Lack of data is one of the things that is hampering us most in providing effective guidance and care during the COVID-19 pandemic. Perhaps nowhere is that more obvious than in the care of pregnant women who are ill with coronavirus at the time of delivery.
Fortunately, medical journals are rushing data online as fast as becomes available. Today JAMA Pediatrics published the latest data on newborn early onset COVID-19, Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China.
Here are the highlights:
– Babies can be infected with COVID-19 at the time of birth but it is unclear whether the virus was transmitted in utero or during delivery.
– The transmission rate is relatively high at 9%.
– The babies experienced only mild illness.
The authors described the 3 cases:
Patient 1 was born at 40 weeks’ gestation. The delivery was by cesarean delivery because of meconium-stained amniotic fluid and confirmed maternal COVID-19 pneumonia. On day 2 of life, the infant experienced lethargy and fever, with unremarkable physical examination results, and was moved to the neonatal intensive care unit. A chest radiographic image showed pneumonia … Nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days 2 and 4 of life and negative on day 6.
Patient 2 was born at 40 weeks’ and 4 days’ gestation by cesarean delivery because of confirmed maternal COVID-19 pneumonia. He presented with lethargy, vomiting, and fever… A chest radiographic image showed pneumonia. Nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days 2 and 4 of life and negative on day 6.
Patient 3 was born at 31 weeks’ and 2 days’ gestation by cesarean delivery because of fetal distress and confirmed maternal COVID-19 pneumonia. Resuscitation was required. The infant’s Apgar scores were 3, 4, and 5 at 1, 5, and 10 minutes after birth. Neonatal respiratory distress syndrome and pneumonia confirmed by chest radiographic image on admission resolved on day 14 of life after treatment … Nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days 2 and 4 of life and negative on day 7.
In all cases, strict infection control procedures were in place during delivery. So how did the babies become infected? They got the virus from their mothers either in utero or during delivery itself:
Because strict infection control and prevention procedures were implemented during the delivery, it is likely that the sources of SARS-CoV-2 in the neonates’ upper respiratory tracts or anuses were maternal in origin. Although 2 recent studies1,2 have shown that there were no clinical findings or investigations suggestive of COVID-19 in neonates born to affected mothers, and all samples, including amniotic fluid, cord blood, and breast milk, were negative for SARS-CoV-2, the vertical maternal-fetal transmission cannot be ruled out in the current cohort.
The authors recommend rigorous screening and infection control measures:
… [I]t is crucial to screen pregnant women and implement strict infection control measures, quarantine of infected mothers, and close monitoring of neonates at risk of COVID-19.
Unfortunately this study can’t tell us whether strict separation of newborns from infected mothers is necessary because every baby in the study was separated.
The bottom line is that newborns can and do get infected when mothers are ill at the time of birth. That raises the possibility that temporary separation of mother and baby could prevent serious illness. We need more data before we can know for sure.
