Abstract
BackgroundNewborn care practices that best promote the health and well-being of mother-infant dyads after birth while minimizing transmission of COVID-19 were uncertain at the onset of the COVID-19 pandemic.ObjectiveExamine variation in COVID-19 newborn care practices among U.S. birth hospitals and by hospital characteristics (U.S. census region, highest level of neonatal level of care, and Baby-Friendly hospital status).Study DesignWe surveyed physicians via American Academy of Pediatrics email listservs and social media between 5/26/2020-6/8/2020. Physicians identified the birth hospital in which they provided newborn care and their hospital’s approach to obstetrical and newborn care related to COVID-19. Chi-square tests were used to examine variation in hospital practices by U.S. census region, highest level of neonatal care, and Baby-Friendly hospital status.ResultsFour hundred thirty three physicians responded from 318 hospitals across 46 states. Variation in care of SARS-CoV-2 positive mother-infant dyads was greatest for approaches to location of newborn care (31% separation, 17% rooming-in, and 51% based on shared-decision making), early skin-to-skin care (48% prohibited/discouraged, 11% encouraged, and 40% based on shared-decision making) and direct breastfeeding (37% prohibited/discouraged, 15% encouraged, and 48% based on shared-decision making). Among presumed uninfected dyads, 59% of hospitals discharged at least some mother-infant dyads early. We found variation in practices by U.S. census region.ConclusionApproaches to newborn care and breastfeeding support for mother-infant dyads with positive SARS-CoV-2 testing differed across U.S. birth hospitals during the COVID-19 pandemic. Early discharge of presumed uninfected mother-infant dyads was common.
Highlights
In response to the increase of pregnant women who tested positive for SARS-CoV-2 presenting to birth hospitals for delivery within the setting of the COVID-19 pandemic in the spring of 2020, U.S hospitals rapidlyParker et al BMC Pediatrics (2022) 22:55(WHO) recommended that infants remain in close contact with SARS-CoV-2 positive mothers and directly breastfeed after delivery, if mothers are stable to do so [3], while the American Academy of Pediatrics (AAP) interim guidance from April 2, 2020 [4] and May 21, 2020 [5] recommended temporary separation of mother and infant as the safest course of action to minimize the risk of mother-to-infant transmission during the postpartum period
Variation in care of SARS-CoV-2 positive mother-infant dyads was greatest for approaches to location of newborn care (31% separation, 17% rooming-in, and 51% based on shared-decision making), early skin-to-skin care (48% prohibited/discouraged, 11% encouraged, and 40% based on shared-decision making) and direct breastfeeding (37% prohibited/discouraged, 15% encouraged, and 48% based on shared-decision making)
Approaches to newborn care and breastfeeding support for mother-infant dyads with positive SARSCoV-2 testing differed across U.S birth hospitals during the COVID-19 pandemic
Summary
In response to the increase of pregnant women who tested positive for SARS-CoV-2 presenting to birth hospitals for delivery within the setting of the COVID-19 pandemic in the spring of 2020, U.S hospitals rapidlyParker et al BMC Pediatrics (2022) 22:55(WHO) recommended that infants remain in close contact with SARS-CoV-2 positive mothers and directly breastfeed after delivery, if mothers are stable to do so [3], while the American Academy of Pediatrics (AAP) interim guidance from April 2, 2020 [4] and May 21, 2020 [5] recommended temporary separation of mother and infant as the safest course of action to minimize the risk of mother-to-infant transmission during the postpartum period. The language was slightly modified on May 20, 2020 [7], to “risks and benefits of temporary separation of the mother and her baby should be discussed with the mother by the healthcare team, and decisions about temporary separation should be made in accordance with the mother’s wishes.”. The impact of these varying recommendations on clinical practice among U.S birth hospitals is unknown. Newborn care practices that best promote the health and well-being of mother-infant dyads after birth while minimizing transmission of COVID-19 were uncertain at the onset of the COVID-19 pandemic
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