Challenges and improvement in management of neonates born to mothers with COVID-19 in China

Abstract

Abstract Objective China was the first country suffering from the SARS-CoV-2 pandemic and one of the countries with stringent mother-neonate isolation measure implemented. Now increasing evidence suggests that coronavirus disease 2019 (COVID-19) should not be taken as an indication for formula feeding or isolation of the infant from the mother. Methods We conducted a retrospective cohort study in 44 hospitals from 14 provinces in China to investigate the management of neonates whose mothers have confirmed or suspected COVID-19. In addition, 65 members of Chinese Neonatologist Association (CNA) were invited to give their comments and suggestions on the clinical management guidelines for high-risk neonates. Results There were 121 neonates born to 118 mothers suspected with COVID-19 including 42 mothers with SARS-CoV-2 positive results and 76 mothers with SARS-CoV-2 negative results. All neonates were born by caesarean section, isolated from their mothers immediately after birth and were formula-fed. Five neonates were positive for SARS-CoV-2 at initial testing between 36 and 46 h after birth. Regarding the confusion on the clinical management guidelines, 58.78% of the newborns were put into isolation, 32.22% were subject to PCR tests, and 5.16% and 2.75% received breastfeeding and vaccination, respectively. Conclusion The clinical symptoms of neonates born to mothers with confirmed SARS-CoV-2 were mild, though five neonates might have been infected in utero or during delivery. Given the favorable outcomes of neonates born to COVID-confirmed mothers, full isolation may not be warranted. Rather, separation of the mother and her newborn should be assessed on a case-by-case basis, considering local facilities and risk factors for adverse outcomes, such as prematurity and fetal distress.