Prevalence of SARS-CoV-2 Among 2-Week-Old Infants Born to Positive Mothers
by Anne Eglash MD, IBCLC, FABM
At the beginning of the COVID-19 pandemic, there was concern that newborn infants born to a SARS-CoV-2-positive mother were at risk of contracting SARS-CoV-2. Subsequent studies have shown that newborns have a low risk of positive testing or infection at 24 hours of age. Based on these findings, the American Academy of Pediatrics and the American College of Obstetrics and Gynecology recommend rooming-in and breastfeeding as usual for SARS-CoV-2-positive mothers.
The study for this week analyzed the prevalence of SARS-CoV-2 at 2 weeks of age among 293 infants born to SARS-CoV-2-positive mothers at a NY hospital system March 2020-March 2022. Approximately 60% of the mothers were asymptomatic at the time of hospital admission for labor. All mothers were masked and newborns were allowed to room-in and directly breastfeed if the mother was asymptomatic. Symptomatic mothers were instructed to express milk and have another person feed the infant. All newborns were tested for SARS-CoV-2 at 24 hours of age. At the time of discharge postpartum, all mothers were advised to wear a mask, wash their hands, and pump parts, and perform ‘breast hygiene’ (not defined). The infants were re-swabbed at 14 days for SARS-CoV-2.
All infants tested negative for SARS-CoV-2 at 24 hours of age. Of the 293 infants followed at birth, 222 were tested for SARS-CoV-2 at 14 days of age.
What % of infants were positive on day 14? See the question!
- 21.4%
- 12.7%
- 7.2%
- 3.2%
See the Answer
Abstract
Introduction
Limited evidence exists on management recommendations for neonates born to SARS-CoV-2-positive mothers. This study looked at transmission risk of neonates presenting for primary care in a large regional health system within New York during the early months of the COVID-19 pandemic.
Methods
This was a prospective, observational study of newborns born to SARS-CoV-2-positive mothers presenting at any of the 19 Northwell HealthCohen Children’s Medical Center primary care practices who underwent another oropharyngeal/nasopharyngeal swab for detection of SARS-CoV-2 by day of life (DOL) 14.
Results
Among 293 newborns born to SARS-CoV-2-positive mothers who were negative at birth, 222 were retested at DOL 14, corresponding to times with different predominant strains. Of these, seven tested positive but had no symptoms.
Conclusion
The overall low transmission rates and absence of symptomatic infection support the safety of direct breastfeeding after hospital discharge with appropriate hand and breast hygiene.
Among the 3.2% of infants who tested positive for SARS-CoV-2 at 14 days of age, none were symptomatic.
This study validates the recommendations by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics to not separate newborns from the birthing parent if they are positive for SARS-CoV-2, and to directly breastfeed. Because the infants of symptomatic mothers were not more likely to become symptomatic with SARS-CoV-2, it does not appear indicated to separate these newborns from their mothers unless the mother’s illness circumstance precludes rooming-in.