Caring for Newborns Born to Mothers With COVID-19: More Questions Than Answers

Gupta, Munish; Zupancic, John A.F.; Pursley, DeWayne M.

doi:10.1542/peds.2020-001842

Cited by 14 publications

(17 citation statements)

References 13 publications

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“…We anticipate the publication of data from ongoing larger registry studies to assess the generalizability of these early observations. 35 Regarding infection control practices, we found that a large proportion of infants were not managed according to AAP and CDC recommendations in place at the time of delivery, 14,15 with half of dyads colocating and 40% directly breastfeeding. Rates of indirect breastfeeding of expressed maternal milk were exceedingly low in this sample, despite being the recommended practice by both AAP 14 and CDC, 15 at the time of data collection to preserve breastfeeding during temporary mother-infant separation.…”

Section: Discussionmentioning

confidence: 91%

Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals

et al. 2021

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Objective There is a paucity of evidence to guide the clinical care of late preterm and term neonates born to women with perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The objective of this case series is to describe early neonatal outcomes and inpatient management in U.S. hospitals. Study Design We solicited cases of mother–infant dyads affected by novel coronavirus disease 2019 (COVID-19) from the Better Outcomes through Research for Newborns (BORN) Network members. Using a structured case template, participating sites contributed deidentified, retrospective birth hospitalization data for neonates ≥35 weeks of gestation at birth with mothers who tested positive for SARS-CoV-2 before delivery. We describe demographic and clinical characteristics, clinical management, and neonatal outcomes. Results Sixteen U.S. hospitals contributed 70 cases. Birth hospitalizations were uncomplicated for 66 (94%) neonates in which 4 (6%) required admission to a neonatal intensive care unit. None required evaluation or treatment for infection, and all who were tested for SARS-CoV-2 were negative (n = 57). Half of the dyads were colocated (n = 34) and 40% directly breastfed (n = 28). Outpatient follow-up data were available for 13 neonates, all of whom remained asymptomatic. Conclusion In this multisite case series of 70 neonates born to women with SARS-CoV-2 infection, clinical outcomes were overall good, and there were no documented neonatal SARS-CoV-2 infections. Clinical management was largely inconsistent with contemporaneous U.S. COVID-19 guidelines for nursery care, suggesting concerns about the acceptability and feasibility of those recommendations. Longitudinal studies are urgently needed to assess the benefits and harms of current practices to inform evidence-based clinical care and aid shared decision-making. Key Points

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Section: Discussionmentioning

confidence: 91%

Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals

et al. 2021

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“…Approximately 217 neonates delivered to pregnant women with COVID-19 have been reported in the literature. 51 More recently, 19 additional infected neonates were reported 24 from 10 hospitals in Iran, among whom there were infants with early and late positive testing for the virus. The relative risks and proportions of neonatal infections that result from a) intrauterine transmission of SARS-CoV-2 from either transplacental or ascending infection; b) acquiring infection during labor and delivery; or c) following delivery from the mother, other individuals, or the environment remain unknown.…”

Section: Discussionmentioning

confidence: 99%

Confirming Vertical Fetal Infection With Coronavirus Disease 2019: Neonatal and Pathology Criteria for Early Onset and Transplacental Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Infected Pregnant Mothers

Schwartz

Morotti

Beigi

et al. 2020

Archives of Pathology &Amp; Laboratory Medicine

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Increasing numbers of pregnant women with COVID-19 are being reported around from the world. The majority of neonates delivered to pregnant women infected with the new coronavirus SARS-CoV-2 have been negative for the virus, but a small number have tested positive for infection. It is important to determine whether vertical transmission of COVID-19 occurs and the mechanisms for its development. Based on a number of clinical and laboratory findings it has been suggested that transplacental transmission may be occurring, but a method to confirm this is necessary. This communication analyzes and evaluates the covariables that have been discussed as potential indicators of vertical and, specifically, intrauterine transmission including the timing of onset of neonatal illness, neonatal viral test positivity, neonatal antibody testing for IgG and IgM, and viral analysis of swabs of whole specimens of placental tissue. None of these methods can provide confirmatory evidence that infection developed prior to labor and delivery, or that transplacental transmission occurred. This commentary proposes that diagnosis of early-onset neonatal COVID-19 infection should be limited to neonates with positive RT-PCR testing for SARS-CoV-2 within the initial 72 hours of life. It also proposes that the occurrence of intrauterine transplacental SARS-CoV-2 among infected mother-infant dyads be based upon identification of SARS-CoV-2 in chorionic villous cells using immunohistochemistry or such nucleic acid methods such as in situ hybridization. Evaluating placentas from neonates with COVID-19 using these methods will be instrumental in determining the potential role and prevalence of transplacental transmission of the coronavirus.

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“…Newborn infants born to these mothers were screened for the virus. Although a limited number of cases in the current literature reveal that most newborns have favorable outcomes, there remain uncertainties concerning the possible transmission of the virus from the mother to the baby [4][5][6]. This case series of SARS-CoV-2 positive newborns is thus an important contribution to understanding the etiopathology and management of these infants.…”

Section: Introductionmentioning

confidence: 99%

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Positive Newborns of COVID-19 Mothers After Dyad-Care: A Case Series

Patil

Krishnan

Abudinen-Vasquez

et al. 2021

Cureus

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The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in newborns is extremely rare, and there is a scarcity of research pertaining to epidemiology, clinical presentation, transmission, and prognosis in this population. We present five newborns who tested positive while colocating with their SARS-CoV-2 positive mothers from March 19 to May 15, 2020, at a large public hospital in Queens, New York that was severely affected by the coronavirus disease 2019 (COVID-19) pandemic. All the newborns subsequently tested negative and remained asymptomatic, including through median outpatient follow-up of three weeks.

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Caring for Newborns Born to Mothers With COVID-19: More Questions Than Answers

Cited by 14 publications

References 13 publications

Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals

Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals

Confirming Vertical Fetal Infection With Coronavirus Disease 2019: Neonatal and Pathology Criteria for Early Onset and Transplacental Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Infected Pregnant Mothers

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Positive Newborns of COVID-19 Mothers After Dyad-Care: A Case Series

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