Mothers with COVID-19 Can Safely Room-in with Newborns

Newborns are unlikely to contract SARS-CoV-2 while breastfeeding and rooming-in with mothers infected with the virus that causes coronavirus disease 2019 (COVID-19), if precautions such as wearing a mask and practicing careful hand hygiene are taken, a new study suggests.

The study, published in JAMA Pediatrics, included 62 infants born to 61 mothers who tested positive for SARS-CoV-2 at 6 maternity centers in northern Italy between March 19 and May 2. During follow-up over 3 weeks, only one infant tested positive for the virus.

“COVID-19 positive mothers who mask, perform excellent hand hygiene can know it is safe to room-in with their newborn as well as provide breast milk if they feel well enough to care for their baby,” David A. Kaufman, MD, a professor in the Department of Pediatrics at the University of Virginia School of Medicine, told Contagion®. Kaufman co-authored an editorial published in association with the study on JAMA Pediatrics.

Early in the pandemic, the American Academy of Pediatrics recommended that new mothers with COVID-19 be physically separated from their newborns to avoid transferring the virus. The AAP has since updated its recommendations to allow rooming in with precautions such as mask wearing and hand hygiene. Rooming-in promotes the mother-child relationship and breastfeeding.

All of the mothers who participated in the study had mild symptoms or were asymptomatic at the time of delivery and felt well enough to care for their infants. In the one case where they infant tested positive for SARS-CoV-2, rooming-in was interrupted at Day 5 when the mother’s condition worsened, requiring ICU admission and mechanical ventilation. The infant displayed mild symptoms that resolved after a few days, and the infant was discharged to the father’s care at Day 18.

Among the infants, 95% were breastfed, including 73% who were exclusively breastfed.

“Breastfeeding or receiving expressed breast milk should be considered protection against infection and not as a risk for the virus to be transmitted to the newborn via the breast milk,” Kaufman said.

To qualify for rooming-in practices, mothers had to be well enough to care for their infants with temperatures less than 38ºC (100.4ºF) and no need for supplemental oxygen or respiratory support. Infants were born at 34 weeks of gestational age or later with birth weights over 2000 grams (4.4 pounds) and healthy physical examinations and vital signs.

Mothers were educated about droplet and contact precautions, hand hygiene and rigorous application of recommendations to prevent transmission of the virus.

“COVID-19 infected mothers who mask, perform hand hygiene before and after all contact with their infant, breastfeed and have their newborn 6 feet away when they are not feeding or caring for the baby safely prevents transmission to the baby during the time the mom is infectious,” Kaufman said. “If a COVID-19 mother has or develops moderate or severe symptoms while she is still infectious, she should consult with her health care provider and have another person care for her baby until she is better.”

The study offers further evidence that breast feeding is safe for infants born to mothers with COVID-19. An earlier study involving 18 mothers in California who tested positive for SARS-CoV-2 found no evidence that the virus is transmitted through breast milk.

While cases of COVID-19 have been reported among newborns, symptoms have been milder than in adults.