Clinical Practice Resources

This document describes care and services for heathy populations and contains guidance in four key areas: Reducing Health Inequities; Promoting and Supporting Healthy Infant Development; Promoting and Supporting Parent Postpartum Physical and Emotional Well-Being; and Supporting Healthy Transitions and Follow-up.

The purpose of these bulletins is to share current information and Nova Scotia guidance about care for pregnant and childbearing persons and newborns during the COVID-19 pandemic. Our NS guidelines may differ from those of other countries and possibly from other Canadian provinces. Please consult with IWK and/or NSHA program leaders before adopting any guidance from outside of NS. The format of these documents is adapted with permission from bulletins produced by Vancouver Coastal Health Authority. Our thanks for their willingness to share with Nova Scotia.

Knowledge, understanding and terminology about COVID-19 is changing rapidly. Information in these documents will be modified in response to new data and evidence. NEW content added will be indicated as such. Please check http://rcp.nshealth.ca to ensure you are referring to the latest Maternal Newborn Care Bulletin.

The rotavirus vaccine has been added to Nova Scotia’s publicly funded childhood immunization program. Babies born on or after November 1, 2019 are eligible to receive this vaccine orally, starting at 2 months of age. Since rotavirus vaccine is a live attenuated vaccine, there may be implications for babies whose mothers are on biologic monoclonal antibodies. The exception is babies whose mothers are taking certolizumab or Cimzia (no implications with this medication).

If you have questions, you may contact the IWK Special Immunization Clinic by e-mail at sicnurse@iwk.nshealth.ca or by calling Karen Branscombe at 902-470-7859.

A referral form is attached below.

As of January 20, 2020, the Office of the Chief Medical Officer of Health for Nova Scotia has declared a provincial syphilis outbreak. Across Canada syphilis outbreaks have been declared in most provinces/territories, due to increasing rates of infection. Changes to recommendations for pregnant women and newborns are outlined in the documents below:

The Canadian Paediatric Society (CPS) has recommended moving from universal newborn ocular prophylaxis, to universal prenatal screening for Neisseriae gonorrhoeae (GC) and Chlamydia trachomatis (CT) and treatment of those with positive results in order to eradicate infection and prevent intrapartum transmission to the newborn.

As universal ocular prophylaxis is eliminated from routine newborn care, functions of the health system must be optimized and synchronized to prevent ON. RCP has partnered with clinical experts and stakeholders from across NS to produce these resources, which are designed to offer guidance for the prevention of ON:

In February of 2018, the National Advisory Committee on Immunization issued updated guidelines for pertussis vaccination in pregnancy.

https://www.canada.ca/en/public-health/services/publications/healthy-liv...

Tdap in Pregnancy:

  • Immunization with Tdap vaccine should be offered in every pregnancy at 27-32 weeks of gestation, regardless of previous Tdap immunization history.
  • Tdap immunization in pregnancy has been shown to protect infants against pertussis in the first three months of life. The safety of the Tdap vaccine during pregnancy is well established.
    • Based on safety and effectiveness data, the ideal timing for immunization is 27-32 weeks of gestation. Immunization between 22-26 weeks may be considered for specific clinical or operational reasons, e.g. increased risk of preterm delivery. Although NACI supports immunization between 13-26 weeks, 22-26 weeks covers most preterm babies.
    • Immunization until the end of pregnancy should be considered as it has the potential to provide partial protection (four weeks are required for optimal transfer of antibodies and direct protection of the infant against pertussis). In addition, there may be indirect protection through breast milk.
    • Women who were not immunized during pregnancy should receive Tdap as soon as possible after birth to protect the baby from coming into contact with pertussis. Immunization is particularly important if the baby is preterm.
  • If Tdap immunization was provided early in pregnancy (e.g. prior to recognition of pregnancy), it is not necessary to re-immunize after 13 weeks of gestation.

In addition, all caregivers and close contacts, both children and adults, should be up to date with their pertussis immunization. The Nova Scotia Routine Immunization schedule is available here:

https://novascotia.ca/dhw/cdpc/documents/Routine-Immunization-Schedules-...

Infants and young children are at particular risk of contracting pertussis until they have completed their primary immunization series. For maximum protection, children need a primary series of pertussis-containing vaccine at two, four, and six months followed by booster doses at 18 months, between four to six years of age, and again as part of the school-based immunization program, which in Nova Scotia, occurs in Grade 7.

The best way to prevent mortality and significant morbidity from pertussis is for health care providers to:

  • offer one dose of pertussis containing vaccine (Tdap) to all pregnant women, ideally at 27-32 weeks of gestation. An earlier gestation may be chosen in some circumstances;
  • ensure that infants and young children are immunized according to the recommended schedule; and
  • recommend that caregivers and close contacts of infants and young children receive a pertussis immunization.

The current recommendation from the Canadian Cardiovascular Society (CCS), Canadian Pediatric Cardiology Association (CPCA), and the Canadian Pediatric Society (CPS) is that pulse oximetry screening should be routinely performed in all healthy newborns to enhance the detection of critical congenital heart disease (CCHD) in Canada.

RCP has worked with physicians from IWK Pediatric Cardiology and Neonatology to support the implementation of pulse oximetry screening for all healthy newborns in Nova Scotia based on the protocol outlined in the 2016 CCS/CPCA Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease. Results of this collaboration are available as a recorded presentation made in September 2017.

Please see the attached documents for further information and resources to support pulse oximetry screening.

The Nova Scotia Hyperbilirubinemia Guideline Implementation Working Group provides a provincial strategy for implementing the Canadian Pediatric Society's (CPS) Position Statement and Guidelines for Detection, Management and Prevention of Hyperbilirubinemia in Term and Late Preterm Newborn Infants. The following tools have been developed and others adapted from the CPS Guidelines to assist the Nova Scotia Health Authority and the IWK with this implementation.

Palivizumab (Synagis®) for RSV prevention

IWK Health Centre manages the utilization of palivizumab in Nova Scotia for the prevention of respiratory syncytial virus (RSV) infection in infants. For information regarding the guidelines for the use of this product and the request approval process, please go to the palivizumab section of the IWK Health Centre's website or contact:

Karen Chestney, RN
Provincial Palivizumab Monitoring Nurse
IWK Health Centre
470-2723