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Universal screening of high-risk neonates, parents, and staff at a neonatal intensive care unit during the SARS-CoV-2 pandemic

Our take —

Incidence of SARS-CoV-2 infection was high in Padua, Italy during the spring of 2020. This study documents universal screening and testing of newborns, parents, and staff at a neonatal ward in Padua during this period. Five parents and staff members tested positive and were immediately isolated for two weeks. Three newborns who had close contact with suspected or known cases were quarantined, but no neonates tested positive for SARS-CoV-2 infection. Universal screening and careful isolation of suspected cases may have helped prevent transmission to this highly vulnerable population of neonates.

Study design

Other

Study population and setting

This study describes outcomes of a screening and testing protocol in place at the neonatal ward of a single hospital in Padua, Italy from February 21 to April 21, 2020. All neonates (n=75) admitted during this period, along with their parents (n=114) and all staff (n=112) in the ward, were included in the study. At the start of the study period, the neonatal ward implemented a 5-part intervention aimed at controlling SARS-CoV-2 infection: 1) Parents were triaged for symptoms upon neonate admission and were asked about contacts with potential COVID-19 cases. Parents were allowed to visit neonates one at a time, for one hour per day only, and all parents were asked to wear gloves and masks while visiting; 2) All neonates, parents, and staff were tested with RT-PCR for SARS-CoV-2 infection via weekly nasopharyngeal (NP) swabs (high-risk patients were tested daily for the first 3 days after admission). All neonates were tested for IgG and IgM antibodies after April 7, 2020; 3) Individuals testing positive, and neonates born to mothers testing positive, were quarantined in a negative pressure room where parents were not allowed; 4) Neonates were kept separate from mothers with suspected or confirmed COVID-19, and all neonates with low birth weight or of low gestational age at birth were fed with donors’ milk; 5) Staff and parents were given guidance on reducing transmission. Personal protective equipment including eye protection, N95 respirators, gloves, and gowns were worn in quarantine areas.

Summary of Main Findings

No neonates tested positive for SARS-CoV-2 infection or for presence of SARS-CoV-2 antibodies during the study period. Of the 75 neonates, 36 (48%) required admission to intensive care, and 8 (11%) of these infants required mechanical ventilation. Three newborns (4%) were deemed high-risk and quarantined: one was born from a mother who required mechanical ventilation for severe SARS-CoV-2 respiratory distress, one was breastfed by a mother with asymptomatic SARS-CoV-2 infection, and one had close contact with an infected staff member. All three newborns repeatedly tested negative for SARS-CoV-2, and none subsequently seroconverted; they were moved out of quarantine after 14 days. The 112 staff members and 114 parents were subject to 6,726 triage procedures. Three parents had fever or flu-like symptoms and were not allowed entry, and each subsequently tested negative for SARS-CoV-2. A total of 954 nasopharyngeal swabs were collected from staff and parents. Two parents and three staff members (2.2%) tested positive for SARS-CoV-2; all were asymptomatic and isolated for 14 days, and none seroconverted. The authors reported qualitatively high compliance by parents and staff to all protocols.

Study Strengths

Most protocols and outcomes were well described. Antibody testing later during the study period provided a useful adjunct to RT-PCR.

Limitations

The interventions described here may not be generalizable to neonatal wards with different physical layouts (the pod-based arrangement of rooms allowed for a greater degree of physical separation than might be possible elsewhere). Universal testing may not be possible in resource-limited settings. Measures of adherence to protocols were not quantitatively assessed. Protocols for RT-PCR testing of neonates were not well described, and it is unclear how often this testing occurred. Cord blood, placenta, and amniotic fluid were not tested, so some SARS-CoV-2 infections among neonates may have been missed.

Value added

This study adds to a limited evidence base on universal screening and testing procedures among neonates, parents, and staff in neonatal wards.

This review was posted on: 24 September 2020