Mothers with coronavirus unlikely to infect newborn babies and can breastfeed if they take precautions: Study
Researchers reported no cases of viral transmission among babies born to Covid-19 positive mothers after two weeks of breastfeeding and skin-to-skin contact
Mothers with Covid-19 infection are unlikely to pass the virus to their newborn babies if proper safety precautions are taken, according to an observational study. Researchers found no cases of transmission of the coronavirus during childbirth or after two weeks of breastfeeding and with skin-to-skin contact among babies born to mothers with Covid-19. The findings suggest that mothers with Covid-19 can breastfeed and stay in the same room as their newborn safely if they use appropriate face coverings and follow infection control procedures, say researchers from the Weill Cornell Medicine-New York-Presbyterian Komansky Children's Hospital, US.
"We know that skin-to-skin contact and breastfeeding are important both for mother-infant bonding and for long-term child health. Our findings suggest that babies born to mothers with Covid-19 infection can still benefit from these safely if appropriate infection control measures are followed," writes Dr Patricia DeLaMora, who jointly led the study from the Weill Cornell Medicine-New York-Presbyterian Komansky Children's Hospital, in the report published in The Lancet Child & Adolescent Health journal.
In the study, researchers identified all neonates born between March 22 and May 17 at three New York-Presbyterian Hospitals in New York City to mothers positive for Covid-19 at delivery. The authors observed outcomes from 120 babies born to 116 mothers who tested positive for Covid-19. All of the babies were allowed to share a room with their mothers and be breastfed if their mothers were well enough. The babies were kept in enclosed cribs, six feet apart, except during feeding. The mothers were required to wear surgical masks while handling their babies. They also followed frequent hand and breast-washing procedures.
The babies underwent tests within the first 24 hours of birth and none tested positive for Covid-19. Follow-up data were available for 82 babies after five to seven days of life. Of these, the vast majority had been sharing a room with their mothers (83% or 68) and three quarters were still breastfeeding (78% or 64). The study shows that 79 babies were tested for Covid-19 again after five to seven days and 72 babies received a further test after two weeks. None of the results were positive and none of the babies showed symptoms of Covid-19 at any time. The report says that 53 babies underwent a remote check-up by video conferencing after one month of life. All of them continued to be clinically well and were growing appropriately. “Our data suggest that perinatal transmission of Covid-19 is unlikely to occur if correct hygiene precautions are undertaken and that allowing neonates to room in with their mothers and direct breastfeeding are safe procedures when paired with effective parental education of infant protective strategies,” says the team.
The Covid-19 test used in the study relied on nasal swabs. If babies had been infected in the womb, it is possible the virus would not have been present in these samples, say experts. The researchers were not able to screen for the presence of the virus in blood, urine or fecal samples because these tests were not validated at the time of the study.
The authors also caution that since the sample size in the study is small to draw firm conclusions, larger studies may be needed. Besides, almost one-third of babies were not followed-up (38 out of 120), which they say, might be explained by parents' fear of leaving their homes and using public transportation to attend clinic appointments amid the pandemic. “Data on the risk of Covid-19 transmission during pregnancy or while breastfeeding are limited to a small number of case studies. We hope our study will provide some reassurance to new mothers that the risk of them passing Covid-19 to their babies is very low. However, larger studies are needed to better understand the risks of transmission from mother to child,” says Dr Christine M Salvatore, the primary lead for the study from the Weill Cornell Medicine-New York-Presbyterian Komansky Children's Hospital.
Writing in a linked comment, Dr Melissa Medvedev from the University of California San Francisco, who was not involved in the study, says that the research has provided valuable data, indicating that perinatal Covid-19 transmission is unlikely and allowing newborns to room-in and breastfeed is safe, with appropriate precautions. “Despite these insights, key questions remain unanswered. Robust population-based data are needed to quantify the incidence of complications among pregnant women and neonates and to understand rates and routes of vertical and horizontal transmission, including asymptomatic transmission. Studies are also required to determine the effectiveness of infection prevention and control practices in the neonatal care setting,” says Dr Medvedev.
US medical body updates guidance
The American Academy of Pediatrics (AAP) has updated its guidance for care of newborns to mothers with Covid-19, finding that evidence now suggests that babies are at low risk of becoming infected when they remain in-room with the mother after birth, if infection control practices are used. This marks a change from the initial AAP guidance which recommended temporary separation of newborn infants from infected mothers.
According to the updated guidance, mothers confirmed or suspected of Covid-19 may “room-in” with their newborns according to usual center practice when precautions are taken. During the birth hospitalization, the mother should maintain a reasonable distance from her infant when possible. When a mother provides hands-on care to her newborn, she should wear a mask and perform hand-hygiene, says the advisory. “What we now know is the risk of the newborn becoming infected around the time of birth is low when safety precautions are taken to protect the baby. In fact, the risk in the short-term appears to be no greater if mother and infant room-in together using infection control measures compared to physical separation of the infant in a room separate from the mother. We do not yet know how many newborns might become ill at home following hospital discharge,” says Dr Karen Puopolo, lead author of the guidance.
Healthcare workers should use gowns, gloves, standard procedural masks, and eye protection (face shields or goggles) when providing care for infants, suggest experts. “If noninfected partners or other family members are present during the birth hospitalization, they should use masks and hand hygiene when providing hands-on care to the infant,” they add.
The AAP also strongly supports breastfeeding as the best choice for infant feeding. “Several published studies have detected SARS-CoV-2 nucleic acid in breast milk. It is not yet known whether a viable, infectious virus is secreted in breast milk, nor is it yet established whether protective antibody is found in breast milk. Given these uncertainties, breastfeeding is not contraindicated at this time. Mothers should perform hand hygiene before breastfeeding and wear a mask during breastfeeding. If an infected mother chooses not to nurse her newborn, she may express breast milk after appropriate hand hygiene, and this may be fed to the infant by other uninfected caregivers,” say guidelines.