Caring for Newborns Born to Mothers With COVID-19: More Questions Than Answers.

Abstract

* Abbreviations: AAP — : American Academy of Pediatrics CDC — : Centers for Disease Control and Prevention COVID-19 — : coronavirus disease 2019 PCR — : polymerase chain reaction SARS-CoV-2 — : severe acute respiratory syndrome coronavirus 2 WHO — : World Health Organization As the coronavirus disease 2019 (COVID-19) pandemic continues, its impact on newborns remains uncertain. Early reports from China suggested that although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could be associated with adverse pregnancy outcomes, newborns did not appear to show clinical signs of infection and had negative viral testing results.1,2 More recent reports suggest that, although low, risk of neonatal infection does exist. A recent (as we write this commentary) review identified 27 publications describing 217 newborns born to mothers with COVID-19, of which 21 publications describing 187 newborns were from China.3 Of the 217 newborns, 7 (3%) had evidence of SARS-CoV-2 infection: 3 had positive serum levels of immunoglobulin G and immunoglobulin M antibodies with negative polymerase chain reaction (PCR) test results, and 4 had positive PCR test results. Beyond the immediate postnatal period, in several case studies, authors report positive SARS-CoV-2 test results in symptomatic newborns in the first month of life, and new reports are published frequently.3–7 The mechanism of neonatal infection is unclear. Vertical transmission during pregnancy is not thought to be likely; SARS-CoV-2 test results on placenta, umbilical cord, amniotic fluid, vaginal secretions, and breast milk samples have uniformly been negative.8 More likely is postnatal infection through horizontal transmission. This uncertainty around neonatal infection risk has led to notable variations in care practices for newborns born to mothers with COVID-19. Hospitals, professional organizations, and public health agencies have interpreted the limited available data in the context of their local environments to develop practice recommendations that then are applied to a wide range of clinical and social conditions. Although there is … Address correspondence to Munish Gupta, MD, MMSc, Beth Israel Deaconess Medical Center and Harvard Medical School, Harvard University, 330 Brookline Ave, Rose 339, Boston, MA 02215. E-mail: mgupta{at}bidmc.harvard.edu