Very Low Risk to Newborns from Moms with COVID-19

Mothers with SARS-CoV-2 infection rarely transmit the virus to their newborns when basic infection-control practices are followed, according to a new study by researchers at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital. The findings—the most detailed data available on the risk of SARS-CoV-2 transmission between moms and their newborns—suggest that more extensive measures like separating SARS-CoV-2-positive mothers from their newborns and avoiding direct breastfeeding may not be warranted.

The study was published online today in JAMA Pediatrics.

“Our findings should reassure expectant mothers with COVID-19 that basic infection-control measures during and after childbirth—such as wearing a mask and engaging in breast and hand hygiene when holding or breastfeeding a baby—protected newborns from infection in this series," says Cynthia Gyamfi-Bannerman, MD, MSc, the Ellen Jacobson Levine and Eugene Jacobson Professor of Women's Health in Obstetrics & Gynecology at Columbia University Vagelos College of Physicians and Surgeons, a maternal-fetal medicine expert at NewYork-Presbyterian/Columbia University Irving Medical Center, and a senior author of the paper. 

Basic infection-prevention measures reduced COVID-19 risk in newborns 

The researchers examined outcomes in the first 101 newborns born to COVID-19-positive mothers at NewYork-Presbyterian Morgan Stanley Children’s Hospital or NewYork-Presbyterian Allen Hospital from March 13 to April 24, 2020. 

To reduce the risk of transmitting SARS-CoV-2 to newborns after delivery, hospital staff practiced social distancing, wore masks, and placed COVID-positive moms in private rooms. The hospitals provided the mothers with educational materials about COVID-19 and shortened hospital stays for all mothers without complications from delivery. 

Most of the newborns roomed with their mothers, including during the first postpartum checkup. (Some were admitted to the newborn intensive care unit for non-COVID-related health reasons.) Infants who roomed with their moms were placed in protective cribs six feet away from the mothers’ beds when resting. Direct breastfeeding and skin-to-skin contact with babies were strongly encouraged, provided the moms wore masks and washed hands and breasts with soap and water.

“During the pandemic, we continued to do what we normally do to promote bonding and development in healthy newborns, while taking a few extra precautions to minimize the risk of exposure to the virus,” says Gyamfi-Bannerman.

Only two of the newborns tested positive for SARS-CoV-2 but had no clinical evidence of illness. (The researchers were unable to pinpoint how the babies became infected.) Physicians followed up with about half of the infants, including the two who tested positive for the virus, during the first two weeks of life, and all remained well.

Data support breastfeeding, skin-to-skin contact with baby even if mom has COVID-19

In the early part of the pandemic, a number of pediatric and health organizations had released interim guidelines for pregnant women with SARS-CoV-2, recommending the separation of mothers and newborns during their hospital stay, no direct breastfeeding, and bathing newborns as soon as possible. (Normally, newborns are bathed a day after delivery because it interferes with bonding and breastfeeding and increases the risk of dangerously low temperatures and blood sugars.) 

“These recommendations were made in the absence of data on rates of mother-to-newborn SARS-CoV-2 transmission and are based on experience with mother-newborn transmission of other infectious diseases,” says lead author Dani Dumitriu, MD, PhD, assistant professor of pediatrics in psychiatry at Columbia University Vagelos College of Physicians and Surgeons and a pediatric newborn hospitalist in the Division of Child and Adolescent Health at NewYork-Presbyterian Morgan Stanley Children’s Hospital. “But some of the recommendations conflict with what we know about the developmental benefits of early breastfeeding and skin-to-skin contact. Our study offers further evidence that these measures may not be necessary for healthy newborns with SARS-CoV-2-positive moms.”

Since then, the American Academy of Pediatrics has updated its guidance on rooming-in for mothers with suspected or confirmed COVID-19.

“We think it’s particularly important that mothers with SARS-CoV-2 have the opportunity to directly breastfeed their newborns,” Gyamfi-Bannerman says. “Breast milk is known to protect newborns against numerous pathogens, and it may help protect newborns against infection with the virus. Most studies have not found SARS-CoV-2 in breast milk, and breast milk has been found to contain antibodies against the virus.”