Breastfeeding |
Breastfeeding as soon as possible, preferably in the first hour of life, still in the delivery room, in addition to exclusive breastfeeding.(2727. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. Atenção à saúde do recém-nascido: guia para os profissionais de saúde. intervenções comuns, Icterícia e Infecções. 2a ed. vol. 2. Brasília (DF): Ministério da Saúde; 2014 [citado 2020 Jun 24]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/atencao_saude_recem_nascido_v2.pdf https://bvsms.saude.gov.br/bvs/publicaco...
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Breastfeeding through the expression of milk following biosafety precautions, to avoid contagion.(1919. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatology. 2020;987–96.,2020. Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. Breastfeeding and coronavirus disease-2019: Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr. 2020;16(3):e13010. Review.)Direct breastfeeding should be allowed after the adoption of precautionary measures, such as the mother's hygiene and the use of a surgical mask.(11. Brasil. Ministério da Saúde. Secretaria de Atenção Primária a Saúde. Nota Técnica n°10/2020-COCAM/CGCIVI/DAPES/SAPS/MS. Brasília (DF): Ministério da Saúde; 2020 [citado 2020 Jun 25]. Disponível em: https://saude.rs.gov.br/upload/arquivos/202006/03180219-nota-tecnica10-2020-cocamcgcividapessapsms-003.pdf https://saude.rs.gov.br/upload/arquivos/...
,2121. Chawla D, Chirla D, Dalwai S, Deorari AK, Ganatra A, Gandhi A, et al. Perinatal-Neonatal Management of COVID-19 Infection—Guidelines of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum of India (NNF), and Indian Academy of Pediatrics (IAP). Indian Pediatr. 2020;57(6):536-48.
22. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11.
23. São Paulo. Prefeitura Municipal de São Paulo. Secretaria Municipal de Saúde. Coordenadoria de Vigilância em Saúde. Normas de biossegurança para prevenção da infeção pelo SARS-CoV2 a serem adotadas nos serviços de obstetrícia para atendimento ao parto e recém-nascido. São Paulo: Prefeitura Municipal de São Paulo; 2020 [citado 2020 Jul 1]. Disponível em: https://docs.bvsalud.org/biblioref/2020/06/1100233/nota_tecnica_08_obstetrica_atendimento_parto_covid19.pdf https://docs.bvsalud.org/biblioref/2020/...
24. Stanojević M. Are Covid-19-positive mothers dangerous for their term and well newborn babies? Is there an answer? J Perinat Med. 2020;48(5):441-5.
25. Tran HT, Nguyen PT, Huynh LT, Le CH, Giang HT, Nguyen PT, et al. Appropriate care for neonates born to mothers with COVID-19 disease. Acta Paediatr. 2020;109(9):1713-6.-2626. Procianoy RS, Silveira RC, Manzoni P, Sant’Anna G. Neonatal COVID-19: little evidence and the need for more information. J Pediatr (Rio J). 2020;96(3):269-72.)
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Skin-to-skin contact |
It should be performed in maternal and child binomials with stable and asymptomatic clinical conditions, right after birth, in order to reduce the risk of hypothermia and favor breastfeeding.(2828. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Portaria n° 371, de 7 de Maio de 2014. Institui diretrizes para a organização da atenção integral e humanizada ao recém-nascido (RN) no Sistema Único de Saúde (SUS). Brasília (DF): Ministério da Saúde; 2014 [citado 2020 Jun 24]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/sas/2014/prt0371_07_05_2014.html#:~:text=PORTARIA%20N%C2%BA%20371%2C%20DE%207,Considerando%20os%20Art https://bvsms.saude.gov.br/bvs/saudelegi...
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Immediate skin-to-skin contact should be avoided when suspected of COVID-19, and mother-infant separation is recommended to perform first care;(1919. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatology. 2020;987–96.,2222. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11.)early skin-to-skin contact is recommended after mothers’ body hygiene and personal protection equipment (PPE) exchange.(2121. Chawla D, Chirla D, Dalwai S, Deorari AK, Ganatra A, Gandhi A, et al. Perinatal-Neonatal Management of COVID-19 Infection—Guidelines of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum of India (NNF), and Indian Academy of Pediatrics (IAP). Indian Pediatr. 2020;57(6):536-48.,2525. Tran HT, Nguyen PT, Huynh LT, Le CH, Giang HT, Nguyen PT, et al. Appropriate care for neonates born to mothers with COVID-19 disease. Acta Paediatr. 2020;109(9):1713-6.,2626. Procianoy RS, Silveira RC, Manzoni P, Sant’Anna G. Neonatal COVID-19: little evidence and the need for more information. J Pediatr (Rio J). 2020;96(3):269-72.)
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Umbilical cord clamping |
It can be performed late, if NBs is born in healthy conditions, from 1 to 3 minutes after birth.(2828. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Portaria n° 371, de 7 de Maio de 2014. Institui diretrizes para a organização da atenção integral e humanizada ao recém-nascido (RN) no Sistema Único de Saúde (SUS). Brasília (DF): Ministério da Saúde; 2014 [citado 2020 Jun 24]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/sas/2014/prt0371_07_05_2014.html#:~:text=PORTARIA%20N%C2%BA%20371%2C%20DE%207,Considerando%20os%20Art https://bvsms.saude.gov.br/bvs/saudelegi...
,2929. World Health Organization (WHO). Delayed clamping of the umbilical cord to reduce infant anaemia. Geneva: WHO; 2014 [cited 2020 Nov 20]. Available from: https://apps.who.int/iris/handle/10665/120074 https://apps.who.int/iris/handle/10665/1...
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At gestational age ≥ 34 weeks with good muscle tone and adequate breathing at birth, clamping can be performed in a timely manner. In NBs with gestational age <34 weeks, it is indicated to wait 30-60 seconds before clamping the umbilical cord.(3030. Word Health Organization (WHO). Clinical management of COVID-19: interim guidance. Geneva: WHO; 2020 [cited 2020 Nov 20]. Available from: https://www.who.int/publications/i/item/clinical-management-of-covid-19 https://www.who.int/publications/i/item/...
,3131. Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). Protocolo de Atendimento no Parto, Puerpério e Abortamento durante a Pandemia da COVID-19. São Paulo: FREBASGO; 2020 [citado 2020 Nov 20]. Disponível em: https://www.febrasgo.org.br/pt/covid19/item/1028-protocolo-de-atendimento-no-parto-puerperio-e-abortamento-durante-a-pandemia-da-covid-19 https://www.febrasgo.org.br/pt/covid19/i...
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Breathing procedures |
The recommendations suggest that they should be carried out by a trained multidisciplinary team, duly attired with the PPE available. They can be performed in the delivery room.(3232. Almeida MF, Guinsburg R. Programa de reanimação neonatal da sociedade brasileira de pediatria: condutas 2011. Sociedade Brasileira de Pediatria. São Paulo: SBP; 2021 [citado 2020 Nov 20] Disponível em: https://www.sbp.com.br/fileadmin/user_upload/pdfs/PRN-SBP-ReanimacaNeonatal-2011-24jan11.pdf https://www.sbp.com.br/fileadmin/user_up...
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In case of suspicion, the need for complete vesting for respiratory care of NBs is reinforced.(2323. São Paulo. Prefeitura Municipal de São Paulo. Secretaria Municipal de Saúde. Coordenadoria de Vigilância em Saúde. Normas de biossegurança para prevenção da infeção pelo SARS-CoV2 a serem adotadas nos serviços de obstetrícia para atendimento ao parto e recém-nascido. São Paulo: Prefeitura Municipal de São Paulo; 2020 [citado 2020 Jul 1]. Disponível em: https://docs.bvsalud.org/biblioref/2020/06/1100233/nota_tecnica_08_obstetrica_atendimento_parto_covid19.pdf https://docs.bvsalud.org/biblioref/2020/...
)Assessment should be started quickly in the delivery room and continued in a negative pressure room.(1919. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatology. 2020;987–96.)
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