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Home Books Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 7e

Appendix F: Isolation Guidelines

INTRODUCTION

The following table, Transmission-Based Precautions for Perinatal/Neonatal Patients in conjunction with Standard Precautions, is based on current knowledge and practices in the fields of epidemiology, pediatrics, and perinatology. Published resource references are listed immediately after the table.

Instructions for Using Precautions for Perinatal/Neonatal Patients Table

  • Each disease is considered individually so that only precautions indicated to interrupt transmission for that disease are recommended.

  • The column “Maternal Precautions” describes the precautions to be used by staff providing care to the mother.

  • The column “Neonatal Precautions” describes the precautions to be used by staff, patients, or visitors in contact with the neonate.

  • Staff should assess the mother's ability to wash hands correctly and comply with precautions when determining the appropriateness of permitting rooming in.

Precautions shall be initiated for suspected as well as confirmed infectious diseases/conditions.

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Infection/Disease Maternal Precautions Neonatal Precautions Room-In Mother May Visit in Nursery Breast-Feeding Additional Considerations
AIDS/HIV positive Standard

Standard

Bathe baby ASAP when stable

 Yes Yes

No

HIV may be transmitted through breast milk.

Recommend tuberculosis testing for mother.

Due to constant HIV antiretroviral (ARV) treatment option changes, consult with neonatology expert and refer to http://aidsinfo.nih.gov for current ARV treatment options. Report AIDS to health department.
Chickenpox (see Varicella)
Chlamydia trachomatis Standard Standard Yes Yes Yes

Topical prophylaxis is ineffective for Chlamydia ophthalmic disease.

Treatment for Chlamydia conjunctivitis and pneumonia is systemic erythromycin for 14 days.
Cytomegalovirus (CMV) Standard Standard Yes Yes Yes No additional precautions for pregnant health care workers.
Gastroenteritis Contact precautions for diapered or incontinent persons for the duration of illness or to control outbreaks for gastroenteritis caused by infectious agents such as Clostridium difficile Contact precautions for the duration of illness to control outbreaks for gastroenteritis/diarrhea caused by infectious agents such as C. difficile Yes Yes Yes

The most effective method to remove C. difficile spores from contaminated hands is through meticulous hand hygiene with soap and water. Alcohol-based hand hygiene products do not inactivate C. difficile spores. Because C. difficile spores are difficult to kill, most surface disinfectants are ineffective. When outbreaks of C. difficile diarrhea are not controlled by other measures, it is recommended to use a disinfectant with sporicidal activity (eg, hypochlorite).
Gonococcal ophthalmia neonatorum Standard Standard

Yes

After 24 hours of maternal treatment with antibiotics

Yes

After 24 hours of maternal treatment with antibiotics

Yes

After 24 hours of maternal treatment with antibiotics

Prophylactic use of topical 0.5% erythromycin ophthalmic or 1% tetracycline ointment at birth should be performed to prevent ophthalmic neonatorum. Prophylaxis may be delayed for as long as 1 hour after birth to facility parent infant bonding.

Newborns born to mothers with active gonorrhea should receive a single dose of ceftriaxone 125 mg IV or IM. For low birthweight neonates, the dose is 25–50 mg/kg of body weight. Cefotaxime (100 mg/kg) ...

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