Am J Perinatol 2021; 38(06): 622-631
DOI: 10.1055/s-0041-1726036
Original Article

Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals

1   Department of Pediatrics, University of California San Francisco, San Francisco, California
Laura R. Kair
2   Department of Pediatrics, University of California, Davis, Sacramento, California
Valerie J. Flaherman
1   Department of Pediatrics, University of California San Francisco, San Francisco, California
Kelly E. Wood
3   Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
Mary Ann LoFrumento
4   Department of Pediatrics, Columbia University, New York, New York
Eberechi Nwaobasi-Iwuh
5   Department of Pediatrics, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey
Carrie A. Phillipi
6   Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
on behalf of the Better Outcomes through Research for Newborns (BORN) Network › Author Affiliations
Funding Research staff was supported by the Academic Pediatric Association. L.R.K. was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (through grant UL1 TR001860), and the National Institutes of Health Building Interdisciplinary Research Careers in Women's Health Program (K12HD051958). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health.


Objective There is a paucity of evidence to guide the clinical care of late preterm and term neonates born to women with perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The objective of this case series is to describe early neonatal outcomes and inpatient management in U.S. hospitals.

Study Design We solicited cases of mother–infant dyads affected by novel coronavirus disease 2019 (COVID-19) from the Better Outcomes through Research for Newborns (BORN) Network members. Using a structured case template, participating sites contributed deidentified, retrospective birth hospitalization data for neonates ≥35 weeks of gestation at birth with mothers who tested positive for SARS-CoV-2 before delivery. We describe demographic and clinical characteristics, clinical management, and neonatal outcomes.

Results Sixteen U.S. hospitals contributed 70 cases. Birth hospitalizations were uncomplicated for 66 (94%) neonates in which 4 (6%) required admission to a neonatal intensive care unit. None required evaluation or treatment for infection, and all who were tested for SARS-CoV-2 were negative (n = 57). Half of the dyads were colocated (n = 34) and 40% directly breastfed (n = 28). Outpatient follow-up data were available for 13 neonates, all of whom remained asymptomatic.

Conclusion In this multisite case series of 70 neonates born to women with SARS-CoV-2 infection, clinical outcomes were overall good, and there were no documented neonatal SARS-CoV-2 infections. Clinical management was largely inconsistent with contemporaneous U.S. COVID-19 guidelines for nursery care, suggesting concerns about the acceptability and feasibility of those recommendations. Longitudinal studies are urgently needed to assess the benefits and harms of current practices to inform evidence-based clinical care and aid shared decision-making.

Key Points

  • Birth hospitalizations were uncomplicated for late preterm and term infants with maternal COVID-19.

  • Nursery management of dyads affected by COVID-19 varied between hospitals.

  • Adherence to contemporaneous U.S. clinical guidelines for nursery care was low.

  • Breastfeeding rates were lower for dyads roomed separately than those who were colocated.

* For a complete list of BORN Network Collaborators, please refer to the [Supplementary Material] (available in the online version).

Supplementary Material

Publication History

Received: 12 August 2020

Accepted: 28 January 2021

Article published online:
15 March 2021

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