Management of Infants Born to Mothers with Suspected or Confirmed COVID-19

COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has led to an unprecedented global pandemic affecting persons of all ages. Severe respiratory disease can occur in adults, particularly the elderly and those with underlying health conditions. Limited data are available for pregnant women and newborns with COVID-19. A few small case series suggest that congenital and perinatal transmission to newborns from infected women may occur, likely infrequently. Pediatric data demonstrate that children of all ages are susceptible to SARSCoV-2, and that infants under 1 year of age are at risk for severe disease although this still is a relatively rare outcome. Here are some points & recommendations Current evidence is consistent with low rates of peripartum transmission and is inconclusive about in utero transmission of SARS-CoV-2 from mothers with COVID-19 to their newborns. • Neonates can acquire SARS-CoV-2 after birth. Their immature immune system leaves newborns vulnerable to other serious respiratory viral infections, raising concern that SARS-CoV-2 may cause severe disease among neonates. • Airborne, Droplet, and Contact Precautions should be utilized when attending deliveries from women with COVID-19 due to the increased likelihood of maternal virus aerosols and the potential need to administer newborn resuscitation to infants with COVID-19 infection that can generate virus aerosol • When the physical environment allows, newborns should be separated at birth from mothers with COVID-19. Families who choose to have their infants room in with the mother should be educated on the potential risk to the newborn of developing COVID-19. • SARS-CoV-2 has not been detected in breast milk to date. Mothers with COVID-19 can express breast milk to be fed to their infants by uninfected caregivers until specific maternal criteria are met. • Infants born to mothers with COVID-19 should be tested for SARS-CoV-2 at 24 hours and, if still in the birth facility, at 48 hours after birth. Centers with limited resources for testing may make individual risk/benefit decisions regarding testing. • A newborn who has a documented SARS-CoV-2 infection (or who remains at risk for postnatal acquisition of COVID-19 due to inability to test the infant) requires frequent outpatient follow-up via telephone, telemedicine, or in-person assessments through 14 days after discharge. • After hospital discharge, a mother with COVID-19 is advised to maintain a distance of at least 6 feet from the newborn, and when in closer proximity use a mask and hand-hygiene for newborn care until (a) she is afebrile for 72 hours without use of antipyretics, and (b) at least 7 days have passed since symptoms first appeared. • A mother with COVID-19 whose newborn requires ongoing hospital care should maintain separation until (a) she is afebrile for 72 hours without use of antipyretics, and (b) her respiratory symptoms are improved, and (c) negative results are obtained from at least two consecutive SARS-CoV-2 nasopharyngeal swab tests collected ≥24 hours apart. To read more-


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