TABLE 1.
International guidelines for neonates exposed to mother who has suspected or confirmed COVID‐19
| Guidelines | Separation at birth? | Neonate tested for COVID‐19 | Mother COVID‐19 positive | Breastmilk from COVID‐19 positive mother | Neonate COVID‐19 positive | Neonate COVID‐19 negative |
|---|---|---|---|---|---|---|
| Chinese consensus 4 | Yes. Infant admitted to quarantine ward in a designated hospital | Nasopharyngeal swab on day one of life | Separation from the baby until she's negative. This should last at least 14 d | No |
Quarantine in incubator in pressure‐negative room until: a) two consecutive, negative samples at least 24 h apart b) no symptoms for 3 d. Quarantine at home for at least 14 d |
Routine care by parents or guardians |
| United States of America consensus 5 , 6 , 7 |
Yes, if mother agrees and separate area available. Default should be incubator in same room as mother |
Nasopharyngeal, throat, rectal swab at 24 and 48 h | Separation from the baby until she's negative. At least 14 d | Yes |
Quarantine in hospital and, or, at home for at least 14 d. Mask, gloves, hand hygiene for all caregivers. If possible, testing every 48/72 h until two consecutive tests are negative. Follow‐up in hospital, by phone or telemedicine |
Routine care by parents or guardians |
| Australian and New Zealand consensus 8 , 9 | No routine separation | Not stated | No routine separation | Yes | Not stated | Not stated |
| Canadian consensus 10 , 11 | No | Not stated | No routine separation | Not stated | Not stated | Not stated |
| European societies 12 , 13 , 14 | No, unless mother has moderate or severe symptoms or baby needs NICU care | Nasopharyngeal swab if mother is positive. Test repeated at 96 h if baby is admitted to NICU | No separation unless mother or baby need specific hospital care. Strict maternal droplet precautions | Yes | Quarantine in hospital and home for at least 14 d with mother. Strict maternal droplet precautions | Routine care by mother or guardian if mother is hospitalised. Strict maternal droplet precautions |
| UK consensus 15 , 16 | No, unless mother has moderate or severe signs or baby needs NICU care | Nasopharyngeal swab if the baby meets case‐definition for NICU care: clinical or radiological evidence of pneumonia or acute respiratory distress syndrome or influenza like illness. Swab repeated after 48 h | No separation, unless the mother or baby need hospital care. Strict maternal droplet precautions | Yes | Quarantine in hospital and home for at least 14 d with the mother. Strict maternal droplet precautions | Routine care by the mother or guardian if mother is hospitalised. Strict maternal droplet precautions |
| World Health Organization 17 | No | Not stated | No separation, unless mother or baby need hospital care | Yes | Quarantine in hospital and home for at least 14 d with mother. Droplet precautions | Routine care |
| Academy of Breastfeeding Medicine – worldwide organisation 18 | No | Not stated | No separation from the baby, unless mother or baby need hospital care | Yes | Quarantine in hospital and home for at least 14 d with mother. Droplet precautions | Routine care |
| UNICEF 19 | No | Not stated | No separation, unless mother or baby need hospital care | Yes | No separation, unless mother or baby need hospital care | Routine care |
United States of America consensus: Center for Disease Control, American College of Obstetricians and Gynecologists, American Academy of Pediatrics. Australian and New Zealand consensus: Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Ministries of Health for both countries. Canadian consensus: Society of Obstetricians and Gynaecologists, Ministry of Health. European societies: Italian, French, and Swedish Societies of Neonatology, Union of European Neonatal and Perinatal Societies. UK consensus: Royal College of Obstetricians Gynaecologists, British Association of Perinatal Medicine.