Only 1 of 62 newborns who breastfed and roomed with their 61 COVID-19–infected mothers in Lombardy, Italy, was diagnosed as having the novel coronavirus, suggesting that mother-to-infant transmission is rare, according to a study published today in JAMA Pediatrics.
From Mar 19 to May 2, the prospective, six-center study monitored the infant and mother pairs for 20 days after birth. The one infected newborn was taken to the neonatal intensive care unit (NICU) after 5 days, when the mother developed bilateral pneumonia and pulmonary embolism requiring mechanical ventilation for 14 days. Two days after arrival in the NICU, the infant tested positive for SARS-CoV-2, the virus that causes COVID-19, and had periodic, mild shortness of breath for a few days.
The centers encouraged mothers to room with and breastfeed their babies. The mothers were housed in dedicated COVID-19 units and advised to wash their hands and don a surgical mask before breastfeeding or providing other care and to otherwise stay 2 meters (6.6 feet) away from their infants.
The mothers, who didn't wear gloves, gowns, or goggles, couldn't have visitors (including the fathers) and had to follow sterilization protocols when feeding their babies expressed milk or formula. Four (6%) of newborns were initially unprotected while rooming-in because their mothers weren't tested for COVID-19 until after childbirth.
Good clinical outcomes for all
Fifty-six of the 62 newborns (90%) were born at term, while 6 (10%) were born after their due dates. One newborn, who needed resuscitation at birth, was given ventilation with a mask.
Forty-six of the 61 mothers (75%) delivered vaginally. Forty-four (72%) were diagnosed as having COVID-19 before delivery, while 14 (23%) were suspected of being infected at delivery, and 3 (5%), including the 1 who had twins, were diagnosed 2 to 5 days after delivery on the basis of symptoms. Of all the newborns in the study, 95% were breastfed.
Thirty-four of the 61 women (55%) had symptoms at diagnosis, while 43 (70%) were asymptomatic at delivery. No deaths were reported, and all infants remained in good clinical condition throughout the study.
The authors noted that while current recommendations vary, most advise either separating COVID-19–infected mothers from their babies after birth or keeping them together and breastfeeding while taking infection-control precautions. They added that separating mothers from their newborns interferes with both bonding and breastfeeding.
"We believe that SARS-CoV-2–infected mothers in good clinical condition and willing to take care of their babies should be encouraged to practice rooming-in and breastfeeding after being carefully instructed about the appropriate droplet and contact precautions," the authors wrote.
Better together
In a commentary in the same journal, David Kaufman, MD, of the University of Virginia in Charlottesville, and Karen Puopolo, MD, PhD, of the University of Pennsylvania in Philadelphia, said that the study's findings align with those of the American Academy of Pediatrics' (AAP's) Section on Neonatal Perinatal Medicine's COVID-19 perinatal registry of 4,000 newborns tested for COVID-19.
Registry data show that about 60% of the mother and child pairs roomed together, with less than 2% of newborns testing positive for coronavirus. They also cited recent placental studies with results suggesting that the placenta is an unlikely route of mother-to-child SARS-CoV-2 transmission.
"Immunocompetent patients who are not critically ill, at least 10 days removed from their onset of symptoms or first positive test, afebrile [having no fever] for at least 24 hours, and are improving overall are highly unlikely to be shedding infectious virus," Kaufman and Puopolo wrote.
The study results confirm newly updated advice from the AAP that infection-prevention measures should be taken to protect the newborns of potentially infectious mothers at delivery, the commentary authors said. At the same time, because infected infants and young children tend to have greater COVID-19 viral loads in their upper respiratory tract than adults do, they should be considered a source of community spread and kept away from others while contagious.
Kaufman and Puopolo added that the study findings should reassure families and clinicians about the low risk of transmission to mothers and newborns rooming together in the hospital. "For newborns, this accumulation of evidence is ensuring that, with proper precautions, they can stay where they belong: with their mothers," they said.
