COVID-19 Infection Among Newborns of SARS-CoV-2 Positive Mothers
by Anne Eglash MD, IBCLC, FABM
Due to varying recommendations between professional organizations, such as the American Academy of Pediatrics and the World Health Organization, hospital policies in the USA vary regarding the separation of newborns and mothers postpartum when mom is positive for coronavirus infection. So far it has been pretty clear that infection among newborns is not common, but there has not been a wealth of evidence as to whether allowing newborns to be skin to skin and rooming in with mom increases the risk of infant infection.
We do know that when moms and infants are separated postpartum, breastfeeding is more difficult to establish. This is the underlying premise behind the Baby Friendly Hospital Initiative (BFHI). Hospitals that fulfill the 10 steps of BFHI have higher rates of breastfeeding initiation, and higher rates of exclusive breastfeeding at the time of hospital discharge. Breastfeeding within the first hour, skin to skin after birth, and rooming in are all tenets of BFHI.
The authors of this week’s study evaluated 49 studies published between 4/7/20-5/6/20 from a variety of countries that reported on maternal SARS-COV-2 status and neonatal outcomes. These studies included 666 neonates and 656 COVID-19 positive women. The authors sought to determine if the risk of neonatal infection was related to vaginal vs cesarean birth, breastfeeding vs formula feeding, and rooming in vs mother-baby separation.
The authors found that 28/666 neonates had confirmed COVID-19 infection. Eight neonates had symptoms, but 4 of the eight possibly had symptoms related to prematurity. For most infants, the method of feeding was not reported.
Among the 666 neonates, 52 were isolated from their mothers, 107 were cared for in the same room as their mother, and for the other 502 neonates, mode of care was not reported. Among the 28 infants infected with COVID-19, 7 were kept isolated from their mother, 5 were cared for in the same room, and for the other 16, mode of care was not reported. The authors determined that among the 159 infants for whom mode of postpartum care was reported, room-sharing between a COVID-19 positive mother and her newborn is not associated with a significantly higher risk of COVID-19 infection for newborns.
- Infants were more likely to be COVID-19 positive if born via cesarean vs vaginal birth.
- Babies should be born via cesarean birth to decrease the risk of COVID-19 infection when mom is positive for SARS-COV-2.
- Neonates who test positive for COVID-19 within 12 hours after birth have been proven to become infected as fetuses (vertical transmission).
- Based on the infant feeding data among COVID-19 positive newborns, there is no evidence that breastfeeding increases the risk of COVID-19 infection.
See the Answer
Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding, is this practice justified?
To estimate the risk of the neonate becoming infected with the SARS-COV-2 by mode of delivery, type of infant feeding, and mother-infant interaction.
Two biomedical databases were searched between September 2019-June 2020.
Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported.
Data Collection and Analyses
Data was extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection a critical analysis was performed to evaluate the likelihood of vertical transmission.
We included 49 studies which included 666 neonates and 655 women where information was provided on mode of delivery and the infant’s infection status. 28/666 (4%) neonates had confirmed COVID-19 infection, 7 were breastfed, 3 formula fed, 1 was given expressed breast milk and in 17 neonates the method of infant feeding was not reported.
Neonatal COVID-19 infection is uncommon, uncommonly symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfeed, or allowed contact with the mother.
Among the 49 studies, it was clear that the risk of COVID-19 infection among newborns of SARS-COV-2 positive mothers is very low. Granted, most newborns were not routinely tested after birth, but it very uncommon for newborns to have symptoms of illness from the coronavirus.
The risk of infection among newborns was actually slightly higher with cesarean birth, at 5.3% vs 2.7% for newborns born vaginally.
Vertical transmission from mother to fetus has not been proven. It is possible that some of the newborns who tested positive within 12 hours after birth may have been colonized by the virus due to exposure to maternal stool or blood. At least 1 infant was retested 12 hours later, after having a bath, and was negative.
Overall, despite the number of known cases of COVID+ mothers delivering, the details on feeding type and maternal separation vs room sharing has not been documented. This is disappointing, and hopefully over time we will have more robust data on the effects of infant feeding and infant-maternal contact postpartum. This data does not indicate that maternal-infant separation is warranted, that cesarean birth will prevent spread of COVID-19 to neonates, or that newborns should be given formula instead of breastmilk.