key: cord-0786757-1ogz07yb authors: Cavicchiolo, Maria Elena; Lolli, Elisabetta; Trevisanuto, Daniele; Baraldi, Eugenio title: Managing a tertiary‐level NICU in the time of COVID‐19: Lessons learned from a high‐risk zone date: 2020-04-21 journal: Pediatr Pulmonol DOI: 10.1002/ppul.24788 sha: c4fb2881366fb007b6c9f5f8d79e77c77e5551a8 doc_id: 786757 cord_uid: 1ogz07yb nan To the Editor, The novel coronavirus named COVID-19 is a microorganism with a high rate of diffusion among humans. Since 21 February, it has spread exponentially across Italy, with more than 10 000 deaths at the time of writing (28 March). Older people and adults with underlying health conditions seem to be at higher risk of developing severe COVID-19-related illness. Given the limitations of the accuracy of COVID-19 infection diagnosis, young children appear to be at similar risk of infection as the general population, generally experience milder symptoms, and complications appear to be uncommon, but this remains to be independently confirmed. 1, 2 It is well known that preterm newborns are a special population with an immature immune system, placing them at greater risk of severe infections. In addition, most of extremely low birth weight infants develop a severe respiratory distress syndrome at birth and can develop bronchopulmonary dysplasia. Cases of pneumonia have been described in neonates born to mothers with COVID-19. 3 No recommendations are available on how to prevent the spread of COVID-19 in neonatal intensive care units (NICUs). In Italy, Veneto and Lombardy are among the most affected regions, and Padua is among the top 10 cities in Italy for number of cases. That is why Padua was classified as a "high-risk" zone on 9 March. Padua University Hospital's pediatric department is a tertiary-level referral center for eastern Veneto. It manages about 3000 deliveries a year, and its NICU (35 beds) handles 400 hospitalizations a year, including 110 infants born preterm weighing less than 1500 g. We report our experience so far during the COVID-19 outbreak in Padua, where the epidemic is ongoing and rapidly evolving, to promote debate on the preventive measures to adopt in NICUs. Given the spread of COVID-19 infection, we have established a triage system for all parents of newborn admitted to our NICU. We measure their body temperature and ask them to complete a questionnaire about their health status, their contacts or travels from affected areas in the previous 2 weeks, and any recent influenza-like symptoms. All the newborns hospitalized after 21 February, with and without respiratory symptoms, and all patients already admitted the NICU are tested for COVID-19. In addition, all healthcare providers working at the NICU and parents are tested once a week. The test, using the real-time polymerase chain reaction, seeks evidence of the COVID-19 virus in respiratory specimens (nasopharyngeal swabs), as recommended by the Centers for Disease Control and Prevention (CDC) guidelines. 4 As an additional precaution during the epidemic, all newborns are kept isolated in thermostat-controlled cribs, and preventive measures are in place for both healthcare providers and parents. Physicians and nurses wear surgical masks, wash their hands frequently, and use hand sanitizers containing at least 60% alcohol before and after any contact with the newborn. Parents' visits are restricted to 2 hours a day, and only one parent for each baby, at scheduled times. All parents must wear masks, gloves, and disposable clothing. Social distancing practices are adopted. Preterm babies born from mothers testing positive for COVID-19 are kept isolated in a dedicated area of the NICU ("quarantine zone"), where parents are not allowed, and physician and nurses have to wear personal protective equipment according to CDC guidelines (ie, N95 respirators, gloves, eye protection, and gowns). Any close contact between NICU staff and parents or colleagues is avoided. Meetings, clinical updates, journal clubs, and lessons are kept to a minimum, ensuring a distance of at least 1 m between participants, or replaced with teleconferences. Considering the widespread anxiety among parents of admitted infants, a supportive psychological service has been activated. Table 1 shows the checklist of preventive measures adopted at our unit for the duration of the pandemic. Paediatric and Neonatal Intensive Care scientific statement. 5 The main concern regarding healthy term-born neonates is not whether the virus can be transmitted through breast milk, but whether an infected mother can transmit the virus through respiratory droplets while breastfeeding. 6 Epidemiology and transmission of COVID-19 in Shenzhen China: analysis of 391 cases and 1,286 of their close contacts. medRix Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease European Society of Pediatric Intensive Care (ESPNIC) COVID-19). 2020. https:// www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/ Practice-Advisory-Novel-Coronavirus2019 We thank the Hospital Direction of the Azienda Ospedaliera-Università degli Studi di Padova, the microbiological laboratory, all NICU physicians, residents, and nurses for their valuable contribution. The authors declare that there are no conflict of interests.