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NSW Health COVID-19

Maternity, Neonatal, Special Care Nurseries and Child and Family Health

Community of Practice

18 June 2020

Respiratory Pandemic Preparedness

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Today’s Agenda

►Welcome and update on Community of Practice

►Update from Dr Jan Fizzell, COVID-19 Response Team

Senior Medical Advisor

►Feedback from issues arising in last week

►Prof Michael Nicholl (Maternity)

►Dr Srini Bolisetty (NICU & SCN)

►A/Prof Elisabeth Murphy (Child and Family Health)

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Update from Dr Nigel Lyons

►Communities of Practice

►What’s new this week

►Weekly surveillance report:

https://www.health.nsw.gov.au/Infectious/covid-19/Pages/stats-nsw.aspx

►List of current guidance and resources

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Update - Data

To Date:

► Eighteen pregnant, or recently pregnant, women have been diagnosed with COVID-19. This represents a

small proportion of all COVID-19 cases (0.6%)

► Six women were in their first trimester, six in their second and six in their third trimester at the time of

diagnosis

► Of the 18 cases, 7 most likely acquired their infection overseas and the remaining 11 acquired their

infection locally in NSW. Of those who acquired their infection in NSW, 8 were linked to a family member

who was a confirmed case or were part of a known cluster

► Of the 17 women who were symptomatic, 15 have fully recovered

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Guidance available

► Guidance for maternity and newborn services (V3)

► https://www.health.nsw.gov.au/Infectious/covid-19/Pages/guidance-for-maternity-services.aspx

►CEC has updated the following guidance documents

► Management of COVID-19 in Healthcare settings- V3.2

► Appendix 1 – Maternity and Neonatal Services

► CEC Primary Community and Outpatient Settings - V2 Guidance

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CoP – Maternity/Neonates/Child & Family► Today is our 11th broadcast

► 211 individual enquiries have been received in the mailbox

► 34 related to all areas

► 40 related to Child & Family

► 75 related to Maternity

► 28 related to Neonates

► 34 related to a combination of areas

► Of these 187 have been resolved and 24 remain open

► 102 of these issues have been included in these broadcasts and each of those have been escalated to THEOC

► Of those escalated to THEOC 95 have been closed and 7 remain open

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CoP – Maternity/Neonates/Child & Family► Today is our 11th broadcast

► 211 individual enquiries have been received in the mailbox

► 34 related to all areas

► 40 related to Child & Family

► 75 related to Maternity

► 28 related to Neonates

► 34 related to a combination of areas

► Of these 187 have been resolved and 24 remain open

► 102 of these issues have been included in these broadcasts and each of those have been escalated to THEOC

► Of those escalated to THEOC 95 have been closed and 7 remain open

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Relevant issues for all areas

► Guidance for working in confined office spaces – Workforce 9 June 20

Includes;

► The SafeWork Australia Fact Sheet

► The Safe Work Australia COVID SAFE – Workplace Checklist

► COVID-19 Risk Assessment

► Ability to print resources for pregnant women and their families and new parents

► Difficulty in maintain version control

► Direct people to the web page – provide the links

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Relevant issues for all areas

► Visiting guidelines for birthing units, wards, nurseries, NICUs

► Continues to be raised

► Care in a hospital setting is different to what is otherwise happening in the community

► A conservative approach should be taken in terms of relaxing restrictions

► Determined at a local level

► to assess local risk factors including including physical space available in wards and shared spaces

► local prevalence rates and risks relating to transmission to other patients, staff and visitors.

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Dr Jan Fizzell MB BS BSc(Med)(Hons) MPH FAFPHMCOVID-19 Response TeamSenior Medical Advisor

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Specific issues and information week ending 12 June 2020

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Maternity

Issue What we know

Use of rapid testing Rapid point of care testing is available at some facilities. Clinicians should seek

advice from their infectious disease physicians and pathology departments regarding

the use of these tests, noting that the management of women at high risk who return

a negative point of care test should be discussed with an infectious disease physician

before precautions are ceased.

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Neonatal: Safety Notice – Use of Viral Filters for Respiratory Care in Neonates

What do we know?

➢ Babies with suspected or confirmed COVID-19 pneumonia who require respiratory support should be nursed in closed

cribs with airborne precautions

Should viral filters be used in addition to PPE to reduce risk of spread?

There are risks to the neonate when viral filters are used:

➢ The smallest filter has 10ml deadspace

➢ Deadspace causes inefficient chest wall movement and accumulation of CO2…...

➢ Risk of intraventricular haemorrhage in small preterm neonates

Filters should NOT be used in the following situations:

Resuscitation at birth (baby is a contact not a case)

In the first 14 days of life in neonates born to women with COVID-19

Added to the inspiratory or expiratory humidified circuit during ventilation

At the Neopuff T piece

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Neonatal: Safety Notice – Use of Viral Filters for Respiratory Care in Neonates

A filter may be used in the following situations

➢ Added to the exhaust vent of a ventilator (see photo)

➢ Where the neonate re-presents to a setting where staff care for

all age groups eg emergency departments. In these settings

filters with the smallest deadspace should be used for short

periods of time as per APLS algorithm

The Safety Notice is likely to be published early next

week. Districts will be notified via normal channels.

All Safety Notices require feedback to the CEC. Districts will be notified by

the CEC about requirements

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Child and Family HealthGuidance on Child and Family Health Services, Version 4

• Focused on returning to face to face services where possible.

• Refer to the CEC Guidance on Home Visits and CEC Guidance on Primary, Community and

Outpatient Settings for all Infection Prevention and Control matters.

• StEPS Screening can resume as soon as possible where feasible.

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Child and Family Health – what’s happening nationally?

► Regular contact with child and family health

representatives in each jurisdiction

► Most states and territories are returning to usual care with

additional infection control measures in place.

Immunisations

• It is important that all children receive their immunisations

and any missed doses are caught up.

• Australia is on track to deliver over 17 million vaccine

doses this year.

• From 1 July 2020 there will be changes to the

immunisation schedule designed to improve protection

against meningococcal and pneumococcal disease.

Further detail: https://www.health.gov.au/news/clinical-

update-national-immunisation-program-nip-schedule-

changes-from-1-july-2020-advice-for-vaccination-providers

RACGP NSW and ACT and NSW Health webinar, Thursday

11 June: https://www.health.nsw.gov.au/Infectious/covid-

19/Pages/racgp-webinar.aspx

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Child and Family HealthResources

• Advocate for Children and Young People (ACYP) – Digital Lunchbreak - Resources

A selection of helpful resources relating to Covid-19 collated from across government and non-

government organisations. Adults are encouraged to guide children and young people through the

information.

• Centre on the Developing Child, Harvard University: https://developingchild.harvard.edu/

• The Kings Fund, Leading through COVID-19: supporting health and care leaders in

unprecedented times: https://www.kingsfund.org.uk/projects/leading-through-covid-19

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Thank you.Ask questions via:

MOH-maternityNICU-SCN-CFH-COVID-

19@health.nsw.gov.au

Find COVID-19 NSW Health Information:

www.health.nsw.gov.au/Infectious/diseases/Pages/cor

onavirus.aspx

Next meeting: 9am 2 July