The American Academy of Pediatrics (AAP) strongly supports the continued provision of health care for children during the COVID-19 pandemic unless community circumstances related to the pandemic require necessary adjustments.
Newborn and infant care should be provided consistent with the Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (4th Edition) and the corresponding Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) whenever possible.
The AAP recommends that pediatricians continue to follow federal and state guidelines on newborn screening and that state newborn screening programs screen for all diseases included in the Recommended Uniform Screening Panel set by the Advisory Committee on Heritable Disorders in Newborn and Children. Pediatricians should follow their specific state guidance for procurement and follow up of results.
Newborn Bloodspot Screening
States and territories have newborn screening programs and systems in place to ensure that newborns are screened at birth and receive timely follow-up and treatment for preventable complications from certain congenital conditions. Individual state guidance should be consulted for newborn bloodspot screening. A missed out-of-range dried blood spot screen can have devastating consequences for an affected child and family. The individual conditions detected by newborn screening are rare and screening is designed to detect asymptomatic individuals, primary care pediatricians are unlikely to recognize these conditions before symptoms arise if screening does not occur.
Early Hearing Detection and Intervention (Newborn Hearing Screening)
States and territories have early hearing detection and intervention programs and systems in place to ensure that newborns are screened at birth for hearing loss. Clinical best practices advise that infants be screened by 1 month of age, are diagnosed for hearing loss by 3 months of age and enter into early intervention services by 6 months of age. Continued adherence to these standards amid COVID-19 is essential to ensure healthy and appropriate development.
Critical Congenital Heart Disease Screening
Newborn screening for critical congenital heart disease (CCHD) uses pulse oximetry to check the level of oxygen in the blood of newborns. Children who fail this screening should have further testing to evaluate for congenital heart disease or for other potential causes of low blood oxygen levels.
Follow up Care for an Out-of-range Result
Barriers to follow up care for an infant with an out of range screening result may include lab closures, closed or limited office hours for labs, specialists, genetic counselors and/or audiologists. Further, parents may be hesitant to initiate an inpatient or outpatient visit. Strategies that can be implemented to assure continuity of care for children with an out of range screening result include:
- Utilize telehealth and phone calls to follow up with parent(s)/caregiver(s).
- Utilize telehealth and phone calls to monitor prescriptions, adjustments of dietary protocols and disease progression.
- Consider provider-to-provider communication with specialists and non-physician clinicians to facilitate scheduling and family engagement.
- Become familiar with existing state newborn screening continuity of operations plans.
- Newborn Screening Expands: Recommendations for Pediatricians and Medical Homes – Implications for Systems (AAP clinical report)
- Newborn Screening Contingency Planning During a Disaster
- Early Hearing Detection and Intervention
- Critical Congenital Heart Defects
- Guidance on Providing Pediatric Well-Care During COVID-19
- Association of Public Health Laboratories COVID-19 Resource Library
Interim Guidance Disclaimer: The COVID-19 clinical interim guidance provided here has been updated based on current evidence and information available at the time of publishing. Guidance will be regularly reviewed with regards to the evolving nature of the pandemic and emerging evidence. All interim guidance will be presumed to expire on June 30, 2022 unless otherwise specified.
American Academy of Pediatrics