Newborn Care
General information
Slides from Emma Mohr MD, PhD's DFMCH presentation from 5/14/20 -- For any newborns who test positive for COVID please message a UW Peds ID doc (Emma Mohr, James Conway, etc) as they are adding patients to a registry as well, see also registry below
AAP initial guidance on COVID-19
CDC guidance for care of children and newborns
Meriter visitor information patient handout for L&D/pp/newborn and "Beginning of Life" visitor process
*See specific links for information on Mother-baby separation and breastfeeding below
Current guidance regarding care of newborns in clinic:
Both hospital systems have relaxed expediting discharges at 24 hours for vaginal deliveries and 48 hours for C-sections (still encouraged but use patient factors to drive decision). We anticipate seeing newborns earlier and will need to consider more frequent weight checks. Again, we encourage providers to use their best clinical judgement and modify this workflow as clinically indicated. Helpful tool to assess risk of newborn weight loss: https://www.newbornweight.org/
Please keep in mind that mom may need follow up as well at the first newborn check - make sure to consider bp evaluation and depression screening at all newborn visits. See information on bp monitoring in the section on prenatal care
Suggested newborn workflow:
The first newborn hospital discharge follow up should always be a provider OFV.
For any subsequent newborn weight checks, consider the workflow is as described on the right (or below if on the phone).
As mentioned in Updates we are working on obtaining scales to allow for newborn weight checks to be done at home with telehealth follow up. We hope to have more information when it is available
In the interim consider using Anne Eglash's dotphrase (.scalesinfant) or this link for recommended newborn scale options. Peds clinic has recommended this scale for now
Weekend discharge information -
For Meriter delivered/Quartz/GHC insured newborn weight checks/bilis over the weekend are now being done at UW Health Union Corners Clinic (2402 Winnebago St, Madison, WI)
Family should call the UNC UC Line 608-242-6885 to schedule.
Patients will be scheduled in to the template in 20 min increments beginning at 8:10
For St Mary's delivered/Dean insured newborn weight checks/bilis they can be seen at East and West clinics in nonURI clinic staffed by our Dean FM colleagues on Saturday and Sunday. Babies born to COVID+ or PUI moms follow up in URI urgent care, staffed by pediatric providers from 9-noon on weekends.
We will still see babies who are PUI due to mother's COVID status in our clinics.
These visits should be planned so that the family remains in the vehicle until the provider is ready, brought through an alternative entrance, and all provider ppe should be worn. These patients may be scheduled earlier in the day to facilitate timely bilirubin if needed but otherwise consider seeing these patients at the end of the day to decrease the risk of viral transmission. Please discuss with your site lead if you have questions about this process
An alternative that could be considered was discussed on a podcast with physicians who run a newborn followup clinic in Upper Manhattan/Bronx. They are seeing the babies in a separate place from their routine newborn followup clinic. The physician is doing previsit planning with the COVID+mom via virtual health, and the mom is not bringing the baby in, but rather a healthy adult who is wearing a mask. The telehealth visit with mom goes over all basic newborn/breastfeeding issues, and they also have a breastfeeding telehealth program for f/u.
The inpatient MCTS team should communicate with clinics when a PUI newborn or COVID+ mom is being discharged from Meriter to coordinate a plan. Please also use the MCTS person as a resource for f/u of after hours bili etc. You can reach this person by calling paging at 608-262-2122 and asking for the Family Medicine OB Faculty on call.
Information on Mother-Baby Separation
There are a variety of guidelines regarding management of babes born to COVID+ or PUI mothers (CDC guidelines have evolved during this period). AAP recommends separation of mothers and babies, AAFP statement is less restrictive, and CDC guidance focuses on shared decision making.
Initial AAP guidelines and article link - updated breastfeeding specific guidance from 4/23/20
There has been critique of the initial recommendations, see a succinct discussion from Harvard here. The updated guidelines reflect some of these critiques
Infographic from UC Davis which helps illustrate considerations
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Meriter has recommended separation with baby in NICU and mom on post partum; with update here to account for NICU census. Both hospitals recommend a robust conversation between providers and patients at the time of admission. See shared decision information from Meriter here. Discharge information for COVID+ moms from Meriter is here.
St Marys is keeping dyads in side by side separate rooms - they are calling their options "reduced risk" and "lowest risk" (link for patient facing info sheet). See details of recommendations at SSM system level here. Discharge information for COVID+ moms from St Mary's is here. St Mary's is sending all COVID+ families home with cloth masks made by the auxiliary.
Breastfeeding and COVID information
For vaccination information during breastfeeding go here: Vaccination Guidance
Podcast with a discussion by members of the Academy of Breastfeeding Medicine from Anne Eglash: https://podcasts.apple.com/us/podcast/breastfeeding-medicine-podcast/id417009927
CDC guidance regarding breastfeeding with COVID
WHO guidance (Q&A here):
Close contact and early, exclusive breastfeeding helps a baby to thrive. You should be supported to
Breastfeed safely, with good respiratory hygiene
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.
Hold your newborn skin-to-skin
Share a room with your baby
You should wash your hands before and after touching your baby, and keep all surfaces clean.
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At Meriter : Lactation is currently putting breastfeeding/ feeding plans in all discharge AVS and calling all breastfeeding families 2 days after discharged or sooner if complicated feeding plans. They will continue to call the families who are having issues as well and are hoping to do virtual outpatient visits soon
Feeding plan templates were created by the Meriter newborn team for term and late preterm infants . Here is the AAP article on breastfeeding in late preterm infants which has a nice table on the risks for delayed lactogenesis.
Handouts on caring baby during COVID-19
Link to UC Davis handout here
National perinatal association website including very useful links for families
Meriter's general patient guide
Caring for you Baby - Covid 19 final.docxSt Mary's patient guide
SSMAttachment C New Mom Discharge Instructions COVID-19__4-9-20 .pdfData registries for newborns with COVID+ mothers
From the AAP section on Neonatal Perinatal Medicine (website/info here) -- Registry Link