January 4, 2021
Deborah Lehman, MD reviewing Ronchi A et al. JAMA Pediatr 2020 Dec 7
In an Italian study, breast-feeding and rooming-in were safely practiced with precautions to minimize risk for viral transmission.
Italy experienced high rates of COVID-19 early in the pandemic and was forced to make decisions about management of mothers and their newborns to avoid postnatal transmission. Initial guidance from the American Academy of Pediatrics endorsed mother-infant separation when maternal COVID-19 was suspected or confirmed.
In this prospective, cohort study in six maternity centers in Northern Italy, investigators enrolled 62 neonates (born in-hospital at ≥34 weeks’ gestation; >2000 g, well appearing) from March to May 2020, whose mothers tested positive for SARS-CoV-2 but did not require respiratory support. Infants were tested for SARS-CoV-2 at 1 and 7 days, followed by clinical examination and testing at 20 days. At the time of diagnosis, 55% of the women were asymptomatic; and at delivery, 70% had no symptoms. Most neonates (95%) received breast milk (73%, exclusively) and 82% had protected rooming-in (mothers received education about infection prevention) for the duration of their hospital stay. Visitors were not permitted during the study.
One infant, born to the only mother in the study with decompensating disease, tested positive for SARS-CoV-2 at 7 days and required neonatal intensive care unit (NICU) care. The infant had mild dyspnea that resolved quickly.
This study provides reassurance that, with proper precautions, mothers who test positive for SARS-CoV-2 but are clinically stable and able to care for their infants, can safely room with and breast-feed their newborns. Updated management guidelines now reflect this practice — and these findings, reassuringly, support those recommendations. The role of breast milk in providing protective immunity remains uncertain but will be critical to elucidate.