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Regarding Covid’s involvement in Hungarian hospitals, undeservedly little is said about mothers and their babies cared for in the obstetric intensive care unit and premature infants. This is because the SARS-CoV-2 coronavirus does not prevent pregnant women, pregnant women, or newborns. Health workers have to make the same sacrifices for their treatment, sometimes to save them, as they do for patients on the Covid ward, and isolation from mothers can put enormous mental strain.
With one of them, who cares for healthy and sick newborns as well as premature babies (including premature babies, PICs) at an obstetric institution in Hungary, we managed to talk to an editor about how the birth of a covid mother is performed. baby care and what happens in the rare event that the newborn is born in a Covid-infected state. He asked us not to reveal his identity or the name of the hospital where he works, and our article was born with this in mind.
What does the test depend on?
If a pregnant patient arrives asymptomatically only for a standard CTG, she will not undergo a PCR test. However, if you are admitted to the hospital in case of risk of pregnancy, you will be tested, especially if you are expected to deliver by surgery, that is, a cesarean section is expected, as this can lead to an increase in the Covid infection.
If a normal delivery is expected, there is not necessarily a coronavirus test on admission to the hospital, just the usual questions: have you produced any symptoms of a viral infection or has someone in your environment been coronavirus in recent days? If the answer to any of these questions is yes, then the tests may come.
Quarantine, spacesuit, lock
In the event that a future mother arrives with a mature and healthy baby in her womb and gives a positive pattern, or the suspicion is strong based on her symptoms, she will be placed in a separate room, under quarantine. You can only be alone in this room.
If the midwife and obstetrician visit, they should also wear protective clothing, Plexiglas glasses from head to toe in the foreground, as in a Covid department. When they are done, they must remove their protective clothing and throw it in the garbage container, which means that they cannot enter the clean hall in the clothes that have been with their future mother.
Covid mothers can deliver their children in a separate maternity ward, and a cesarean section is also performed in a dedicated Covid operating room. Only the midwife and obstetrician, as well as the care staff (midwife, operating room child) can enter the maternity ward and operating room. A neonatologist and an infant nurse are prepared to receive the newborn in the lobby of the Covid maternity ward or the Covid operating room, which is also a “hatch” between the clean and Covid-affected rooms. Compared to the “inner” ones, they have enough to wear a surgical mask instead of a FFP2 or FFP3 mask, the rest of their protective clothing is the same as the others (shoe bag, helmet, gloves, full jumpsuit or green cape ).
If the baby is born naturally or by cesarean section without knowing his mother, he is pushed from a small carriage to the fore to the neonatologist. There, they examine him, check if he fits well, and then take him back to his mother.
This is where the first question may arise: why? This is because the mother is confirmed to be a coronavirus, making it contagious. The doctor responds immediately:
In order for the ideal mother-child relationship to be established immediately and breastfeeding not interrupted, the protocol states that the baby should be placed on the mother’s womb as soon as possible.
The importance of this overrides the fact that the baby immediately becomes a contact person with his mother, that is, he has a potential risk of infection. The SARS-CoV-2 coronavirus has been shown to pose negligible risk to infants and even children in general. Our source confirms all this: they often survive asymptomatic illness or mild colds, possibly with intestinal symptoms. (A multi-organ inflammatory disease known as MISC or PIMS does not develop immediately after a coronavirus infection, but weeks later. Most people experience the problem in adolescents, while those under 5 years of age have symptoms such as syndrome of Kawasaki).
If the covid mother has undergone surgery, she may be in the quarantine room with her offspring after the cesarean section, as long as everything is fine with the baby. He is approached by a babysitter dressed in a “space suit”, a lactation consultant, a pediatrician, they are prepared to take care of the baby. If the observation period after delivery or cesarean section expires, you can go home as part of a “48 hour early homecoming”, of course, only if the results of the pediatric examination allow it.
However, the baby may have rapid or wheezing breathing one hour after birth, in which case it will be examined and, if deemed necessary, taken to a separate room in the neonatal intensive care unit (PIC class) in a closed incubator. This separate room must also be entered by a nurse or newborn doctor dressed in full protective gear.
What you should know is that, while an adult exhales an average of half a liter of air before breathing, a newborn has approximately “half a glass”. That is, even if it is infected, it releases a negligible amount of polluted air, aerosol, into the air in the room.
If a premature baby is born whose mother is Covid positive, it is isolated within the PIC class in the same way, but if they test negative, it is released from quarantine.
A new scientific discovery of a thesis
There was no need to fear that babies would be born infected because, until recently, the scientific assumption was that there was no transplacental transmission at birth. That is, mothers cannot transmit the infection to the baby. The last few months have refuted the thesis. In many parts of the world, including Hungary, several premature babies were born, who did not know their mother in the moments after giving birth, but a positive sample was taken during the PCR test, thus confirming their Covid infection. The doctor who spoke to us also told us.
One of the mothers was confirmed to be infected with a coronavirus at birth. Although he had to receive moderate amounts of oxygen, he did not show severe symptoms. The little one, on the other hand, arrived in week 32, two months before the deadline.
The future mother was pushed into the separate operating room, a cesarean section was performed, and then the baby was brought to the neonatologist in the foreground. Due to his shortness of breath, he required respiratory support, and after the first examination, he was immediately transferred to a separate room in the preterm intensive care unit according to protocol. Although she did not spend a single minute with her mother after giving birth, the result of the PCR test taken at the age of 24 hours was positive. The test was repeated for two days, which was again positive.
At the institution, she was the first baby to contract a coronavirus infection in her stomach from her mother.
For us, it turned out that there is a vertical transmission. But it doesn’t happen too often
The doctor explained, telling the Index. The physiological functions, respiration, bowel function and behavior of the premature baby in question were similar to those of a premature baby born at an average of 32 weeks gestation, however these symptoms overlapped with the symptoms of infection by Covid, which makes differentiation extremely difficult. Additional fecal and pharyngeal PCR tests also gave positive results.
Cameras instead of kangaroo
Her mother was unable to see him live, catch her and breastfeed her for a week and a half or two because the quarantine period was even with her mother. Anyone who has already given birth to a child can imagine the spiritual torment his future mother had to go through during this time. In addition to mental strain, the early habituation period, the “kangaroo,” which can have an impact on how well breastfeeding works at home, was also overlooked. Research is currently underway to examine the long-term consequences of separating mother and baby for so long. Researchers fear that the behavioral disturbance could result in a later initial separation.
To partially bridge the gap, a camera system was finally installed in the PIC department so that the mother could at least follow her baby’s days by phone. He managed to milk the breast milk every 2-3 hours and deliver it to the PIC department in a double protective bag so that the baby could get at least his own milk.
The little boy cleared the virus even when his mother released the quarantine and they were able to go home. At that time, however, it most likely could not infect.
Unlike the previous protocol, nursing mothers are no longer prohibited from receiving the coronavirus vaccine, as demonstrated by the resolutions of professional organizations. This topic, and the neutralizing “capacity” of breast milk from Covid-positive mothers, will be addressed in our next article.
(Cover image: Nurse dressed in protective clothing on December 15, 2020 at St. John’s Hospital in the capital. Photo: Zoltán Balogh / MTI)
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