A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units
Identifieur interne : 000308 ( Pmc/Corpus ); précédent : 000307; suivant : 000309A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units
Auteurs : Jianhui Wang ; Hongbo Qi ; Lei Bao ; Fang Li ; Yuan ShiSource :
- The Lancet. Child & Adolescent Health [ 2352-4642 ] ; 2020.
Url:
DOI: 10.1016/S2352-4642(20)30040-7
PubMed: 32043976
PubMed Central: 7128924
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China</nlm:aff></affiliation></author><author><name sortKey="Bao, Lei" sort="Bao, Lei" uniqKey="Bao L" first="Lei" last="Bao">Lei Bao</name><affiliation><nlm:aff id="aff1">Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China</nlm:aff></affiliation></author><author><name sortKey="Li, Fang" sort="Li, Fang" uniqKey="Li F" first="Fang" last="Li">Fang Li</name><affiliation><nlm:aff id="aff1">Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China</nlm:aff></affiliation></author><author><name sortKey="Shi, Yuan" sort="Shi, Yuan" uniqKey="Shi Y" first="Yuan" last="Shi">Yuan Shi</name><affiliation><nlm:aff id="aff1">Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32043976</idno><idno type="pmc">7128924</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128924</idno><idno type="RBID">PMC:7128924</idno><idno type="doi">10.1016/S2352-4642(20)30040-7</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000308</idno><idno type="wicri:explorRef" 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The First Affiliated Hospital of Chongqing Medical University, Chongqing, China</nlm:aff></affiliation></author><author><name sortKey="Bao, Lei" sort="Bao, Lei" uniqKey="Bao L" first="Lei" last="Bao">Lei Bao</name><affiliation><nlm:aff id="aff1">Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China</nlm:aff></affiliation></author><author><name sortKey="Li, Fang" sort="Li, Fang" uniqKey="Li F" first="Fang" last="Li">Fang Li</name><affiliation><nlm:aff id="aff1">Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China</nlm:aff></affiliation></author><author><name sortKey="Shi, Yuan" sort="Shi, Yuan" uniqKey="Shi Y" first="Yuan" last="Shi">Yuan Shi</name><affiliation><nlm:aff id="aff1">Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China</nlm:aff></affiliation></author></analytic><series><title level="j">The Lancet. Child & Adolescent Health</title><idno type="ISSN">2352-4642</idno><idno type="eISSN">2352-4650</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zhu, N" uniqKey="Zhu N">N Zhu</name></author><author><name sortKey="Zhang, D" uniqKey="Zhang D">D Zhang</name></author><author><name sortKey="Wang, W" uniqKey="Wang W">W Wang</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Li, Am" uniqKey="Li A">AM Li</name></author><author><name sortKey="Ng, Pc" uniqKey="Ng P">PC Ng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, C" uniqKey="Huang C">C Huang</name></author><author><name sortKey="Wang, Y" uniqKey="Wang Y">Y Wang</name></author><author><name sortKey="Li, X" uniqKey="Li X">X Li</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Gagneur, A" uniqKey="Gagneur A">A Gagneur</name></author><author><name sortKey="Vallet, S" uniqKey="Vallet S">S Vallet</name></author><author><name sortKey="Talbot, Pj" uniqKey="Talbot P">PJ Talbot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Totura, Al" uniqKey="Totura A">AL Totura</name></author><author><name sortKey="Bavari, S" uniqKey="Bavari S">S Bavari</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="discussion"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet Child Adolesc Health</journal-id><journal-id journal-id-type="iso-abbrev">Lancet Child Adolesc Health</journal-id><journal-title-group><journal-title>The Lancet. Child & Adolescent Health</journal-title></journal-title-group><issn pub-type="ppub">2352-4642</issn><issn pub-type="epub">2352-4650</issn><publisher><publisher-name>Elsevier Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32043976</article-id><article-id pub-id-type="pmc">7128924</article-id><article-id pub-id-type="publisher-id">S2352-4642(20)30040-7</article-id><article-id pub-id-type="doi">10.1016/S2352-4642(20)30040-7</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units</article-title></title-group><contrib-group><contrib contrib-type="author" id="au10"><name><surname>Wang</surname><given-names>Jianhui</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au20"><name><surname>Qi</surname><given-names>Hongbo</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au30"><name><surname>Bao</surname><given-names>Lei</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au40"><name><surname>Li</surname><given-names>Fang</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au50"><name><surname>Shi</surname><given-names>Yuan</given-names></name><email>shiyuan@hospital.cqum.edu.cn</email><xref rid="aff1" ref-type="aff">a</xref></contrib><on-behalf-of>on behalf of the </on-behalf-of><contrib contrib-type="author"><collab>National Clinical Research Center for Child Health and Disorders and Pediatric Committee of Medical Association of Chinese People's Liberation Army</collab></contrib></contrib-group><aff id="aff1"><label>a</label>Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China</aff><aff id="aff2"><label>b</label>Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China</aff><pub-date pub-type="pmc-release"><day>7</day><month>2</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>7</day><month>2</month><year>2020</year></pub-date><elocation-id></elocation-id><permissions><copyright-statement>© 2020 Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>Elsevier Ltd</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions></article-meta></front><body><p id="para70">Since December, 2019, a pneumonia of unknown cause, which has clinical manifestations similar to severe acute respiratory syndrome,<xref rid="bib1" ref-type="bibr">1</xref>, <xref rid="bib2" ref-type="bibr">2</xref> originated in Wuhan, China, and has rapidly spread across China and to at least 23 countries. By Feb 5, 2020, the number of laboratory-confirmed cases had exceeded 20 000, with more than 400 deaths. About 100 children were affected, with the youngest being 30 h after birth. A novel virus named 2019 novel coronavirus (2019-nCoV) was considered to be the causative agent of this pneumonia. Neonates are thought to be susceptible to the virus because their immune system is not well developed, which is of great concern to neonatal medical service providers. Paediatricians and neonatologists belonging to the National Clinical Research Center for Child Health and Disorders and Pediatric Committee of Medical Association of Chinese People's Liberation Army have contributed to the control efforts in China. We aim to elicit a contingency plan for the 2019-nCoV outbreak in neonatal intensive care units (NICUs), mainly focused on diagnostic and discharge criteria, treatment, prevention, and control strategies.</p><p id="para80">Most adults or children with 2019-nCoV infection presented with mild flu-like symptoms, although patients with severe illness could rapidly develop acute respiratory distress syndrome, respiratory failure, and multiple organ failure, and deaths have been reported in some cases.<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> Most patients with pneumonia had abnormal chest radiography findings, such as bilateral ground-glass opacity, multiple lobular, and subsegmental areas of consolidation;<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> those with acute respiratory distress syndrome could show bilateral complete opacification of the lungs on CT scans.<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> Routine blood work was mostly unremarkable.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> The nucleic acid test from respiratory tract samples or serum is effective in detecting the virus, and results are usually available within 4–6 h.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref></p><p id="para90">Neonates might get 2019-nCoV infection through close contact with virus-infected patients or virus carriers. In the case of neonatal infection, the disease might have insidious onset and be non-specific.<xref rid="bib6" ref-type="bibr"><sup>6</sup></xref> The diagnosis of 2019-nCoV neonatal infection should meet all the following requirements: (1) showing at least one of the clinical symptoms, including temperature instability, hypoactivity or poor feeding, or tachypnoea; (2) showing abnormal findings on chest radiograph, including unilateral or bilateral ground-glass opacity, multiple lobular, or subsegmental areas of consolidation; (3) being at high risk of 2019-nCoV infection because the patient's family members or caregivers have been diagnosed with 2019-nCoV infection, had close contact with someone with probable or confirmed 2019-nCoV, had close contact with someone with pneumonia of unknown cause, are living in or travelling to epidemic areas, or have been in animal markets or close contact with wild animals, within 14 days before the onset of illness. Those who meet the criteria of probable infection and have positive virus detection tests are confirmed to be infected with 2019-nCoV.</p><p id="para100">All probable or laboratory-confirmed neonates with 2019-nCoV should be admitted to NICUs. Standard and additional precautions should be implemented immediately (<xref rid="box1" ref-type="boxed-text">panel</xref>). General management comprises homoeostasis maintenance, close follow-up of blood work and chest radiography, and initialisation of respiratory support if necessary. The efficacy of antiviral drugs against 2019-nCoV is not certain.<xref rid="bib7" ref-type="bibr"><sup>7</sup></xref> Antimicrobial drugs are only prescribed to patients with probable or confirmed bacterial infection; empirical use or overuse should be avoided. For neonates with acute respiratory distress syndrome manifested by complete opacification of lungs, high-dose pulmonary surfactant replacement, nitric oxide inhalation, and high-frequency oscillatory ventilation might be effective. Intravenous glucocorticoids or immunoglobulin could be tried in some difficult cases. Neonates with intracranial infection and convulsion should be handled according to corresponding guidelines. In critically ill neonates, continuous renal replacement and extracorporeal membrane oxygenation could be implemented if necessary. Those who have no fever for at least 3 days and improved respiratory symptoms; resolution of previously abnormal chest radiography findings; and a series of two nasopharyngeal and nasal swabs negative for 2019-nCoV at least 48 h apart could be discharged home.<boxed-text id="box1"><label>Panel</label><caption><title>Strategies to be implemented during screening of neonates for 2019-nCoV infection</title></caption><p id="para10"><list list-type="simple" id="celist10"><list-item id="celistitem10"><label>•</label><p id="para20">Standard precautions include signage at the entrance, strict hand and respiratory hygiene, daily cleaning and disinfection of the environment, and provision of gloves, mask, and goggles for all medical staff</p></list-item><list-item id="celistitem20"><label>•</label><p id="para30">Additional enhanced contact precautions and respiratory droplet precautions include patients' own dedicated equipment, limited parents' visits, gown and glove change after procedures, and opening window regularly to change air</p></list-item><list-item id="celistitem30"><label>•</label><p id="para40">Avoid breastfeeding from mothers with probable or laboratory-confirmed 2019-nCoV infection until the recovery of confirmed mothers or rejection of probable infection</p></list-item><list-item id="celistitem40"><label>•</label><p id="para50">Medical waste generated during medical service should be collected into a double-layer infectious waste bag, which should be treated with chlorine-containing preparation for at least 10 min, then disposed of in the same way as infectious medical waste</p></list-item><list-item id="celistitem50"><label>•</label><p id="para60">Terminal disinfection of the patient's room is preferentially done using hydrogen peroxide atomisation or a chlorine-containing preparation spray</p></list-item></list></p></boxed-text></p><p id="para110">All neonates newly admitted to the NICU need to be screened for high risk of 2019-nCoV infection (<xref rid="box1" ref-type="boxed-text">panel</xref>). Neonates at high risk, as assessed by family history, should be isolated in a single room for at least 14 days. If a neonate develops manifestations similar to 2019-nCoV infection during the isolation period or is highly suspected of 2019-nCoV infection on admission, the patient should be immediately referred to a designated hospital or a designated unit for 2019-nCoV infection. The patient's room cannot be used by other patients before being adequately disinfected. If this patient shared a room with other neonates before being identified, all wardmates should be isolated. Isolation must last at least 14 days, unless 2019-nCoV infection is ruled out.</p><p id="para120">In NICUs, a virus outbreak will bring psychological stress to the patient's parents and other family members; therefore, social workers and psychologists should be involved. Medical service providers will also be under tremendous psychological pressure due to overwork, shortage of medical resources, patients' poor outcomes, or other detrimental experiences. Medical staff should be provided with adequate psychological support, as their physical and mental health is crucial in the context of a virus outbreak.</p><p id="para130">Most of our recommendations are based on lessons learned from existing and previous experiences with coronavirus outbreaks in adults and children. The contingency plan will be continuously modified on the basis of accumulated clinical evidence and experience. Medical service providers should also continually update their knowledge and skills on prevention and control of the 2019-nCoV outbreak.</p><p id="para140"><fig id="f10"><graphic xlink:href="fx1_lrg"></graphic><permissions><copyright-statement>© 2020 CDC/Science Photo Library</copyright-statement><copyright-year>2020</copyright-year><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions></fig></p></body><back><ref-list id="bibl10"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sbref10"><person-group person-group-type="author"><name><surname>Zhu</surname><given-names>N</given-names></name><name><surname>Zhang</surname><given-names>D</given-names></name><name><surname>Wang</surname><given-names>W</given-names></name></person-group><article-title>A novel coronavirus from patients with pneumonia in China, 2019</article-title><source>N Engl J Med</source><year>2020</year><comment>published online Jan 24.</comment><pub-id pub-id-type="doi">10.1056/NEJMoa2001017</pub-id></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="other" id="sbref20"><person-group person-group-type="author"><collab>European Centre for Disease Prevention and Control</collab></person-group><article-title>Update: cluster of pneumonia cases caused by a novel coronavirus, Wuhan, China</article-title><ext-link ext-link-type="uri" xlink:href="https://www.ecde.europa.eu/en/news-events/update-cluster-pneumonia-cases-associated-novel-coronavirus-wuhan-china-2019" id="interrefs20">https://www.ecde.europa.eu/en/news-events/update-cluster-pneumonia-cases-associated-novel-coronavirus-wuhan-china-2019</ext-link><year>2019</year></element-citation></ref><ref id="bib3"><label>3</label><element-citation publication-type="journal" id="sbref30"><person-group person-group-type="author"><name><surname>Li</surname><given-names>AM</given-names></name><name><surname>Ng</surname><given-names>PC</given-names></name></person-group><article-title>Severe acute respiratory syndrome (SARS) in neonates and children</article-title><source>Arch Dis Child Fetal Neonatal Ed</source><volume>90</volume><year>2005</year><fpage>F461</fpage><lpage>F465</lpage><pub-id pub-id-type="pmid">16244207</pub-id></element-citation></ref><ref id="bib4"><label>4</label><element-citation publication-type="journal" id="sbref40"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>C</given-names></name><name><surname>Wang</surname><given-names>Y</given-names></name><name><surname>Li</surname><given-names>X</given-names></name></person-group><article-title>Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China</article-title><source>Lancet</source><year>2020</year><comment>published online Jan 24.</comment><pub-id pub-id-type="doi">10.1016/S0140-6736(20)30183-5</pub-id></element-citation></ref><ref id="bib5"><label>5</label><element-citation publication-type="book" id="sbref50"><person-group person-group-type="author"><collab>WHO</collab></person-group><chapter-title>Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases</chapter-title><year>2019</year><publisher-name>World Health Organization</publisher-name><publisher-loc>Geneva</publisher-loc><ext-link ext-link-type="uri" xlink:href="https://www.who.int/docs/default-source/coronaviruse/20200114-interim-laboratory-guidance-version.pdf?sfvrsn=6967c39b_4&download=true" id="interrefs40">https://www.who.int/docs/default-source/coronaviruse/20200114-interim-laboratory-guidance-version.pdf?sfvrsn=6967c39b_4&download=true</ext-link></element-citation></ref><ref id="bib6"><label>6</label><element-citation publication-type="journal" id="sbref60"><person-group person-group-type="author"><name><surname>Gagneur</surname><given-names>A</given-names></name><name><surname>Vallet</surname><given-names>S</given-names></name><name><surname>Talbot</surname><given-names>PJ</given-names></name></person-group><article-title>Outbreaks of human coronavirus in a pediatric and neonatal intensive care unit</article-title><source>Eur J Pediatr</source><volume>167</volume><year>2008</year><fpage>1427</fpage><lpage>1434</lpage><pub-id pub-id-type="pmid">18335238</pub-id></element-citation></ref><ref id="bib7"><label>7</label><element-citation publication-type="journal" id="sbref70"><person-group person-group-type="author"><name><surname>Totura</surname><given-names>AL</given-names></name><name><surname>Bavari</surname><given-names>S</given-names></name></person-group><article-title>Broad-spectrum coronavirus antiviral drug discovery</article-title><source>Expert Opin Drug Discov</source><volume>14</volume><year>2019</year><fpage>397</fpage><lpage>412</lpage><pub-id pub-id-type="pmid">30849247</pub-id></element-citation></ref></ref-list><ack><p>We declare no competing interests. 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