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

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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.


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.

Schwartz  DA .  An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes.   Arch Pathol Lab Med. 2020. doi:10.5858/arpa.2020-0901-SA PubMedGoogle Scholar
Schwartz  DA , Graham  AL .  Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections.   Viruses. 2020;12(2):E194. doi:10.3390/v12020194 PubMedGoogle Scholar
Chen  H , Guo  J , Wang  C ,  et al.  Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.   Lancet. 2020;395(10226):809-815. doi:10.1016/S0140-6736(20)30360-3 PubMedGoogle ScholarCrossref
Rasmussen  SA , Smulian  JC , Lednicky  JA , Wen  TS , Jamieson  DJ .  Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know.   Am J Obstet Gynecol. 2020;222(5):415-426. doi:10.1016/j.ajog.2020.02.017 PubMedGoogle ScholarCrossref
Alzamora  MC , Paredes  T , Caceres  D , Webb  CM , Valdez  LM , La Rosa  M .  Severe COVID-19 during pregnancy and possible vertical transmission.   Am J Perinatol. 2020;37(8):861-865. doi:10.1055/s-0040-1710050 PubMedGoogle ScholarCrossref
Liu  D , Li  L , Wu  X ,  et al.  Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis.   AJR Am J Roentgenol. 2020;215(1):127-132. doi:10.2214/AJR.20.23072 PubMedGoogle ScholarCrossref
Liu  W , Wang  J , Li  W , Zhou  Z , Liu  S , Rong  Z .  Clinical characteristics of 19 neonates born to mothers with COVID-19.   Front Med. 2020;14(2):193-198. doi:10.1007/s11684-020-0772-y PubMedGoogle ScholarCrossref
Mimouni  F , Lakshminrusimha  S , Pearlman  SA , Raju  T , Gallagher  PG , Mendlovic  J .  Perinatal aspects on the COVID-19 pandemic: a practical resource for perinatal-neonatal specialists.   J Perinatol. 2020;40(5):820-826. doi:10.1038/s41372-020-0665-6 PubMedGoogle ScholarCrossref
Parazzini  F , Bortolus  R , Mauri  PA , Favilli  A , Gerli  S , Ferrazzi  E .  Delivery in pregnant women infected with SARS-CoV-2: a fast review.   Int J Gynaecol Obstet. 2020;150(1):41-46. doi:10.1002/ijgo.13166 PubMedGoogle ScholarCrossref
Yang  Z , Liu  Y .  Vertical transmission of severe acute respiratory syndrome coronavirus 2: a systematic review.   Am J Perinatol. 2020;37(10):1055-1060. doi:10.1055/s-0040-1712161 PubMedGoogle ScholarCrossref
Zhu  H , Wang  L , Fang  C ,  et al.  Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia.   Transl Pediatr. 2020;9(1):51-60. doi:10.21037/tp.2020.02.06 PubMedGoogle ScholarCrossref
Liu  W , Wang  Q , Zhang  Q ,  et al Coronavirus disease 2019 (COVID-19) during pregnancy: a case series. Preprints 2020:020373. Published February 25, 2020. Accessed May 25, 2020. https://www.preprints.org/manuscript/202002.0373/v1
Wang  X , Zhou  Z , Zhang  J , Zhu  F , Tang  Y , Shen  X .  A case of 2019 novel coronavirus in a pregnant woman with preterm delivery.   Clin Infect Dis. 2020;71(15):844-846. doi:10.1093/cid/ciaa200 PubMedGoogle ScholarCrossref
Wang  S , Guo  L , Chen  L ,  et al.  A case report of neonatal 2019 coronavirus disease in China.   Clin Infect Dis. 2020;71(15):853-857. doi:10.1093/cid/ciaa225PubMedGoogle ScholarCrossref
Zeng  L , Xia  S , Yuan  W ,  et al.  Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China.   JAMA Pediatr. 2020;174(7):722-725. doi:10.1001/jamapediatrics.2020.0878PubMedGoogle ScholarCrossref
Fan  C , Lei  D , Fang  C ,  et al.  Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry?   Clin Infect Dis. 2020;ciaa226. doi:10.1093/cid/ciaa226 PubMedGoogle Scholar
Davanzo  R , Moro  G , Sandri  F , Agosti  M , Moretti  C , Mosca  F .  Breastfeeding and coronavirus disease-2019: ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies.   Matern Child Nutr. 2020;16(3):e13010. doi:10.1111/mcn.13010 PubMedGoogle Scholar
 Covid-19 and pregnancy.   BMJ. 2020;369:m1672.PubMedGoogle Scholar
World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts. Accessed March 17, 2020. https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
UNICEF. Infant and young child feeding in the context of COVID-19. Accessed March 30, 2020. https://www.unicef.org/documents/infant-and-young-child-feeding-context-covid-19
Pietrasanta  C , Pugni  L , Ronchi  A ,  et al.  Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context.   J Neonatal Perinatal Med. 2020;13(3):307-311. doi:10.3233/NPM-200478 PubMedGoogle ScholarCrossref
Wyckoff AS. AAP issues guidance on infants born to mothers with suspected or confirmed COVID-19. Accessed April 2, 2020. Updated July 22, 2020. https://www.aappublications.org/news/2020/04/02/infantcovidguidance040220
Chen  D , Yang  H , Cao  Y ,  et al.  Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection.   Int J Gynaecol Obstet. 2020;149(2):130-136. doi:10.1002/ijgo.13146 PubMedGoogle ScholarCrossref
Centers for Disease Control and Prevention. Evaluation and management considerations for neonates at risk for COVID-19. Updated October 23, 2020. Accessed May 25, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-newborns.html
Cantey  JB , Bascik  SL , Heyne  NG ,  et al.  Prevention of mother-to-infant transmission of influenza during the postpartum period.   Am J Perinatol. 2013;30(3):233-240. doi:10.1055/s-0032-1323585 PubMedGoogle ScholarCrossref
World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053PubMedGoogle ScholarCrossref
von Elm  E , Altman  DG , Egger  M , Pocock  SJ , Gøtzsche  PC , Vandenbroucke  JP ; STROBE Initiative.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.   Lancet. 2007;370(9596):1453-1457. doi:10.1016/S0140-6736(07)61602-X PubMedGoogle ScholarCrossref
Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic. Updated July 25, 2020. Accessed May 25, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
World Health Organization. Diagnostic detection of 2019-nCoV by real-time RT-PCR. Published Accessed January 17, 2020. Accessed January 17, 2020. https://www.who.int/docs/default-source/coronaviruse/protocol-v2-1.pdf
Corman  VM , Landt  O , Kaiser  M ,  et al.  Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR.   Euro Surveill. 2020;25(3). doi:10.2807/1560-7917.ES.2020.25.3.2000045 PubMedGoogle Scholar
Bertino  E , Spada  E , Occhi  L ,  et al.  Neonatal anthropometric charts: the Italian neonatal study compared with other European studies.   J Pediatr Gastroenterol Nutr. 2010;51(3):353-361. doi:10.1097/MPG.0b013e3181da213e PubMedGoogle Scholar
World Health Organization & United Nations International Children's Emergency Fund. Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-Friendly Hospital Initiative. Revised 2018. Accessed May 20, 2020. https://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation/en/
Sinelli  M , Paterlini  G , Citterio  M , Di Marco  A , Fedeli  T , Ventura  ML .  Early neonatal SARS-CoV-2 infection manifesting with hypoxemia requiring respiratory support.   Pediatrics. 2020;146(1):e20201121. doi:10.1542/peds.2020-1121 PubMedGoogle Scholar
Sutton  D , Fuchs  K , D’Alton  M , Goffman  D .  Universal screening for SARS-CoV-2 in women admitted for delivery.   N Engl J Med. 2020;382(22):2163-2164. doi:10.1056/NEJMc2009316 PubMedGoogle ScholarCrossref
Lai  CC , Shih  TP , Ko  WC , Tang  HJ , Hsueh  PR .  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges.   Int J Antimicrob Agents. 2020;55(3):105924. doi:10.1016/j.ijantimicag.2020.105924 PubMedGoogle Scholar
Centers for Disease Control and Prevention. Discontinuation of isolation for persons with COVID-19 not in healthcare settings. Updated July 20, 2020. Accessed May 31, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html
Chantry  CJ , Howard  CR , Auinger  P .  Full breastfeeding duration and associated decrease in respiratory tract infection in US children.   Pediatrics. 2006;117(2):425-432. doi:10.1542/peds.2004-2283 PubMedGoogle ScholarCrossref
Yu  X , Sun  S , Shi  Y , Wang  H , Zhao  R , Sheng  J .  SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression.   Crit Care. 2020;24(1):170. doi:10.1186/s13054-020-02893-8 PubMedGoogle ScholarCrossref
Liu  Y , Yan  LM , Wan  L ,  et al.  Viral dynamics in mild and severe cases of COVID-19.   Lancet Infect Dis. 2020;20(6):656-657. doi:10.1016/S1473-3099(20)30232-2 PubMedGoogle ScholarCrossref
Castagnoli  R , Votto  M , Licari  A ,  et al.  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review.   JAMA Pediatr. 2020. doi:10.1001/jamapediatrics.2020.1467 PubMedGoogle Scholar
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