Preparing A University Hospital Neonatal Intensive Care Unit for Covid-19 Pandemic and Country Lockdown

Jordan is one of the earliest countries that took a very strict approach to contain COVID-19 pandemic by declaring a country lock down. Our neonatal intensive care unit is a level three 30 beds unit. The shortage of neonatal nurses, doctors, and of respiratory support devices are the major existing challenges. During COVID-19 pandemic, those two issues were magnified. This paper will shortly discuss the measures taken as a preparedness for COVID-19 Pandemic in our unit. Team development and work schedule: The medical knowledge about COVID-19 was foggy, however; teamwork is the only ev-ident thing. Our team included, the neonatologists, pediatric intensivist, pediatric pul-monologists, in addition to the infectious disease specialist. The team also included three of our senior residents, and the neonatal unit head nurse. To enhance communication, we created a WhatsApp group (Peds COVID -19). Among this group, unidentified Patients’ information, in addition to recent publications and sci-entific opinions, were shared. Meeting with the obstetric department was done to famil-iarize both teams with the measures taken on both sides. The neonatal care is provided by two neonatologists. The in-house care providers are the pediatric residents. Senior residents are well-trained on neonatal resuscitation, endotra-cheal intubation, and umbilical venous catheterization. During COVID-19 lock down, residents were split into separate teams. Neonatal team, the pediatric floor team, and the emergency room team, each team had their sleeping room and lounges. The consultants did rounds daily, the in-house team consisted of two senior residents, and a junior resident. they did a 24-hour shift every four days and are off duty for the next three days. Regarding the nursing staff schedule, their work schedule changed from an 8- hour shift to a 12- hour shifts schedule. The aim was to promote staff well-being, minimize the number of staff who could potentially be exposed to a COVID-19 case, and therefore will need to be quarantined. Visitation policy: Mothers could come at any time, but fathers could visit briefly. Parents were requested to wear gowns and face masks. We continued to encourage breast feeding, and we continued to receive expressed breast milk from mothers at home. Neonatal isolation area: A separate area was designated for isolating asymptomatic infants born to COVID-19 positive or suspected mothers, another area was designated for sick newborns, both areas were outside the current NICU. A separate nursing staff were assigned to take care of the isolated newborns. Infection control measures: The unit medical and nursing staff were instructed to stay home if feeling unwell, with fever or respiratory illness. They were also instructed to declare any contact with sick individuals. Wearing face mask and maintaining social distancing whenever possible, is a policy we adopted very early. When providing medical care to suspected cases, the staff were instructed to follow the hospital protocol. Management plan: After reviewing the available literature of COVID-19 infection a management flow chart was constructed to standardize the care. It contains the main steps and principles of management. It was circulated to all residents, the hospital administration, and to the hospital infection control unit (Table1). This chart is designed to help with the initiation of the care. The management process might vary according to the patient situation, in addition to the change of the current COVID-19 knowledge that will mandate a change in the implemented guidelines. Neonatal units should have an in-house policy that will guarantee standardization of care, better communication with different disciplines, and most importantly policies that could decrease the transmission risk of the corona virus among the staff and neonatal patients. Infection control measures, minimum staff on duty, and shorter contact time, are the most important items in such policies.