Newborn and child health services in the context of COVID-19

Pediatric & Neonatal Care during COVID-19 caused by SARS-CoV-2

1. INTRODUCTION

Children generally experience milder illness compared to adults; however, they play a major epidemiological role in transmission and a small proportion develop severe disease (e.g., pneumonia, hypoxia, inflammatory complications). Neonates are particularly vulnerable due to immature immunity and dependency on caregivers.

Therefore, health services must:

• Rapidly identify suspected pediatric cases

• Prevent hospital transmission

• Maintain essential newborn services

• Protect breastfeeding and maternal bonding

2. TRIAGING OF CHILDREN WITH RESPIRATORY SYMPTOMS (OUTPATIENT DEPARTMENTS)

2.1 Objectives of Pediatric Triage

1. Early detection of infection

2. Immediate separation of infectious children

3. Prevention of facility outbreaks

4. Protection of vulnerable infants

2.2 Mandatory Screening Criteria

All children presenting within 14 days with:

2.3 Triage Workflow

Step 1 — Arrival Screening

• Temperature check

• Respiratory symptom questionnaire

• Exposure history

Step 2 — Immediate Separation

Children with respiratory symptoms must be:

• Directed to designated respiratory waiting area

• Kept 1–2 meters apart

• Fast-tracked for clinician assessment

2.4 Isolation Protocol

• Suspected cases → isolation room

• Confirmed cases → COVID pediatric ward

• Caregiver allowed: only one masked guardian

2.5 Testing Priority

Children meeting pneumonia criteria under IMCI must be prioritized for COVID testing:

Priority indicators

• Chest indrawing

• Hypoxia

• Cyanosis

• Severe respiratory distress

3. TRAINING REQUIREMENTS FOR HEALTHCARE WORKERS

All staff must be trained in:

A. Screening

• Pediatric symptom recognition

• Exposure risk assessment

B. Infection Prevention

• PPE selection

• Donning & doffing

• Pediatric sample collection

C. Isolation Care

• Handling frightened children

• Safe caregiver presence

4. NEONATAL CARE IN THE CONTEXT OF COVID-19

4.1 Vertical Transmission

Current evidence:

• No confirmed intrauterine transmission

• Breast milk negative for virus

• Transmission risk mainly post-delivery respiratory exposure

5. BREASTFEEDING POLICY

Breastfeeding must continue because it significantly reduces neonatal mortality.

Benefits

• Immunoglobulins

• Anti-infective factors

• Nutrition

• Thermoregulation

• Bonding

Infection-Safe Breastfeeding Rules

Mother must:

1. Wear medical mask

2. Wash hands before touching baby

3. Clean breast surface if coughing

4. Disinfect surrounding surfaces

If Mother Too Sick

Use:

• Expressed breast milk

• Donor milk (if available)

• Breast milk substitute (last option)

6. MANAGEMENT IN NEONATAL CARE UNIT (NCU)

Admission Principles

Bed Spacing

If no isolation room available:

• Minimum 2 meters between incubators

Respiratory Support

All neonates requiring respiratory therapy:

• CPAP in incubator

• Closed circuits preferred

• Minimal handling

Investigations

Avoid unnecessary testing unless clinically indicated.

7. KANGAROO MOTHER CARE (KMC)

Allowed with precautions:

Mother must:

• Wear mask continuously

• Perform hand hygiene

• Avoid kissing baby

If mother symptomatic → care in designated room (NOT NCU)

8. VISITOR POLICY

Strict limitation:

• No visitors in isolation units

• One consistent caregiver only

9. EQUIPMENT DECONTAMINATION

All neonatal equipment must be disinfected after use:

High-risk Items

• Incubators

• CPAP circuits

• Feeding tubes

• Thermometers

• Monitoring probes

Follow national sterilization protocols.

10. HEALTHCARE WORKER PROTECTION

Mandatory PPE:

• Medical mask/N95

• Eye protection

• Gown

• Gloves

Applies when:

• Handling newborns

• Assisting feeding

• Performing procedures

11. CORE PRINCIPLES OF PEDIATRIC COVID CARE

1. Separate early

2. Protect breastfeeding

3. Avoid mother-baby separation unless necessary

4. Minimize invasive procedures

5. Protect healthcare workers

12. KEY CLINICAL MESSAGE