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

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Are rooming-in and breastfeeding safe for neonates born to mothers infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?

Findings  In this multicenter cohort study, 62 neonates born to 61 mothers with SARS-CoV-2 infection were roomed-in with appropriate precautions; no neonate tested positive for SARS-CoV-2 on nasopharyngeal swab at birth, and 95% of them were breastfed. All neonates were followed up until age 3 weeks; only 1 neonate was diagnosed as having SARS-CoV-2 infection during follow-up.

Meaning  The findings of this study suggest that mother-to-infant transmission of SARS-CoV-2 during rooming-in practice is rare, provided that adequate droplet and contact precautions are taken.

Abstract

Importance  The 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 Participants  A 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.

Results  Of 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 Relevance  The 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.

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Article Information

Accepted for Publication: July 15, 2020.

Published Online: December 7, 2020. doi:10.1001/jamapediatrics.2020.5086

Corresponding Author: Lorenza Pugni, MD, Clinica Mangiagalli, via della Commenda 12, 20122 Milan, Italy (lorenza.pugni@mangiagalli.it).

Author Contributions: Dr Pugni had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Ronchi and Pietrasanta contributed equally as co–first authors.

Concept and design: Ronchi, Pietrasanta, Mosca, Pugni.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Ronchi, Pietrasanta, Pugni.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Spada.

Administrative, technical, or material support: Zavattoni, Schena.

Supervision: Baldanti, Mosca, Pugni.

Conflict of Interest Disclosures: None reported.

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