NOTE: This interim guidance has been updated to replace previously posted guidance entitled “Considerations Regarding Novel H1N1 Flu Virus in Obstetric Settings”, dated July 6, 2009. This document clarifies clinical considerations related to management of suspected or confirmed maternal infection with 2009 H1N1 influenza virus infection within labor and delivery, postpartum, and newborn care settings in hospitals. A cautious approach to the management of ill mothers and their newborns is still recommended, but several options are provided based on hospital configuration, staffing, and surge capacity.
SUMMARY: Pregnant women who enter the hospital setting with illness from suspected or confirmed 2009 H1N1 influenza virus infection represent a special population warranting clinical management that considers the specific risks that 2009 H1N1 virus exposure poses to the newborn infant. The location of the mother and newborn should be considered based on postpartum and/or newborn ward configuration and existing infection control policies. As clinically indicated providers should consider a TWO-STEP process to manage postpartum and newborn care.
ONE: Providers should consider temporarily separating the infected mother from the newborn within her room (in an isolette) or in separate rooms until the risk of infectious transmission is reduced, defined as having met ALL of the following criteria: * The mother has received antiviral medications for at least 48 hours and; * The mother is without fever for 24 hours without antipyretics and; * The mother can control cough and respiratory secretions. Once these criteria are met, the mother and infant can initiate close contact throughout the postpartum period with droplet precautions and the mother can begin infant feedings.
TWO: Once the mother and infant are able to initiate close contact, the following guidance is offered for mothers immediately prior to feeding and handling the infant in order to protect the newborn from droplet exposure: * The mother should wash her hands with soap and water; * The mother should put on a face mask; * The mother should observe all respiratory hygiene/ cough etiquette guidelines. These precautions should be followed for 7 days after symptom onset or 24 hours after resolution of symptoms, whichever is longer. Healthy term newborns of infected mothers with suspected or confirmed 2009 H1N1 should be considered exposed, rather than infected, if they are born in the hospital setting following infection control guidelines. These infants should be observed for signs of infection. Unless clinically indicated, these newborns should be cared for with standard precautions whether they are cared for in the mother’s room or in the term newborn nursery setting.