Clinical Practice Resources

The Safe Infant Sleep Clinical Practice Resource is intended to help guide perinatal care providers in giving evidence-based information to families to support them in making informed decisions about safe sleep for their babies. All families should be provided with education about safe sleep practices, including modifiable factors that can reduce the risk of SIDS and other sleep related infant deaths or injuries. This resource overviews key safe sleep messages to address key modifiable risk factors along with harm reduction strategies that can be discussed with families.

This practice resource provides a provincial approach that aligns with 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 resource and tools have been developed and/or adapted from the CPS Guidelines to assist care providers from Nova Scotia Health and the IWK in making decisions regarding the care of babies > 35 weeks gestation who are well with no clinical signs of jaundice.

The late preterm infant (LPI) requires frequent assessment and close observation due to their inherent risks and medical vulnerability compared to the term infant. These guidelines focus on these infants cared for in a postpartum setting and will support health care providers in the proactive approach to the care requirements, assessment, monitoring, and discharge planning of the late preterm infant.

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 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 Pamela MacIntyre at 902-470-8948.

A referral form is attached below.

Syphilis and Screening in NS for Pregnant Persons and Newborns

The rate of syphilis in Canada has been steadily rising in recent years, becoming a significant public health concern. A surge in syphilis infection among women of childbearing age has led to more cases of congenital syphilis (transmission from the pregnant person to the fetus during pregnancy), which can result in severe health outcomes or death in newborns. An infographic created by the Public Health Agency of Canada provides a visual aid depicting the increase in syphilis rates in Canada. Cases of syphilis in pregnancy and confirmed cases of syphilitic stillbirth are reportable to Public Health. The rise in cases has led to national research exploring strategies to address infectious and congenital syphilis in Canada. 

Screening

Screening recommendations for syphilis during the antenatal and postpartum periods, and for newborns are provided below.  These recommendations have been in place since 2020, were adapted from national guidelines, and remain in place until further notice. See the letter to care providers from January 2020 for additional practice guidance regarding consultation, testing and treatment.
Perform syphilis serology:

• Early in pregnancy for all pregnant persons.
• Repeat for all pregnant persons at 24 -28 weeks gestation.
  • For patients considered at high risk for syphilis, repeat syphilis serology at the time of birth.
• For patients considered at high risk for syphilis, repeat syphilis serology at the time of birth.
• In pregnant persons who experience a stillbirth from 20 weeks gestation onward.
• In pregnant persons who have NOT had the recommended syphilis serology during pregnancy, complete the screening prior to discharge following birth.
• In infants presenting with symptoms or signs compatible with early congenital syphilis even if the parent was seronegative at birth, due to the possibility of a very recent parental infection. 

Provincial Syphilis Outbreak: Recommendations for pregnant persons and newborns

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:

Provincial Pertussis Information from Public Health

Canada is seeing an overall increase in pertussis (whooping cough) cases, including here in Nova Scotia. Pertussis is a vaccine preventable disease that can be easily spread from person to person. It is spread by close contact with drops of fluid from the nose and throat of someone who has the disease.
Pertussis is very serious for babies and young children, especially newborns because they cannot be vaccinated until at least two months of age and can become extremely sick from pertussis. For this reason pregnant persons are strongly encouraged to get a dose of the pertussis vaccine (Tdap) during the third trimester of pregnancy, as the immunization offers some protection for newborns.
NS Public Health is requesting that care providers and community partners share information about pertussis prevention, signs and symptoms with pregnant persons and those with new babies, so they will be better informed about options for protecting their children. Please share the letter and infographic with the people you serve and post the infographic in public spaces.
As a reminder for healthcare providers, anyone suspected to have pertussis should have a nasopharyngeal (NP) swab to rule in or out the diagnosis. These swabs should preferably be done prior to starting antibiotics. Pertussis is a notifiable disease and all confirmed diagnoses must be reported to Public Health. This document provides details on how to report notifiable diseases. More information about pertussis is also available at www.nshealth.ca/pertussis .

National Advisory Committee on Immunization(2018)

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.