Evaluation of Rooming-in Practice for Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Italy

Abstract

IMPORTANCEThe management of mother-infant dyads during the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic constitutes a major issue for neonatologists. In mothers with SARS-CoV-2 infection, current recommendations suggest either to separate the dyad or encourage protected rooming-in under appropriate precautions. No data are available regarding the risk of mother-to-infant transmission of SARS-CoV-2 during rooming-in.OBJECTIVE To evaluate the risk of postnatal transmission of SARS-CoV-2 from infected mothers to their neonates following rooming-in and breastfeeding. DESIGN, SETTING, AND PARTICIPANTSA prospective, multicenter study enrolling mother-infant dyads from March 19 to May 2, 2020, followed up for 20 days of life (range, 18-22 days), was performed. The study was conducted at 6 coronavirus disease 2019 maternity centers in Lombardy, Northern Italy. Participants included 62 neonates born to 61 mothers with SARS-CoV-2 infection who were eligible for rooming-in practice based on the clinical condition of the mother and infants whose results of nasopharyngeal swabs were negative at birth. EXPOSURES Mothers with SARS-CoV-2 infection were encouraged to practice rooming-in and breastfeeding under a standardized protocol to minimize the risk of viral transmission.MAIN OUTCOMES AND MEASURES Clinical characteristics and real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 on neonatal nasopharyngeal swabs at 0, 7, and 20 days of life. RESULTSOf the 62 neonates enrolled (25 boys), born to 61 mothers (median age, 32 years; interquartile range, 28-36 years), only 1 infant (1.6%; 95% CI, 0%-8.7%) was diagnosed as having SARS-CoV-2 infection at postbirth checks. In that case, rooming-in was interrupted on day 5 of life because of severe worsening of the mother's clinical condition. The neonate became positive for the virus on day 7 of life and developed transient mild dyspnea. Ninety-five percent of the neonates enrolled were breastfed. CONCLUSIONS AND RELEVANCEThe findings of this cohort study provide evidence-based information on the management of mother-infant dyads in case of SARS-CoV-2 maternal infection suggesting that rooming-in and breastfeeding can be practiced in women who are able to care for their infants.

The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study

“…The possibility of maternal-fetal virus transmission leading to infection in the neonatal period had been observed in other respiratory diseases before the current pandemic [28]. While the literature on COVID-19 is still limited, the available data has not observed significant infection rates among neonates born from mothers who tested positive for COVID-19; when it occurred, clinical manifestations were generally mild [1][2][3][4][5][6][11][12][13][14].…”

“…Despite recommendations for breastfeeding and other protective practices to minimize viral transmission, including temporary separation of mother and child during active infection, the precise numbers of maternalinfant transmission are not known due to the potentially high number of asymptomatic infected women who are not tested for COVID-19. Nevertheless, COVID-19 fatality among neonates and the infection during breastfeeding seem infrequent [3][4][5]. Although it cannot be excluded that an infant exposed to SARS-CoV-2 may develop COVID-19 and respiratory failure, the reported neonatal cases to date are generally mild with favorable outcomes [5,6].…”

“…Breastfeeding improves both the mother's and infant's health and has a positive social and economic impact [7][8][9][10]. Based on current scientific knowledge, there is no evidence that breast milk from a mother with COVID-19 is a transmission vehicle [4,[11][12][13][14]. The guidelines for the management of the mother-infant dyad exposed to SARS-CoV-2 recommend a complex hospital organization and infection control measures for neonates during breastfeeding; however, there are few references on promoting and supporting this practice in the pandemic [15][16][17][18][19][20][21][22][23][24][25][26][27].…”

“The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study”

“…The possibility of maternal-fetal virus transmission leading to infection in the neonatal period was observed in other respiratory diseases before the current pandemic [28]. However, the literature on COVID-19 is still limited, and the available data has not observed signi cant infection rates among neonates born from mothers who tested positive for COVID-19; when it occurred, clinical manifestations were generally mild [1][2][3][4][5][6][11][12][13][14].…”

“…Despite the recommendations for the practice of breastfeeding, protective measures, and even the temporary separation between mother and child during the transmission phase of the infection, may not be effective to prevent the transmission of SARS-CoV-2, due to the potentially high number of asymptomatic infected women who are not tested for COVID-19. Nevertheless, COVID-19 fatality among neonates and the infection during breastfeeding seems to be lower [3][4][5]. Although it cannot be excluded that an infant exposed to SARS-CoV-2 may develop COVID-19 and respiratory failure, the reported neonatal cases to date are generally mild with a favorable evolution [5,6].…”