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Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. HospitalsFunding 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.
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).
Received: 12 August 2020
Accepted: 28 January 2021
15 March 2021 (online)
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- 1 Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
- 2 Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med 2020; (e-pub ahead of print) DOI: 10.5858/arpa.2020-0901-SA.
- 3 Shalish W, Lakshminrusimha S, Manzoni P, Keszler M, Sant'Anna GM. COVID-19 and neonatal respiratory care: current evidence and practical approach. Am J Perinatol 2020; 37 (08) 780-791
- 4 Wang S, Guo L, Chen L. et al. A case report of neonatal 2019 coronavirus disease in China. Clin Infect Dis 2020; 71 (15) 853-857
- 5 Zeng L, Xia S, Yuan W. et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; 174 (07) 722-725
- 6 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; 37 (08) 861-865
- 7 Blumberg DA, Underwood MA, Hedriana HL, Lakshminrusimha S. Vertical transmission of SARS-CoV-2: what is the optimal definition?. Am J Perinatol 2020; 37 (08) 769-772
- 8 Knight M, Bunch K, Vousden N. et al; UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107
- 9 Verma S, Bradshaw C, Auyeung NSF. et al. Outcomes of maternal-newborn dyads after maternal SARS-CoV-2. Pediatrics 2020; 146 (04) e2020005637
- 10 Groß R, Conzelmann C, Müller JA. et al. Detection of SARS-CoV-2 in human breastmilk. Lancet 2020; 395 (10239): 1757-1758
- 11 Buonsenso D, Costa S, Sanguinetti M. et al. Neonatal late onset infection with severe acute respiratory syndrome coronavirus 2. Am J Perinatol 2020; 37 (08) 869-872
- 12 Chen L, Li Q, Zheng D. et al. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China. N Engl J Med 2020; 382 (25) e100
- 13 Sutton D, Fuchs K, D'Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020; 382 (22) 2163-2164 DOI: 10.1056/NEJMc2009316.
- 14 American Academy of Pediatrics. FAQs: management of infants born to mothers with suspected or confirmed COVID-19. Accessed June 11, 2020 at: http://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/
- 15 Centers for Disease Control and Prevention. Pregnancy, breastfeeding, and caring for newborns. Accessed June 9, 2020 at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html
- 16 World Health Organization. Clinical Management of COVID-19. Accessed June 11, 2020 at: https://www.who.int/publications-detail-redirect/clinical-management-of-covid-19
- 17 American Academy of Pediatrics. FAQs: Management of Infants Born to Mothers with Suspected or Confirmed COVID-19. Published July 22, 2020. Accessed August 6, 2020 at: http://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/
- 18 Centers for Disease Control and Prevention. Coronavirus disease 2019 in children — United States, February 12–April 2, 2020. MMWR 2020; 69 (14) 422-426
- 19 Lu X, Zhang L, Du H. et al; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020; 382 (17) 1663-1665 DOI: 10.1056/NEJMc2005073.
- 20 Parri N, Lenge M, Buonsenso D. Children with Covid-19 in pediatric emergency departments in Italy. N Engl J Med 2020; 383 (02) 187-190
- 21 Coronado Munoz A, Nawaratne U, McMann D, Ellsworth M, Meliones J, Boukas K. Late-onset neonatal sepsis in a patient with Covid-19. N Engl J Med 2020; 382 (19) e49
- 22 Dong Y, Mo X, Hu Y. et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020; 145 (06) e20200702
- 23 Verdoni L, Mazza A, Gervasoni A. et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395 (10239): 1771-1778
- 24 Whittaker E, Bamford A, Kenny J. et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324 (03) 259-269
- 25 Feldstein LR, Rose EB, Horwitz SM. et al; Overcoming COVID-19 Investigators, CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383 (04) 334-346
- 26 Perlman J, Oxford C, Chang C, Salvatore C, Di Pace J. Delivery room preparedness and early neonatal outcomes during COVID-19 pandemic in New York city. Pediatrics 2020; 146 (02) e20201567
- 27 Breslin N, Baptiste C, Gyamfi-Bannerman C. et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; 2 (02) 100118
- 28 Salvatore CM, Han J-Y, Acker KP. et al. Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. Lancet Child Adolesc Health 2020; 4 (10) 721-72
- 29 Academic Pediatrics Association. The Better Outcomes through Research for Newborns (BORN) Network. Accessed December 11, 2020 at: https://www.academicpeds.org/groups-networks/research-networks/born/
- 30 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 31 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
- 32 Flaherman VJ, Afshar Y, Boscardin J. et al. Infant outcomes following maternal infection with SARS-CoV-2: first report from the PRIORITY study. Clin Infect Dis 2020; (e-pub ahead of print) DOI: 10.1093/cid/ciaa1411.
- 33 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. National vital statistics reports. Births: final data for 2018. Accessed February 12, 2021 at: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_13-508.pdf
- 34 American Academy of Pediatrics, American Heart Association. Weiner GM, Zaichkin J, Kattwinke J. et al, eds. Textbook of Neonatal Resuscitation (NRP), 7th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2020
- 35 Gupta M, Zupancic JAF, Pursley DM. Caring for newborns born to mothers with COVID-19: more questions than answers. Pediatrics 2020; 146 (02) e2020001842
- 36 Cheema R, Partridge E, Kair LR. et al. Protecting breastfeeding during the COVID-19 pandemic. Am J Perinatol 2020; (e-pub ahead of print) DOI: 10.1055/s-0040-1714277.
- 37 Murray EK, Ricketts S, Dellaport J. Hospital practices that increase breastfeeding duration: results from a population-based study. Birth 2007; 34 (03) 202-211
- 38 Thulier D, Mercer J. Variables associated with breastfeeding duration. J Obstet Gynecol Neonatal Nurs 2009; 38 (03) 259-268
- 39 Griffin I, Benarba F, Peters C. et al. The impact of COVID-19 infection on labor and delivery, newborn nursery, and neonatal intensive care unit: prospective observational data from a single hospital system. Am J Perinatol 2020; 37 (10) 1022-1030
- 40 Garg S. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 — COVID-NET, 14 states, March 1–30, 2020. MMWR 2020; 69 (15) 458-464
- 41 Gold JAW, Wong KK, Szablewski CM. et al. Characteristics and clinical outcomes of adult patients hospitalized with COVID-19 - Georgia, March 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (18) 545-550
- 42 Stokes EK. Coronavirus disease 2019 case surveillance — United States, January 22–May 30, 2020. MMWR 2020; 69 (24) 759-765
- 43 Emeruwa UN, Ona S, Shaman JL. et al. Associations between built environment, neighborhood socioeconomic status, and SARS-CoV-2 infection among pregnant women in New York City. JAMA 2020; 324 (04) 390-392
- 44 Wadhera RK, Wadhera P, Gaba P. et al. Variation in COVID-19 hospitalizations and deaths across New York City boroughs. JAMA 2020; 323 (21) 2192-2195