BENGALURU: While many private and government doctors are grappling with the lack of knowledge on how to treat various Covid-19 related infections in newborns, the National Neonatology Forum of India (NNF) on Thursday released the “NNF Perinatal and Neonatal guidelines”. The guidelines were formulated by the apex body of neonatologists and paediatricians involved in newborn care, in collaboration with a team of obstetricians, neonatologists and paediatricians from the Indian Academy of Paediatrics (IAP) and Federation of Obstetric and Gynaecological Societies of India (FOGSI).
The 73-page document will not only help doctors, but also carries detailed information on what pregnant women diagnosed with Covid-19 or those who deliver a Covid-positive baby should do.Dr Ranjan Kumar Pejaver, president of NNF, told The New Indian Express, “In the first wave, neonates getting infected with Covid-19 and related infections was extremely rare, and in the second wave it was still rare. But, in the third wave, we don’t know what might happen. It is better to be prepared. This document definitely reflects the research and the best evidence gathered till June 2021 from across India.”
The document explains that newborns can be infected with Covid-19 in three ways — through transplacental passage from mother to foetus, which is relatively rare; direct exposure to maternal blood during delivery; and through aerosol or direct contact from infected mothers or caregivers in the post-natal period, which is the most likely transmission mode.
The NNF guidelines explains in detail how to deal with rare effects of maternal Covid-19 infection like Multisystem Inflammatory Syndrome in Children-Neonates (MISC-N). Neonates with MIS can become critically ill with severe multi-organ dysfunction, including myocarditis, pericardial effusion, disseminated intravascular coagulation, hypoxemia, acute kidney injury, diarrhoea, necrotizing enterocolitis-like illness and skin ulceration.
Karnataka has seen about four cases of Multisystem Inflammatory Syndrome in Neonates (MISC-N) in the last one month.According to Dr Chikkanarasa Reddy, head of paediatrics, Bowring and Lady Curzon Medical College & Hospital, who treated two such cases, “We ourselves were surprised as it was Karnataka’s first such cases we were dealing with. We had limited research on how to treat these cases.”
The guidelines also explain how doctors should refrain from using medication given to children or adults and specifically administer medicines mentioned in the protocol for neonates.NITI Ayog member Dr V K Paul has appreciated the document saying that the Central Government will soon release guidelines for neonatal care based on these suggestions.
Guidelines for neonatal care
Vaccinate all pregnant and lactating women, irrespective of comorbidities
Pregnant women can choose not to take the vaccine before 12 weeks of pregnancy, which is the first trimester, and not after the third trimester, which is after 28 weeks
Mode of delivery in pregnant women with Covid should be guided by obstetric indications and physiological stability
Healthy neonates should be roomed with mothers
Neonates born to Covid- +ve mothers should be followed up for 14 to 28 days