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Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study

Our take —

This observational study of neonates whose mothers had COVID-19 at delivery found no cases of transmission within the first two weeks of life. Though it is possible that some infections were missed due to lower participation in follow-up testing and the reliance on PCR testing of respiratory secretions, these data provide evidence that the risk of transmission is very low in a setting that enabled mother and newborn contact coupled with infection control practices and patient education.

Study design

Prospective Cohort

Study population and setting

This cohort study included 120 neonates whose mothers had laboratory-confirmed SARS-CoV-2 infection at delivery in three New York City hospitals from March 22 to May 17, 2020. Maternal cases were identified through universal screening by PCR at delivery and all mothers used a surgical mask and cleaned their hands and skin prior to holding the newborn for skin-to-skin care, breastfeeding, and other care. As long as their condition allowed, newborns could room with their mother in a closed Giraffe isolette 6 feet away; no additional family or visitors were permitted on the ward. Mothers of newborns in the neonatal ICU could visit after 14 days of testing positive and at least 72 hours without a fever. Patient education emphasized reducing continued mask use and hand hygiene by the mother and other household members after discharge. The primary outcome was transmission of SARS-CoV-2 infection, tested by PCR on nasopharyngeal swabs collected from the neonates at 24 hours, 5 to 7 days, and 14 days after birth. A telemedicine visit was conducted at 1 month to assess clinical presentation and collect data on infection control practices within the home.

Summary of Main Findings

Among 1,481 women admitted for delivery during the study period, 116 (8%) women had evidence of SARS-CoV-2 infection; they had a total of 120 live births, of whom 82 completed follow-up beyond the 24-hour PCR test. The median gestational age was 38 weeks (IQR: 27-41), 14 were born preterm (17%), and 36 (44%) were delivered by Cesarean section among those with follow-up data; the prevalence of preterm birth and C-section were higher among this group than among the neonates who weren’t followed. Most neonates (83%) roomed with the mother after birth; 15% were admitted to the neonatal intensive care unit. Breastfeeding was reported by 78% of mothers at the 5-7 day visit. None of the neonates were positive for SARS-CoV-2 at 24 hours after birth. There were no subsequent positive tests among the 79 neonates tested at 5-7 days or among the 72 neonates tested at 14 days old. At the one-month telemedicine visit only the four neonates with symptoms were tested again; all were negative.

Study Strengths

Serial PCR testing at three time points within the first two weeks of life reduced the chance of missing asymptomatic infections in neonates. This study described the practices that were implemented to prevent transmission in the hospital setting and measured exposure to self-reported behavior at home.

Limitations

Though all infants tested negative at 24 hours of life, it is possible that some cases were missed among the 35% of neonates who did not return for subsequent PCR testing. Additionally, it is possible that swabbing only the nose and throat missed viral shedding that might have been identified in other specimens such as stool or blood. Finally, the relatively small sample size and opportunity for recall bias related to maternal reporting of infection control practices introduces uncertainty that limits how well these data apply to other settings.

Value added

This was the first study to focus on the role of postpartum infection control practices in perinatal transmission of SARS-CoV-2.

This review was posted on: 20 November 2020