Prevention and control measures for neonatal COVID-19 infection: a scoping review

Freitas, Bruna Hinnah Borges Martins de; Alves, Mayrene Dias de Sousa Moreira; Gaíva, Maria Aparecida Munhoz

doi:10.1590/0034-7167-2020-0467

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 73 (suppl 2) • 2020 • https://doi.org/10.1590/0034-7167-2020-0467 copy

Prevention and control measures for neonatal COVID-19 infection: a scoping review

Medidas de prevención y control para la infección neonatal de COVID-19: revisión del alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to identify with the literature the measures to prevent and control neonatal infection by COVID-19.

Methods:

a scope review carried out by searching for studies in databases and institutional health websites. The final sample was 25 articles.

Results:

among the main measures are the use of masks by suspected or infected people in contact with healthy newborns, hand hygiene before and after each care and feeding as well as the tools used for milking. It is indispensable to use personal protective equipment by health professionals in neonatology services to maintain a private room for infected newborns or to use physical barriers. Early diagnosis and timely case management is essential to reduce virus transmissibility.

Conclusions:

the research contributed to elucidate health and nursing actions in preventing and controlling neonatal infection by COVID-19.

Descriptors:
Newborn; Communicable Diseases; Disease Prevention; Infection Control; Review

Database (Total texts)	Crossing-descriptors	Selected articles
MEDLINE (219)	"infant, newborn" OR "neonate" AND "disease prevention" AND "SARS-CoV-2" OR "Wuhan coronavirus" OR "the new coronavirus" OR "COVID-19" OR "severe acute respiratory syndrome coronavirus 2 "	13
CINAHL (88)	"infants or baby or newborn or neonate" AND "disease prevention" AND "covid-19 or coronavirus or 2019-ncov or sars-cov-2 or cov-19" OR "wuhan coronavirus or novel coronavirus" OR "the new coronavirus" OR "severe acute respiratory syndrome coronavirus 2"	0
Scopus (24)	"infant, newborn" OR "neonate" AND "SARS-CoV 2" OR "wuhan coronavirus" OR "the new coronavirus" OR "covid-19" OR "severe acute respiratory syndrome coronavirus 2"	5
Web of Science (1.536)	"infant, newborn" OR "neonate" AND "disease prevention" AND "SARS-CoV-2" OR "Wuhan coronavirus" OR "the new coronavirus" OR "COVID-19" OR "severe acute respiratory syndrome coronavirus 2 "	1
Total		19

Study	Title	Type of study	Country
P1	Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults⁽¹⁴14 Ludvigsson JF. Systematic review of COVID‐19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;00:1-8. doi:10.1111/apa.15270 https://doi.org/10.1111/apa.15270... ⁾	Systematic review	Sweden
P2	A Case Report of Neonatal 2019 Coronavirus Disease in China⁽¹⁵15 Wang S, Guo L, Chen L, Liu W, Cao Y, Zhang J, Feng L. A Case Report of Neonatal 2019 Coronavirus Disease in China. Clin Infect Dis. 2020;XX(XX):1-5. doi: 10.1093/cid/ciaa225 https://doi.org/10.1093/cid/ciaa225... ⁾	Case report	China
P3	Chinese expert consensus on the perinatal neonatal management for the prevention and control of the 2019 novel coronavirus infection (First edition)⁽¹⁶16 Wang L, Shi Y, Xiao T, Fu J, Feng X, Mu D, Feng Q, Hei M, Hu X, Li Z. et al. Chinese expert consensus on the perinatal and neonatal management for the prevention and control of the 2019 novel coronavirus infection (First edition). Ann Transl Med. 2020;8(3):47. doi: 10.21037/atm.2020.02.20 https://doi.org/10.21037/atm.2020.02.20... ⁾	Opinion of experts	China
P4	An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes⁽¹⁷17 Schwartz DA. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med In-Press. 2020. doi: 10.5858/arpa.2020-0901-SA https://doi.org/10.5858/arpa.2020-0901-S... ⁾	Opinion of experts	USA
P5	Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection⁽¹⁸18 Chen D, Yang H, Cao Y, Cheng W, Duan T, Fan C, Fan S, Feng L, Gao Y, He F. et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet. 2020;149:130-136. doi: 10.1002/ijgo.13146 https://doi.org/10.1002/ijgo.13146... ⁾	Opinion of experts	China
P6	Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia⁽¹⁹19 Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, Xia S, Zhou W. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51-60. doi: 10.21037/tp.2020.02.06 https://doi.org/10.21037/tp.2020.02.06... ⁾	Retrospective cross-sectional study	China
P7	Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections⁽²⁰20 Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2). pii: E194. doi: 10.3390/v12020194 https://doi.org/10.3390/v12020194... ⁾	Opinion of experts	USA
P8	Management strategies of neonatal jaundice during the coronavirus disease 2019 outbreak⁽²¹21 Ma XL, Chen Z, Zhu JJ, Shen XX, Wu MY, Shi LP, Du LZ, Fu JF, Shu Q. Management strategies of neonatal jaundice during the coronavirus disease 2019 outbreak. World J Pediatr. 2020. doi: 10.1007/s12519-020-00347-3. https://doi.org/10.1007/s12519-020-00347... ⁾	Review study	China
P9	New coronavirus: new challenges for pediatricians⁽²²22 Chen ZM, Fu JF, Shu Q. New coronavirus: new challenges for pediatricians. World J Pediatr. 2020. doi: 10.1007/s12519-020-00346-4 https://doi.org/10.1007/s12519-020-00346... ⁾	Opinion of experts	China
P10	Proposal for prevention and control of the 2019 novel coronavirus disease in newborn infants⁽⁹9 Li F, Feng ZC, Shi Y. Proposal for prevention and control of the 2019 novel coronavirus disease in newborn infants. Arch Dis Child Fetal Neonatal Ed. 2020;0(0):F1. doi: 10.1136/archdischild-2020-318996 https://doi.org/10.1136/archdischild-202... ⁾	Opinion of experts	China
P11	Managing neonates with respiratory failure due to SARS-CoV-2⁽⁸8 Luca D. Managing neonates with respiratory failure due ta SARS-CoV-2. Lancet Child Adolesc Health. 2020;4: e8. doi:10.1016/S2352-4642(20)30073-0 https://doi.org/10.1016/S2352-4642(20)30... ⁾	Opinion of experts	France
P12	SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics⁽⁶6 Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. J Formos Med Assoc. 2020;119(3):670-673. doi: 10.1016/j.jfma.2020.02.009 https://doi.org/10.1016/j.jfma.2020.02.0... ⁾	Opinion of experts	China
P13	Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China⁽²³23 Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, Long X. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. 2020;26. doi: 10.1001/jama.2020.4861 https://doi.org/10.1001/jama.2020.4861... ⁾	Cohort study	China
P14	Antibodies in Infants Born to Mothers With COVID-19 Pneumonia⁽²⁴24 Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, Zhou W. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatr. 2020;26. doi: 10.1001/jamapediatrics.2020.0878 https://doi.org/10.1001/jamapediatrics.2... ⁾	Retrospective cross-sectional study	China
P15	Coronavirus disease (COVID-19) and neonate: What neonatologist need to know⁽²⁵25 Lu Q, Shi Y. Coronavirus disease (COVID‐19) and neonate: What neonatologist need to know. J Med Virol. 2020:1-4. doi: 10.1002/jmv.25740 https://doi.org/10.1002/jmv.25740... ⁾	Review study	China
P16	Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth⁽²⁶26 Khan S, Peng L, Siddique R, Nabi G, Xue M, Liu J, Han G. Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth. Infect Control Hosp Epidemiol. 2020:1-9. doi: 10.1017/ice.2020.84 https://doi.org/10.1017/ice.2020.84... ⁾	Case report	China
P17	Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults⁽²⁷27 Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID‐19infection: Different points from adults. Pediatric Pulmonology. 2020;1-6. doi: 10.1002/ppul.24718 https://doi.org/10.1002/ppul.24718... ⁾	Retrospective cross-sectional study	China
P18	Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children⁽²⁸28 Hong H, Wang Y, Chung H, Chen C. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr Neonatol. 2020;61:131-132. doi: 10.1016/j.pedneo.2020.03.001 https://doi.org/10.1016/j.pedneo.2020.03... ⁾	Opinion of experts	China
P19	A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units⁽²⁹29 Wang J, Shi Y. Managing neonates with respiratory failure due ta SARS-CoV-2 - Authors' reply. Lancet Child Adolesc Health. 2020;4(4):e9. doi: 10.1016/S2352-4642(20)30072-9 https://doi.org/10.1016/S2352-4642(20)30... ⁾	Opinion of experts	China
P20	Interim considerations for infection prevention and control of coronavirus disease 2019 (COVID-19) in inpatient obstetric healthcare settings⁽³⁰30 Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Interim considerations for infection prevention and control of coronavirus disease 2019 (COVID-19) in inpatient obstetric healthcare settings. 2020 [cited 2020 Abr 02]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html. https://www.cdc.gov/coronavirus/2019-nco... ⁾	Briefing	USA
P21	Pregnancy & Breastfeeding⁽¹¹11 Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Pregnancy & Breastfeeding. 2020 [cited 2020 Mar 26]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html#anchor_1584169983 https://www.cdc.gov/coronavirus/2019-nco... ⁾	Briefing	USA
P22	For Child Care Programs That Remain Open⁽³¹31 Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). For Child Care Programs That Remain Open. 2020 [cited 2020 Abr 02]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html https://www.cdc.gov/coronavirus/2019-nco... ⁾	Briefing	USA
P23	Nota Técnica Nº 06/2020 – Atenção à Saúde do RN no Contexto da Infecção pelo Novo Coronavírus (SARS-CoV2) ⁽ ³²32 Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Ações Programáticas Estratégicas. NOTA TÉCNICA Nº 6/2020-COCAM/CGCIVI/DAPES/SAPS/MS. Atenção à saúde do recém-nascido no contexto da infecção pelo novo coronavírus. Brasília: Ministério da Saúde, 2020 [cited 2020 Mar 26]. Available from: http://www.mpgo.mp.br/portal/arquivos/2020/03/30/22_34_25_489_SEI_MS_0014134779_Nota_T%C3%A9cnica_Atencao_ao_RN_durante_COVID.pdf http://www.mpgo.mp.br/portal/arquivos/20... ⁾	Technical note	Brazil
P24	Nota técnica referente aos cuidados da equipe de enfermagem obstétrica, neonatal e pediátrica diante de caso suspeito ou confirmado de COVID-19 ⁽ ³³33 Sociedade Brasileira de Enfermeiros Pediatras e Associação Brasileira de Obstretrizes e Enfermeiros Obstetras. Nota técnica referente aos cuidados da equipe de enfermagem obstétrica, neonatal e pediátrica diante de caso suspeito ou confirmado de COVID-19. SOBEP/ABENFO: 2020. ⁾	Technical note	Brazil
P25	Prevenção e Abordagem da Infecção por COVID-19 em mães e RN, em Hospitais-Maternidades ⁽ ³⁴34 Sociedade Brasileira de Pediatria (SBP). Nota de alerta- Prevenção e abordagem da infecção por COVID-19 em mães e recém-nascidos, em hospitais-maternidades. Rio de Janeiro: 2020 [cited 2020 Mar 26]. Available from: https://www.sbp.com.br/fileadmin/user_upload/22412b-Nota_Alerta_PrevenAbordagem_infeccao_COVID19_maes-RN_em_HospMatern.pdf https://www.sbp.com.br/fileadmin/user_up... ⁾	Alert note	Brazil

Focus of attention	Prevention and neonatal control measures by COVID-19	Study
During delivery	Delivery rooms or operating rooms must be specially prepared, preferably with negative pressure.	P10, P14
	Delivery rooms must be prepared with personal protective equipment, disinfectant solution and quick hand sanitizer.	P3
	Health professionals must use all the individual protection equipment recommended during service such as cap, safety glasses or visor type face shield, long sleeve disposable cloak, gloves, N95 masks, among others.	P3, P10, P14, P15, P24
	Pregnant women should use a surgical mask as a precautionary measure during labor.	P5, P14
	The choice of delivery mode and the time of delivery should be individualized based on obstetric indications.	P1, P3, P4, P5, P6, P7, P12, P16, P18, P21
	In the case of cesarean section, operating rooms must have positive pressure off.	P24
	Skin-to-skin contact after delivery should be discontinued.	P3, P23, P24, P25
	Timely umbilical cord clamping is recommended.	P23, P25
	NBs should be cleaned and dried immediately after delivery.	P5
	Neonatal resuscitation in NBs should be performed according to recommendations in neonatology using personal protective equipment.	P5, P10, P15
	The presence of an asymptomatic companion and non-home contact with people with flu-like syndrome or proven respiratory infection is recommended.	P24
	It is suggested that samples of swab pharyngeal, peripheral and cord blood, amniotic fluid, breast milk and placental tissue be stored for investigation.	P2
Breastfeeding	Breastfeeding should be postponed until NBs receive hygiene care and preventive measures for contamination by SARS-CoV2.	P10, P20, P21, P22, P23, P24
	Breastfeeding should be encouraged.	P20, P21, P23, P24
	When breastfeeding their children, women should use a face mask and clean their hands and utensils used for the extraction and supply of breast milk, before and after contact with each feeding.	P20, P21, P23, P24, P25
Neonatal postpartum care	Keep NBs in a private room for 14 days after birth and monitor them for clinical and laboratory manifestations of the infection.	P3, P5, P6, P9, P10, P13, P14, P15, P20, P25
Neonatal postpartum care	Precautions for joint accommodation consist of maintaining a minimum distance of one meter between the mother's bed and the NB's crib.	P24, P25
Neonatal postpartum care	Private accommodation with NBs is suggested, and distance of 1 meter between the mother's bed and the NB's crib must be respected or using physical barriers to maintain distance.	P20, P23
	Isolation of mothers with their babies should be done on a case-by-case basis, using shared decision-making between them and the staff.	P20
	Mothers and families should be made aware of the importance of hand hygiene and the use of a face mask in care of NBs and the importance of social distancing.	P18, P22
	Visits should be restricted to parents or legal guardians for these patients, as long as they do not have a suspicious condition or are confirmed for COVID-19 or have home contact with a person with the flu syndrome. It is strongly recommended that grandparents do not visit their grandchildren.	P24, P25
	Diagnostic and treatment equipment for suspected or confirmed NBs with the infection, such as a stethoscope and thermometer, for instance, must be for individual use.	P3, P8, P24,
	Strict disinfection protocol should be adopted in environments with NBs suspected or confirmed by the disease.	P15
	Strict hand hygiene in care for NBs suspected or confirmed by the disease should be maintained.	P22
	Hand wash is important before and after changing diapers as well as using a glove (if possible) and dispose of it in an appropriate place.	P20, P22, P24
	It is suggested to temporarily postpone elective follow-up appointments at the outpatient clinic of NB follow-up in the hospital.	P24
	Search for alternatives for monitoring NBs after discharge, such as online consultation in order to avoid exposure to the virus. If an injury is identified in NBs, it should be taken to the hospital as soon as possible.	P8
	When transporting a NB with suspicion or confirmation of COVID-19, the ambulance spaces must be strictly closed and isolated, and the car must be provided with protective equipment, disinfectant solution and alcohol gel for the hands. The ambulance must be disinfected before and after transfer.	P3

Focus of attention	Neonatal prevention and control measures by COVID-19	Study
Staff care	Droplet and contact precautions should be instituted during hospitalization of NBs with the use of the respective PPE such as caps, safety glasses and protective clothing, gloves, cloak, surgical mask, among others.
Staff care	Adoption of standard precautionary measures for aerosols in all procedures that can produce them, such as endotracheal intubation, non-invasive ventilation, manual ventilation before intubation, bronchoscopy, among others.	P2, P3, P10, P20, P22, P25
	The staff must adopt strict hand hygiene before and after assisting NBs.	P15
	A minimum number of people working in the isolation of suspected or confirmed NBs should be selected.	P10, P15
	It is recommended that the discussion at the bedside be suspended by the staff providing assistance, as well as any and all collective activities carried out at the Neonatal Unit.	P23
Hospitalization sector	In shared accommodation between hospitalized healthy mothers, whose distance between beds in the binomial does not obey at least one meter, visits and the presence of companions should be suspended to avoid agglomerations.	P23, P24, P25
	The neonatal sector should be divided into transition, quarantine and general wards during the pandemic.	P3
	Implementation of social distancing strategies, covering the mouth when coughing or sneezing with disposable tissues, intensifying the cleaning and disinfection efforts of objects and equipment for NB care are essential.	P12, P22
	When receiving a NB with suspected COVID-19 infection, the investigation should be carried out based on family and clinical history and tested in case of exposure to infected people, regardless of their symptoms.	P9, P11
	SARS-CoV-2 positive neonates should be isolated and clinically monitored for 14 days, but this does not necessarily require admission to the NICU.	P3, P5, P6, P9, P10, P11, P13, P15, P20
	Pressure rooms or rooms in which the exhaust is filtered through high-efficiency particulate air filters for infants with confirmed infection should be used.	P10, P15
	There must be a minimum distance of one meter between incubators, common cribs and/or heated cribs.	P24
	Objects for personal use of NBs with suspicion or confirmation by COVID-19 should not be shared with others in the hospitalization area, including toys in pediatrics.	P12, P20, P23
	Symptomatic parents or home contacts of a person with the virus should not enter the NICU/coNICU until the SARS-CoV-2 transmission period has ended (14 days).	P24, P25
	Professionals should not talk at the bedside and should avoid collective activities carried out in the sector.	P23
Hospitalization sector	Hospital waste produced during the care of NBs with suspected or confirmed COVID-19 must be collected in a double-layer infectious waste bag and treated with a chlorine-containing preparation for at least 10 minutes and then disposed of in the same way as the waste infectious hospital.	P3, P19
Hospitalization sector	Terminal disinfection of the patient's room should preferably be done using atomization with hydrogen peroxide or a preparation spray containing chlorine.	P3, P19, P20

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[1] Corresponding author: Bruna Hinnah Borges Martins de Freitas E-mail: bruhinnah@gmail.com