Clinical Practice Guidelines

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

In January 2002, the Department of Health, Public Health/Health Promotion, asked the Reproductive Care Program of Nova Scotia to "Develop ...Department of Health minimum acceptable standards for initial postpartum contact (0-6 weeks) in Nova Scotia". RCP established a Postpartum Services Review Working Group with representation from hospital and community nursing, nursing education, family practice, public health, obstetrics and pediatrics to assist them with this important task. This report represents the findings of the Postpartum Services Review Working Group and recommends a series of guidelines intended to ensure that postpartum/postnatal services are provided in an informed and consistent way across Nova Scotia.