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. 2021 Feb 1;175(2):157-167.
doi: 10.1001/jamapediatrics.2020.4298.

Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City

Dani Dumitriu  1   2   3   4 , Ukachi N Emeruwa  2   5 , Erin Hanft  6 , Grace V Liao  6 , Elizabeth Ludwig  2   7 , Lauren Walzer  1   2 , Brittany Arditi  2   5 , Minna Saslaw  1   2 , Maria Andrikopoulou  2   5 , Tessa Scripps  1   2 , Caitlin Baptiste  2   5 , Adrita Khan  1   2 , Noelle Breslin  2   5 , David Rubenstein  2   6 , Lynn L Simpson  2   5 , Margaret H Kyle  3 , Alexander M Friedman  2   5 , Daniel S Hirsch  2   6 , Russell S Miller  2   5 , Cristina R Fernández  1   2 , Karin M Fuchs  2   5 , M Kathleen Keown  1   2 , Melissa E Glassman  1   2 , Ashley Stephens  1   2 , Archana Gupta  2   6 , Sally Sultan  1   2 , Caroline Sibblies  2   6 , Susan Whittier  8 , Wanda Abreu  1   2 , Francis Akita  2   6 , Anna Penn  2   6 , Mary E D'Alton  2   7 , Jordan S Orange  2   9 , Dena Goffman  2   5   7 , Lisa Saiman  2   10 , Melissa S Stockwell  1   2   11 , Cynthia Gyamfi-Bannerman  2   5
Affiliations

Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City

Dani Dumitriu et al. JAMA Pediatr. .

Abstract

Importance: Limited data on vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and health outcomes of neonates born to mothers with symptomatic or asymptomatic coronavirus disease 2019 (COVID-19) are available. Studies are needed to inform evidence-based infection prevention and control (IP&C) policies.

Objective: To describe the outcomes of neonates born to mothers with perinatal SARS-CoV-2 infection and the IP&C practices associated with these outcomes.

Design, setting, and participants: This retrospective cohort analysis reviewed the medical records for maternal and newborn data for all 101 neonates born to 100 mothers positive for or with suspected SARS-CoV-2 infection from March 13 to April 24, 2020. Testing for SARS-CoV-2 was performed using Cobas (Roche Diagnostics) or Xpert Xpress (Cepheid) assays. Newborns were admitted to well-baby nurseries (WBNs) (82 infants) and neonatal intensive care units (NICUs) (19 infants) in 2 affiliate hospitals at a large academic medical center in New York, New York. Newborns from the WBNs roomed-in with their mothers, who were required to wear masks. Direct breastfeeding after appropriate hygiene was encouraged.

Exposures: Perinatal exposure to maternal asymptomatic/mild vs severe/critical COVID-19.

Main outcomes and measures: The primary outcome was newborn SARS-CoV-2 testing results. Maternal COVID-19 status was classified as asymptomatic/mildly symptomatic vs severe/critical. Newborn characteristics and clinical courses were compared across maternal COVID-19 severity.

Results: In total, 141 tests were obtained from 101 newborns (54 girls [53.5%]) on 0 to 25 days of life (DOL-0 to DOL-25) (median, DOL-1; interquartile range [IQR], DOL-1 to DOL-3). Two newborns had indeterminate test results, indicative of low viral load (2.0%; 95% CI, 0.2%-7.0%); 1 newborn never underwent retesting but remained well on follow-up, and the other had negative results on retesting. Maternal severe/critical COVID-19 was associated with newborns born approximately 1 week earlier (median gestational age, 37.9 [IQR, 37.1-38.4] vs 39.1 [IQR, 38.3-40.2] weeks; P = .02) and at increased risk of requiring phototherapy (3 of 10 [30.0%] vs 6 of 91 [7.0%]; P = .04) compared with newborns of mothers with asymptomatic/mild COVID-19. Fifty-five newborns were followed up in a new COVID-19 Newborn Follow-up Clinic at DOL-3 to DOL-10 and remained well. Twenty of these newborns plus 3 newborns followed up elsewhere had 32 nonroutine encounters documented at DOL-3 to DOL-25, and none had evidence of SARS-CoV-2 infection, including 6 with negative retesting results.

Conclusions and relevance: No clinical evidence of vertical transmission was identified in 101 newborns of mothers positive for or with suspected SARS-CoV-2 infection, despite most newborns rooming-in and direct breastfeeding practices.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Miller reported receiving personal fees from UpToDate and Medicolegal for consulting work outside the submitted work. Dr D’Alton reported a paid advisory board member for Merck for Mothers, Merck & Co, outside the submitted work. Dr Orange reported receiving stock options for service on the advisory board of GigaGen outside the submitted work. Dr Gyamfi-Bannerman reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Newborn Testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
A total of 141 SARS-CoV-2 nasopharyngeal swabs were obtained and tested from 101 newborns born to mothers with positive or presumptive positive findings for SARS-CoV-2. Owing to evolving recommendations, clinical indications, and availability of swabs, newborns were tested 1 to 4 times each. A total of 135 tests (95.7%) resulted as not detected. Initial test results in 2 infants were indeterminate, considered a low viral load by the assay manufacturer. Initial test results in 4 infants were invalid and negative on repeated testing. NICU indicates neonatal intensive care unit; WBN, well-baby nursery.
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Comment in

  • Balancing Risks in the Time of COVID-19.
    Kimberlin DW, Puopolo KM. Kimberlin DW, et al. JAMA Pediatr. 2021 Feb 1;175(2):129-130. doi: 10.1001/jamapediatrics.2020.4304. JAMA Pediatr. 2021. PMID: 33044485 No abstract available.

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