How a neonatal unit gets ready to admit Covid-19 moms

Charlotte Maxeke Johannesburg Academic Hospital is preparing to admit pregnant women with Covid-19, blazing the trail for neonatal units.

The hospital has prepared disposable boxes for resuscitation equipment, a new messaging system between obstetric and neonatal staff, and an isolation area for newborns of mothers who might be sick.

Dr Robin Saggers and other experts from Johannesburg’s Wits University have ticked all the boxes of international guidelines and written up their preparations in the Wits Journal of Clinical Medicine so other hospitals can take heed.

“The neonatal unit at [Charlotte Maxeke] stands ready to attend to the first newborns of suspected or confirmed mothers of the growing Covid-19 pandemic,” said Saggers and his team.

“While staff anxiety levels are high ... clear protocols and communication of the protocols are vital in allaying fears.”

Anxiety levels could be brought down by neonatal units adopting a “rational approach to suspected cases” and education for health-care workers. Fears had centred on the availability of PPE, Covid-19 transmission to staff and how to nurse potential cases.

“Since our ‘usual’ patient load will not decrease, we must be as prepared, adaptable and efficient as possible,” said Saggers, adding that normal delivery room protocol had been turned upside-down.

“There used to be a ‘bottom-up’ approach, where an intern would attend first and call for a registrar or consultant’s help if required,” but now the opposite approach would be taken. To minimise transmission risk, only essential staff would be in the delivery room or theatre.

The sealed cardboard resuscitation boxes replace trolleys and contain PPE and a full array of equipment.

The hospital has also repurposed a triage area as an isolation area for newborns of suspected or confirmed Covid-19 mothers and created an online resource portal for neonatal consultants and fellows.

Under health department guidelines, healthy newborns will not be tested for Covid-19, “irrespective of maternal Covid-19 result”. Sickly babies will be “tested immediately and considered infectious for at least 14 days after symptom resolution”.

Social workers and psychologists are on standby. “In a neonatal intensive care unit or neonatal unit, a virus outbreak will bring psychological stress to the patient’s parents and other family members,” said Staggers.

According to the US Centers for Disease Control (CDC), “it is not yet known if pregnant women have a greater chance of getting sick from Covid-19 than the general public, nor whether they are more likely to have serious illness as a result”.

However, “pregnant women have changes in their bodies that may increase their risk of some infections”.

The CDC said mother-to-child transmission was unlikely, but “after birth a newborn is susceptible to person-to-person spread”.

A small number of babies have tested positive for the virus shortly after birth, but it is not known if they contracted the infection before or after birth.

A brief from Stellenbosch University said Covid-19-positive mothers should breastfeed their newborns, as recommended by the World Health Organisation (WHO), but that “appropriate infection control measures to limit respiratory droplets from mother” should be observed.

The CDC advises: “If you are sick and choose to breastfeed, wear a face mask and wash your hands before each feeding.”

Breast milk was not believed to transmit the virus. “The virus has not been detected in amniotic fluid, breastmilk or other maternal samples,” said the CDC.

Julie Mentor, leader of the Embrace movement that provides support for early motherhood, encouraged pregnant women and mothers to seek information from a reliable one-stop platform.

Embrace and other NGOs have created Messages for Mothers, which provides expert input on physical and mental health for expectant mothers.

“This pandemic is causing real anxiety for pregnant women and mothers,” said Mentor. “Women are unsure of whom to trust, so we thought we could play a vital role.”

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