Inside Pediatrics, Neonatology

Addressing COVID-19 in the NICU

When you are responsible for the tiniest, sickest babies in the state and a global pandemic hits, there is no time to waste. That’s the approach Hannah Hightower, M.D., a neonatologist at Children’s of Alabama and the University of Alabama at Birmingham (UAB), and her team took in early March 2020, when normal life seemed to cease overnight. The state started shutting down March 13, and by March 19 she and her team released their first set of guidelines for COVID-19-related maternal and infant care.

“I realized this would have a great effect on how the Neonatal Intensive Care Unit (NICU) and infant nurseries operated,” Hightower said. “The virus was a great unknown and very little published guidance was available. There was also a lot of fear among the staff. I felt an urgency to provide our NICU staff a framework of how to safely handle patients and families in the midst of the emerging virus.”

So she took what little information was available from other regions and countries and sought guidance from her pediatric infectious disease colleagues to develop Guidelines of Care for COVID-19-exposed mothers and infants.

Those first guidelines would form the foundation of numerous iterations over the following year as the virus spread and more data on its effects in pregnant women and their babies emerged. “As time went by, the protocols changed pretty frequently because of the speed of the emerging data,” she said.

Early policy changes limited visitors to the NICU to only the mother and one support person in order to reduce possible exposure of infants and staff in the NICU. They also followed national recommendations to briefly separate COVID-positive mothers from their babies after delivery in order to prevent transmission to the infant. That changed over the summer as evidence emerged that as long as the mother was not severely ill and used proper precautions, including wearing a mask and performing hand hygiene, the risk of transmission to her infant was low.

The more the NICU team learned, the more they reached out to share their knowledge, Hightower said. “I coordinated with nursing leadership and other neonatologists around the state to share our experiences with each other,” she said. “It was a big collaborative effort.” She also spent a lot of time on Zoom and national conference calls with other pediatric and neonatal physicians, as well as the hospital’s own infectious disease specialists. In addition, there was also ongoing education for the staff about how to protect themselves and others.

A big part of their effort was educating the families about safety protocols and helping them get COVID tested when necessary, and then explaining the need to quarantine or isolate. After a year of living with the pandemic, Hightower now says, “We are more comfortable handling infants and families dealing with COVID-19. Even though vaccines are becoming available, it will remain important to continue masking throughout the year. For now, limiting visitors is also going to continue,” she said, and they still encourage families to limit their interactions outside the hospital.

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