Additional Infection Prevention and Control Guidance for Pregnant Women, Newborns, and the Postpartum Period

 

Pregnant Women, Newborns, and the Postpartum Period

Background
Epidemiological information has shown that pregnant women with H1N1 are at higher risk of severe influenza illness and influenza complications than non-pregnant women of similar age. Children under two years of age are at high risk for influenza infection and experience more severe morbidity than older children. Infants who are not breastfeeding are more vulnerable to infection in general, and at higher risk of hospitalization for severe respiratory illness than infants who are breastfeeding. Therefore, breastfeeding, as well as maternal bonding, have important health benefits to infants. It is strongly recommended that the potential benefits of implementing infection prevention and control measures involving separation of mother and infant to reduce the risk of influenza transmission be carefully weighed against the negative consequences of this separation.

Recommendations
This guidance is to be used in conjunction with recommendations found in the Guidance Document: Infection Prevention and Control Measures for Health Care Workers in Acute Care Facilities and Clinical Guidance for Pregnant and Breastfeeding Women with ILI in the Context of Pandemic H1N1 2009 virus.

Pregnant and Postpartum Women Exposed to Influenza
Additional precautions are not recommended for pregnant or postpartum women who have been exposed to influenza but who are feeling well. They should be monitored for influenza-like illness (ILI) until 4 days have passed from the last influenza contact.

Exposed Newborns
The risk of transmission of H1N1 from a pregnant woman to her newborn infant is unknown. A newborn infant born to an ill mother from 2 days before through 7 days after illness onset in the mother should be considered to be exposed and potentially infected.

It is recommended that a baby who has been exposed to H1N1 be maintained on additional precautions as outlined in Guidance Document: Infection Prevention and Control Measures for Health Care Workers in Acute Care Facilities until 4 days have passed from the time of last exposure if the infant is still in hospital. The baby should be monitored for signs of sepsis, which may include respiratory symptoms, and tested for H1N1 and other causes of sepsis or respiratory infection, as clinically indicated.

Newborns / Infants with Influenza-like Illness
It is recommended that a baby with clinical evidence of sepsis or respiratory infection suspected or confirmed to be due to H1N1 should be placed on additional precautions as outlined in Guidance document: Infection Prevention and Control Measures for Health Care Workers in Acute Care Facilities and referred to an infectious disease specialist for treatment as per antiviral and clinical care guidelines.

Pregnant and Postpartum Women with Influenza-like Illness
It is recommended that pregnant and postpartum women with ILI suspected or confirmed to be due to H1N1 should receive early treatment with oseltamivir as per Clinical Guidance for Pregnant and Breast Feeding Women with Influenza-like Illness in the context of pH1N1 Virus.

It is preferable for a mother with H1N1 not to be separated from her infant unless absolutely necessary. Such a situation might arise if a symptomatic mother is unable to wear a mask1 or perform respiratory etiquette, is unable to care for the baby, or the infant is admitted to a neonatal intensive care unit or special care nursery.

Where the mother is able to care for her baby, it is recommended that the baby be allowed to room in with the mother. Both the mother and baby should be cared for using additional precautions as outlined in the Guidance document: Infection Prevention and Control Measures for Health Care Workers in Acute Care Facilities.

It is recommended that a mother with H1N1 should be instructed to wear a mask1 when within 2 metres of her well baby and change to a clean gown or clothing and perform hand hygiene before direct contact with her baby. For home care settings or situations where wearing a mask1 is not feasible, the mother should be instructed on how to perform respiratory etiquette and the importance of hand hygiene. These precautions should be continued for at least 7 days after the onset of symptoms or until symptoms have resolved, whichever is longer.

Women with influenza who have mild or moderate symptoms should be encouraged to initiate breastfeeding early and feed frequently. It is recommended that unnecessary formula supplementation be eliminated, so the infant can receive as many maternal antibodies as possible. Antiviral medication treatment or prophylaxis is not a contraindication for breastfeeding.

Mothers who are not well enough to breastfeed, or whose babies are in an NICU, may express breast milk for infant feeding. The breast milk may then be fed to the baby by a well person or HCW.

It is recommended that a mother with H1N1 should be restricted from visiting the neonatal intensive care or special care unit until 7 days have passed from the onset of ILI symptoms and symptoms have resolved, whichever is longer, unless a single room that does not allow exposure of other mothers and infants is available.