Well-Newborn Unit Director Experiences During the COVID-19 Pandemic: A BORN Study

As coronavirus disease 2019 (COVID-19) spread across the country, well-newborn unit medical directors developed newborn care plans as guidelines and evidence evolved. We chose to examine approaches to newborn care during these early phases of the COVID-19 pandemic.

An electronic survey was administered to well-newborn unit directors in a national network of US well-newborn units in May 2020. Respondents were asked about their approaches to testing, infection prevention, routine newborn care, discharge planning, breastfeeding, rounding, and teaching.

Of 107 sites, 65 (61%) respondents completed the survey. Respondents estimated a 1% positivity rate of 1198 newborns tested for COVID-19. Most sites (86%) performed universal maternal COVID-19 testing, and most (82%) tested newborns of COVID-19-positive mothers at 24 hours of life (75%). Infection prevention and visitation policies varied. Of respondents, in COVID-19-positive mothers, 28% permitted no visitors, 54% recommended rooming-in with the newborn, 55% encouraged breastfeeding at the breast, 38% deferred routine circumcisions of the newborn, 74% initiated immediate bathing of the newborn, 68% continued standard newborn screening, and 55% modified newborn follow-up plans. Medical directors reported adjustments to rounding and teaching workflow. Content analysis of free-text responses revealed themes related to challenges with changing recommendations, discomfort with mother-infant separation recommendations, innovations, and stress management.

Well-newborn units quickly adopted universal maternal testing and testing of exposed newborns. Despite guidelines, we identified variation in the care of newborns of COVID-19-positive mothers. Further investigation of these differences and newborn outcomes is warranted to develop best practices.