New CDC Guidelines for H1N1 Infection in the Intrapartum and Postpartum Patient

Last month, the Centers for Disease Control and Prevention (CDC) issued new interim guidelines to clarify clinical considerations related to management of maternal H1N1 infection in labor and delivery, postpartum, and newborn care settings in hospitals.

Pregnant women with H1N1 infection represent a special population group that warrants specialized clinical management, to minimize exposure of the newborn infant to the H1N1 influenza virus. According to the CDC, providers should consider a two-step process to manage postpartum and newborn care.

Step 1: 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. The risk is considered reduced when all of the following criteria are met:

• 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.

Step 2: 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.

For more information, visit: http://emergencydev.cdc.gov/coca/training.asp.