Treatment protocols for neonatal & perinatal: Separate OT, labour room must for +ve mothers

KOLKATA: State Health department has published perinatal and neonatal Covid management protocol giving a detailed outline as to how

to provide better care to pregnant women infected with Covid. Some restrictions have also been imposed on the hospitals.

The protocol says that there should be provision for separate labour rooms and operation theaters (OT) for pregnant Covid positive patients. Neonatal resuscitation corner should be located at least 2 meters away from the delivery table. Labour to be managed as per standard obstetric practice. The new protocol also suggests that delivery should be attended by a minimum number of skilled personnel taking full protection. Additional personnel should wait outside the delivery room. They will be given a cue if needed. A current guideline issued by the Union Health Ministry asks not to recommend certain medicines like Hydroxychloroquine, chloroquine, or antiviral drugs in pregnant women. If a pregnant woman has significant Covid related illness and requires invasive mechanical ventilation, delivery may need to be conducted in the intensive care unit setting, says the new protocol issued by the state Health department.

"Positive mothers after delivery and their healthy babies without need for maternal critical care or neonatal care should be kept together in the immediate postpartum period. A separate isolation room should be available for the infant. An infected mother should wear a surgical mask, wash hands and breasts with soap and water before feeding infants. Between feedings, the infant's crib (incubator) should be placed at least 6 feet from an infected mother's bed, preferably behind a physical barrier such as a curtain. In all stages best possible protective measures must be utilised to prevent postnatal spread," reads the new guideline. The immature immune system, passive transfer of maternal IgG antibodies and lower ACE-2 expression may result in milder illness and fast recovery in infants and children.

Most infected neonates are either asymptomatic or have mild symptoms. Neonatal multi-system inflammatory syndrome has been rarely reported.