Mothers positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at delivery are unlikely to transmit the infection to their infants during the perinatal period provided proper precautions are undertaken, a study in The Lancet Child & Adolescent Health has found.
“This is the largest cohort of neonates born to mothers positive for SARS-CoV-2 at the time of delivery, with prospective follow-up up to 1 month of life,” Christine M Salvatore, Departments of Pediatrics, Weill Cornell Medicine, New York Presbyterian—Komansky Children’s Hospital, New York, NY, and colleagues noted.
“In view of the benefits of early mother–neonate bonding and breastfeeding, rooming in with the mother and direct breastfeeding are safe and should be promoted,” they said, but cautioned that these procedures “need to be paired with effective parental education of infant protective strategies, such as use of surgical masks when near the neonate and frequent hand hygiene.”
The observational cohort study looked at all neonates born between March 22 and May 17, 2020, at three New York Presbyterian Hospitals in New York City to mothers positive for SARS-CoV-2 at delivery. Infection control practices included in the data collection were disposition of the neonate at delivery (allowed to room in with mother or admitted to a dedicated isolation room), feeding method (direct breastfeeding or expressed breast milk or formula), and self-reported frequency of hand hygiene, breast cleansing, and use of surgical masks.
Mothers could practice skin-to-skin care and breastfeed in the delivery room, but had to wear a surgical mask when near their neonate, as well as practice proper hand hygiene before skin-to-skin contact, breastfeeding, and routine care. Unless required otherwise for medical reasons, neonates were kept in a closed Giraffe isolette in the same room as their mothers, and were held by mothers for feeding.
Neonates were tested for SARS-CoV-2 via real-time PCR on nasopharyngeal swabs taken at 24 hours, 5–7 days, and 14 days of life, and were clinically evaluated by telemedicine at 1 month of age. Of 1481 deliveries, 116 (8%) mothers tested positive for SARS-CoV-2, and 120 neonates were identified.
All neonates were tested at 24 hours of life and none were positive for SARS-CoV-2. There were 82 (68%) neonates who completed follow-up at days 5–7 of life. Among these, half were female, 36 (44%) were born by caesarean section, 68 (83%) were born at term, 14 (17%) were preterm, and the median gestational age was 38 weeks (range 27–41). Twelve (15%) neonates were admitted to the neonatal intensive care unit (NICU) and 70 (85%) received routine neonatal care.
Seventy-nine (96%) of 82 neonates had a repeat PCR at 5–7 days of life, which was negative in all cases. In addition, 72 (88%) neonates were also tested at 14 days of life and none were positive. None of the neonates had symptoms of COVID-19.
Meanwhile, of the 82 neonates, 68 (83%) roomed in with the mothers, all of whom were allowed to breastfeed, and at 5–7 days of life, 64 (78%) were still breastfeeding.
By 5–7 days of life, 73 (89%) of 82 neonates were discharged home to parents, and the remaining 9 (11%) remained hospitalised. Forty-four (60%) of these 73 neonates were discharged home to an environment where a household member, other than the mother, had reported symptoms consistent with COVID-19. In most cases, the symptomatic household member was an adult, and in multiple cases, more than one household member was ill.
As of May 17, 53 (65%) of 82 neonates have been followed up by telemedicine at 1 month of life. The authors said 77 (94%) of 82 infant’s parents were symptom-free at the day 14 of life visit and were instructed to discontinue mask precautions at home when around the neonate. Five (6%) of 82 infant’s parents were still symptomatic and were instructed to continue wearing a mask for an extra week.
“Findings from our cohort support the published literature, which consists mainly of small case series that suggest that perinatal transmission of SARS-CoV-2 to neonates from infected mothers or family members are rare events provided close attention to infection precautions are maintained,” the authors said.
They added that “because about half of the mothers were symptomatic shortly before or during delivery, acquisition of protective maternal antibodies in all infants is unlikely. Moreover, our data show no difference in neonatal outcome on the basis of whether mothers were symptomatic or not.”
The authors indicated that a larger cohort and longer follow-up with repeat testing and serology might be needed to confirm that perinatal transmission is unlikely to occur if correct protective strategies are used. They also noted that they were unable to screen for presence of the virus in blood, urine, or stool due to absence of approved testing for these samples during the study period. “Thus, it remains possible that the virus might be detectable only in the blood and urine rather than in the respiratory tract in congenitally infected neonates.”