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What is the risk of mother-to-newborn transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?
In this cohort analysis of the first 101 neonates born to mothers with perinatal SARS-CoV-2 infections at a single institution, 2 (2.0%) had positive test results for SARS-CoV-2, but none had clinical evidence of coronavirus disease 2019 (COVID-19), despite most infants rooming-in with mothers and direct breastfeeding. Fifty-five infants were followed up in the first 2 weeks of life in a new COVID-19 Newborn Follow-up Clinic, all of whom remained healthy.
These findings suggest that during the COVID-19 pandemic, separation of affected mothers and newborns may not be warranted, and direct breastfeeding appears to be safe.
Limited data on vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and health outcomes of neonates born to mothers with symptomatic or asymptomatic coronavirus disease 2019 (COVID-19) are available. Studies are needed to inform evidence-based infection prevention and control (IP&C) policies.
To describe the outcomes of neonates born to mothers with perinatal SARS-CoV-2 infection and the IP&C practices associated with these outcomes.
Design, Setting, and Participants
This retrospective cohort analysis reviewed the medical records for maternal and newborn data for all 101 neonates born to 100 mothers positive for or with suspected SARS-CoV-2 infection from March 13 to April 24, 2020. Testing for SARS-CoV-2 was performed using Cobas (Roche Diagnostics) or Xpert Xpress (Cepheid) assays. Newborns were admitted to well-baby nurseries (WBNs) (82 infants) and neonatal intensive care units (NICUs) (19 infants) in 2 affiliate hospitals at a large academic medical center in New York, New York. Newborns from the WBNs roomed-in with their mothers, who were required to wear masks. Direct breastfeeding after appropriate hygiene was encouraged.
Perinatal exposure to maternal asymptomatic/mild vs severe/critical COVID-19.
Main Outcomes and Measures
The primary outcome was newborn SARS-CoV-2 testing results. Maternal COVID-19 status was classified as asymptomatic/mildly symptomatic vs severe/critical. Newborn characteristics and clinical courses were compared across maternal COVID-19 severity.
In total, 141 tests were obtained from 101 newborns (54 girls [53.5%]) on 0 to 25 days of life (DOL-0 to DOL-25) (median, DOL-1; interquartile range [IQR], DOL-1 to DOL-3). Two newborns had indeterminate test results, indicative of low viral load (2.0%; 95% CI, 0.2%-7.0%); 1 newborn never underwent retesting but remained well on follow-up, and the other had negative results on retesting. Maternal severe/critical COVID-19 was associated with newborns born approximately 1 week earlier (median gestational age, 37.9 [IQR, 37.1-38.4] vs 39.1 [IQR, 38.3-40.2] weeks; P = .02) and at increased risk of requiring phototherapy (3 of 10 [30.0%] vs 6 of 91 [7.0%]; P = .04) compared with newborns of mothers with asymptomatic/mild COVID-19. Fifty-five newborns were followed up in a new COVID-19 Newborn Follow-up Clinic at DOL-3 to DOL-10 and remained well. Twenty of these newborns plus 3 newborns followed up elsewhere had 32 nonroutine encounters documented at DOL-3 to DOL-25, and none had evidence of SARS-CoV-2 infection, including 6 with negative retesting results.
Conclusions and Relevance
No clinical evidence of vertical transmission was identified in 101 newborns of mothers positive for or with suspected SARS-CoV-2 infection, despite most newborns rooming-in and direct breastfeeding practices.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: June 24, 2020.
Corresponding Authors: Cynthia Gyamfi-Bannerman, MD, MSc, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 W 168th St, PH 16-66, New York, NY 10032 (firstname.lastname@example.org); Melissa S. Stockwell, MD, MPH, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, 622 W 168th St, VC 417, New York, NY 10032 (email@example.com).
Published Online: October 12, 2020. doi:10.1001/jamapediatrics.2020.4298
Author Contributions: Drs Dumitriu and Emeruwa contributed equally to this study. Drs Dumitriu and Emeruwa had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Dumitriu, Emeruwa, Liao, Walzer, Arditi, Andrikopoulou, Scripps, Simpson, Friedman, Hirsch, Miller, Glassman, Akita, Penn, D’Alton, Orange, Goffman, Saiman, Stockwell, Gyamfi-Bannerman.
Acquisition, analysis, or interpretation of data: Dumitriu, Emeruwa, Hanft, Liao, Ludwig, Walzer, Arditi, Saslaw, Andrikopoulou, Scripps, Baptiste, Khan, Breslin, Rubenstein, Kyle, Hirsch, Fernandez, Fuchs, Keown, Stephens, Gupta, Sultan, Sibblies, Whittier, Abreu, Penn, Goffman, Stockwell, Gyamfi-Bannerman.
Drafting of the manuscript: Dumitriu, Emeruwa, Hanft, Liao, Ludwig, Arditi, Saslaw, Scripps, Khan, Rubenstein, Simpson, Kyle, Miller, Glassman, Akita, Gyamfi-Bannerman.
Critical revision of the manuscript for important intellectual content: Dumitriu, Emeruwa, Hanft, Liao, Walzer, Arditi, Saslaw, Andrikopoulou, Scripps, Baptiste, Khan, Breslin, Rubenstein, Friedman, Hirsch, Miller, Fernandez, Fuchs, Keown, Glassman, Stephens, Gupta, Sultan, Sibblies, Whittier, Abreu, Penn, D’Alton, Orange, Goffman, Saiman, Stockwell, Gyamfi-Bannerman.
Statistical analysis: Dumitriu, Emeruwa, Liao, Ludwig, Arditi, Kyle.
Administrative, technical, or material support: Dumitriu, Liao, Walzer, Arditi, Saslaw, Scripps, Baptiste, Breslin, Rubenstein, Kyle, Hirsch, Fernandez, Fuchs, Keown, Stephens, Sibblies, Whittier, Abreu, Akita, Penn, D’Alton, Orange, Goffman, Saiman.
Supervision: Dumitriu, Miller, Glassman, Sultan, Penn, D’Alton, Orange, Goffman, Saiman, Stockwell, Gyamfi-Bannerman.
Other - research for discussion section: Gupta.
Conflict of Interest Disclosures: Dr Miller reported receiving personal fees from UpToDate and Medicolegal for consulting work outside the submitted work. Dr D’Alton reported a paid advisory board member for Merck for Mothers, Merck & Co, outside the submitted work. Dr Orange reported receiving stock options for service on the advisory board of GigaGen outside the submitted work. Dr Gyamfi-Bannerman reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development outside the submitted work. No other disclosures were reported.
Additional Contributions: We acknowledge the exceptional work of the entire team on the front line, including physicians, nurses, and staff at Columbia University Irving Medical Center and New York-Presbyterian Hospital. We thank Caroline Torres, MD, and Cynthia Masson, BA, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, without whom this work could not have been completed. They were not compensated for this work. Finally, we thank the mothers who placed their trust in us to care for them and their newborns during this extraordinary time.
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