensive care unit preparedness for the novel Coronavirus Disease-2019 pandemic: A New York City hospital perspective

Since late in 2019, humanity has found itself in the midst of the SARS Cov-2 worldwide pandemic. As of the date of this writing, over 4.3 million cases and nearly 300,000 deaths due to SARS CoV-2 infection have been confirmed worldwide.¹ The United States has had more cases and deaths than any other country, and within the US, New York City has suffered the greatest toll, with nearly 190,000 cases and 16,000 confirmed deaths.² The greatest morbidity and mortality due to this virus has manifested in adult (and particularly older adult) populations, and as a result, the vast majority of published case series and early clinical trials have focused on adult patient populations. While most children who experience SARS CoV-2 infection have mild illness or are asymptomatic, the recently described multisystem inflammatory syndrome in children (MIS-C) demonstrates that children also may suffer their own set of unique and severe consequences of this protean infection, and reminds us that there is still much to be learned about the effects of this virus on human hosts. At this time, the available evidence suggests that the effects of SARS CoV-2 on neonates are mild or inapparent, but the relative paucity of data, our recognition of how much is yet to be learned and traditional concerns about the vulnerability of neonates to overwhelming infection have dictated a conservative and cautious approach to the management of newborns with potential or known exposure to the virus. In addition, the novelty of this virus’ behavior and host interaction has posed particular challenges in infection control.

The authors of this month's issue of Current Problems in Pediatric and Adolescent Health Care, representing the disciplines of neonatology, nursing and pediatric infectious disease, found themselves suddenly confronted with the COVID-19 pandemic as it swept through the population of New York City, and with the challenge of designing and implementing systems of care to protect newborns, families and healthcare personnel in a busy New York City NICU setting. In response, they have developed a careful, reasoned and practical approach which addresses essential preparations before, during and after delivery, intra- and inter-facility transport, mother-baby contact and breastfeeding, care of the newborn in the NICU, issues of vertical and horizontal transmission of the virus, communication with caregivers and other family members, visitation, and protocols for hospital discharge.³ These are guidelines that should help to inform practices in NICUs as providers, patients and families confront and deal with the ongoing pandemic in a safe and humane fashion. I trust you will agree.