This guidance has been designed by clinicians and focuses on specific considerations for neonatal services, including postnatal wards, in the COVID-19 environment. Consider with local teams how various scenarios may work in your unit.
Neonatal services should:
This guidance should be used with:
The mother and baby should be considered as a dyad, with the focus being the COVID-19 status of the mother. Where possible, care should be provided to babies by the mother's bedside to avoid separating mothers and babies.
These babies are considered close contacts.
For current case definitions refer to the
CDNA National Guidelines for Public Health Units.
Being a close contact requires ongoing consideration of testing and isolation. Please also refer to
Self-isolation rules | NSW Government
If other household members are positive, the baby's isolation period starts on the day the
last person in the household was released from isolation.
Participants in care (parents) are to undertake a RAT every 3 days as per
Recommendations for COVID surveillance testing in NSW Healthcare facilities
visiting guidance and
May visit after meeting the criteria for release from isolation as per
NSW Health COVID-19 self-isolation guidance
The principles of safe and evidence based neonatal care remain the same. The
priority is the immediate medical needs of the baby. Optimal care for the baby should not be delayed regardless of their mother's COVID-19 or her vaccination status.
Health workers should acknowledge that separation isolation from their baby, family or children may be a trigger for some parents, including Aboriginal families and refugees. Health workers will need to identify mothers and families that may require additional support on referral or early in the admission.
Whenever possible care should be provided in the community. When a health problem is suspected in a baby at home there must be clear local guidance to ensure rapid referral and assessment. When conducting home visits, clinicians should refer to the CEC
COVID-19 Infection Prevention and Control Manual (Chapter 8: Home Visits. Services should develop local guidance for the re-admission of babies, with suspected or confirmed COVID-19.
A baby may be a close contact because of exposure to a COVID positive parent or healthcare worker or may be considered a close contact if their mother is also a close contact.
If exposure has occurred as a result of contact with a positive health care worker refer to the
Management of patient or visitor COVID19 exposures in healthcare facilities matrix.
Isolation in Neonatal Units
Inpatients in neonatal units who are:
Participants in care (parents) of babies must isolate as per current public health orders and
NSW Health COVID-19 self-isolation guidance
It is recommended that the specialities regularly convene, review, and document the plan for birth, postnatal care, and discharge with involvement of the woman, her partner and family.
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not recommended to routinely test well and asymptomatic babies of mothers who are close contacts or have suspected or confirmed COVID-19 and are co-located with the mother.
Testing should only be done:
Moderate or High
The neonatal/paediatric team should only attend the birth as clinically required.
Maintain high index of suspicion for signs of sepsis or illness for all newborn babies throughout their hospital stay, or during the period of isolation at home. Clinical signs of COVID-19 in a baby can be subtle and therefore regular observations should be performed.
Tiered perinatal networks should consider the capability of the neonatal services within their networks and describe processes for escalation in their operational plans. See
NSW critical care management of neonatal patients
Support maternal feeding preferences. Encourage breastfeeding and expressing breast milk. Further advice for mothers about breastfeeding and expressing can be found at
Guidance on infant feeding
Testing of babies born to mothers who are neither COVID-19 positive or a close contact is not recommended.
Discuss the risks and benefits of being close to the mother and separation. This is particularly important when the baby is ready for discharge home and the mother remains unwell. In this case a suitable appropriate primary caregiver may be necessary.
When a health problem is suspected in a baby at home there must be clear local guidance to ensure rapid referral and when required, face to face assessment. It should be remembered that common newborn complications are the most likely explanation for presenting clinical conditions.
Triage should be undertaken by telephone to determine an appropriate location for the assessment. Local guidance for location of assessment should be developed as per local capacity and clinical situation.
Unplanned access to the facility should be through the emergency department, not through direct access to the postnatal ward or neonatal unit.
Tiered perinatal networks should consider the capabilities of their neonatal and paediatric units and describe processes for escalation in their local operational plans see
NSW critical care management of neonatal patients.
# To calculate the isolation period, day 0 is the day the case took their first positive test day 1 is the first full day after the first positive test was taken
+ To calculate the isolation period, day 0 is the first day since they last had contact with a COVID-19 case (birth is consid-ered a transmission event)
* Isolation period must continue for 7 whole days despite negative PCR when symptoms are present.
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*Must have remained asymptomatic for 72 hours prior to visiting
+PCR confirmed COVID disease does not require RATmonitoring for 30 days after being allowed to visit
#To calculate the isolation period, day 0 is the first daysince they last had contact with a COVID-19 case.
Health and Social Policy Branch (HSPB)
Neonatal COVID-19 Working Group (currently supported by Agency for Clinical Innovation (ACI)
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.
Clinical Lead, Neonatal Community of Practice
Neonatal services, including postnatal wards.