This guideline applies to those infants whose mothers are confirmed as or suspected of having SARS.

There is little information available about infants who have been born to pregnant women who have had SARS.  There are reports in the media of infants suspected of having SARS, although these infants were also premature and may have had morbidity related to other neonatal problems. ^1-3

This protocol is subject to change as new information about management of this condition becomes available.  Other resources which should be consulted include the ADHB Intranet guidelines on SARS which also has links to other websites.

Preparation prior to Delivery

1. Delivery Unit staff will clear Delivery Room 13 of non-essential equipment.
2. A mobile resuscitation table and equipment is put in Room 13.
3. Neonatal Registrar or NS-ANP is called for the delivery, in time to put on protective clothing.
4. Newborn staff will put on personal protective apparel before entering Room 13.
   1. This includes hat, goggles, impermeable gown, and gloves.
   2. Use an N95 mask.  A N100 mask is not needed.

Immediate Care of the Infant

1. The midwife hands the baby to the Neonatal Registrar or NS-ANP in the connecting room between Delivery Room 12 (containing the mother) and Delivery Room 13.
2. The baby is resuscitated if necessary.
3. The baby remains in Delivery Room 13 while stabilised.

Postnatal Care of the Infant

1. When stable, the baby is washed.
2. Carefully dispose of soiled baby wraps into yellow topped linen bag.
3. The Neonatal Registrar or NS-ANP will carefully remove the personal protective equipment and perform hand hygiene.  Both chlorexidine 4% soap for hand washing and alcohol hand gel are good protection against viruses.
4. The Registrar or NS-ANP will put on a new gown and gloves to take the baby to NICU. A N95 mask should be worn if the baby is unwell.
5. The baby is then taken to a side room in NICU (Room 15)
   • Within the isolation room, an incubator is not indicated for isolation measures alone and a cot may be sufficient
6. Notify Infection Control.
7. Strict and careful handwashing procedures (using 4% Chlorhexidine soap or alcohol hand gel) should be followed.
8. Care in NICU is with gown and gloves, but no mask is needed (unless the baby has respiratory symptoms).
9. The baby does not receive breast milk.
   • Mother should be encouraged to express, but the breast milk is discarded until she is non-infectious.
10. There are no visitors allowed (family contacts will be SARS contacts).
11. If the baby has respiratory distress, stricter precautions are needed.
    • A N95 mask is suitable for short exposures.
    • A N100 for prolonged exposures such as primary nurse or for procedures such as suctioning, intubating or taking a nasopharyngeal aspirate. (The N100 mask is reusable after decontamination . Do not discard).
    • Staff contact should be kept to a minimum.
12. Babies can be discharged with the mother when the mother and baby are well enough to go home.  Ensure Public Health are notified.
13. Parents should be instructed to seek medical attention should the mother or baby develop any signs or symptoms of disease within 10 days after delivery.

Investigations and other Management

1. No investigations are indicated if the baby is clinically stable and there are no other indications for tests.
2. Inform the Paediatric Infectious Diseases specialist about the baby, regardless of how well the baby is.  This can be done in normal working hours, unless there are clinical concerns.
3. If there are any clinical concerns about the baby, then send
   • FBC for differential and blood film
   • Blood cultures
   • Chest radiograph
   • Viral studies, specifically looking for the SARS coronavirus, namely
     • Nasopharyngeal aspirate or tracheal aspirate for virus identification (immunofluoresence, PCR for SARS coronavirus, and viral culture)
     • Urine viral culture
     • Faecal specimen
     • Blood for serology (will need subsequent convalescent sample)
       Do not send viral samples for SARS in the Lamson tube.  They must be taken to the laboratory by an orderly.
   • CSF samples for bacterial and viral (PCR for Herpes and enteroviruses) analysis may be considered on an individual case-by-case basis
4. If the baby is unwell, start antibiotics in order to cover other potential bacterial causes of illness.

References