Mothers with suspected or confirmed COVID-19 can room-in with their newborns when precautions are taken to protect the infants from maternal infectious respiratory secretions, according to updated AAP interim guidance.
Revised from May 21, the recommendations are based on months of national and international experience with babies whose mothers tested positive for SARS-CoV-2. Guidance also changed on how to determine when individuals previously infected with COVID-19 can visit a neonatal intensive care unit (NICU).
The interim guidance is titled “FAQs Update: Management of Infants Born to Mothers With Confirmed or Suspected COVID-19.” Since the initial neonatal recommendations came out April 2, health experts have been able to draw evidence from published case series, along with data provided to a national registry. The information has “better informed the risks of perinatal disease,” according to the report, and guidance will continue to be updated.
The Q&A also addresses newborn risk for COVID-19, precautions to take to attend a delivery from an infected mother, whether to continue delayed cord-clamping practices, procedures to follow if an infant needs intensive care, COVID-19 testing of babies and hospital discharge.
When the pandemic began, the only data available came from China, where the universal approach was to immediately separate all newborns from infected mothers and isolate them for 14 days, the AAP statement explains. Therefore, previous AAP guidance on rooming-in was based on the most cautious recommendation at the time, to minimize neonatal infection while the risk remained unknown.
New evidence for rooming-in
Initial guidance had recommended temporary separation of newborns from their infected mothers. But data gathered from more than 1,500 mother-infant dyads in the National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection reveal the likelihood of a positive polymerase chain reaction (PCR) test result for SARS-CoV-2 was similar for infants who were separated from their mothers and those who roomed-in with mothers when infection prevention measures were used.
While it is not known whether any of the infants included in the registry became ill at home after hospital discharge, there are not currently a lot of reports on infants being re-admitted to the hospital due to COVID-19, said Karen M. Puopolo, M.D., Ph.D., FAAP, a lead author of the newborn guidance and a member of the AAP Committee on Fetus and Newborn.
About 2% to 5% of infants born to women with COVID-19 around the time of delivery have tested positive in the first 24-96 hours after birth.
“I think it’s very important for people to understand where we were when guidance was first provided at the end of March-beginning of April,” said Dr. Puopolo. “All we knew about this virus was that it was really contagious and was killing a lot of people. So it was important for us to be cautious. I’m super glad that it doesn’t seem to be a virus that is really dangerous to newborn babies, at least as far as we can currently tell.”
The AAP offers the following guidance for rooming-in:
The updated guidance also addresses how to determine if a former COVID-19 patient who wishes to visit a NICU is no longer contagious. Those who are fully recovered still can test positive by PCR testing for weeks and months, which Dr. Puopolo noted is a problem that can unnecessarily restrict visitation.
While previous recommendations suggested a choice of two strategies for determining when a potential NICU visitor is still contagious, the current version focuses on a symptom- and time-based approach in line with that of the Centers for Disease Control and Prevention (https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html). The test-based approach is reserved for rare circumstances.
Updated NICU visitor recommendations include the following:
Several studies have detected SARS-Co-V-2 nucleic acid in breast milk. It is not known whether viable, infectious virus is secreted in breast milk, nor has it been established whether the milk contains protective antibodies. The AAP continues to strongly support breast milk as the best choice for feeding infants.
Clinicians are asked to participate in the National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection, which will inform future guidance. Register at https://redcap.ctsi.ufl.edu/redcap/surveys/?s=FY44J48D9F.