Abstract
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
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Birth hospitalizations were uncomplicated for late preterm and term infants with maternal
COVID-19.
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Nursery management of dyads affected by COVID-19 varied between hospitals.
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Adherence to contemporaneous U.S. clinical guidelines for nursery care was low.
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Breastfeeding rates were lower for dyads roomed separately than those who were colocated.
Keywords
COVID-19 - SARS CoV-2 - newborn - neonate - nursery - mother–infant dyad - breastfeeding
