An observational study of 120 babies found no transmission of novel coronavirus from infected mothers to newborns up to 14 days even when breastfed and when babies and mother were in the same room. All mothers wore a surgical mask when near the babies and practiced proper hand hygiene before breastfeeding and routine care.

An observational study of 120 babies born to mothers infected with novel coronavirus in three hospitals in New York City found no transmission of the virus even after two weeks of skin-to-skin care and breastfeeding. All mothers wore a surgical mask when near the babies and practiced proper hand hygiene before skin-to-skin contact, breastfeeding and routine care.

Nasopharyngeal swab samples of the neonates were tested for the virus using RT-PCR at 12-24 hours, 5–7 days, and 14 days after birth. Researchers did not find any case of virus transmission during childbirth or up to two weeks of breastfeeding and skin-to-skin contact.

Bases on the results, a team of researchers led by Dr Christine M Salvatore from New York Presbyterian-Komansky Children’s Hospital, New York found that infected mothers could safely stay in the same room as the newborn and breastfeed their babies by taking some precautions — wear a surgical mask when near their newborn and practicing proper hand hygiene before making any skin-to-skin contact, breastfeeding, and providing routine care. All the newborns were kept in a closed isolette — a clear plastic enclosed crib that isolates the baby from germs.

The study was published in the journal The Lancet Child & Adolescent Health.

Why the 14-day timepoint

“The 14-day timepoint was decided on the basis of what was known about viral shedding and antibody responses at that time, and we purported that mothers were unlikely, if asymptomatic, to remain infectious at that time. Thus, if the neonate remained SARS-CoV-2 rtPCR-negative at 14 days, the likelihood of continued risk of transmission from the mother was unlikely,” they write.

All of the babies were tested for the virus within the first 24 hours of birth and none tested positive. Follow-up data was available for 82 babies after five to seven days of life. They found that mothers and babies shared the same room in 83% (68 of 82 babies) and 78% (64 of 82 babies) were being breastfed. Testing for the virus was again carried out on 79 babies after five-seven days, and 72 were tested after two weeks of birth. No baby was found infected or showed any symptoms up to 14 days after birth.

And 53 babies underwent a remote check up by video conferencing after one month of life. None showed any clinical symptoms.

“Our data suggest that perinatal transmission of COVID-19 is unlikely to occur if correct hygiene precautions are undertaken, and that allowing neonates to room in with their mothers and direct breastfeeding are safe procedures when paired with effective parental education of infant protective strategies,” they write.

Conflicting guidelines

About the possibility of virus transmission via breast milk, Centers for Disease Control and Prevention (CDC) June 9 guidelines say: “We do not know whether mothers with COVID-19 can transmit the virus via breast milk, but the limited data available suggest this is not likely to be a source of transmission.” About breastfeeding, CDC maintains that mothers can breastfeed babies but should wear a mask, and maintain hand hygiene.

Current guidance for new mothers infected with COVID-19 is conflicting. The American Academy of Pediatrics (AAP) advises that mothers and newborns should be temporarily separated at birth. The AAP guidelines say: “Temporary separation minimises the risk of postnatal infant infection from maternal respiratory secretions. If possible, admit the infant to an area separate from unaffected infants, and wear gowns, gloves, eye protection goggles and standard procedural masks for newborn care.”

The AAP guidelines further adds: “If the center cannot place the infant in a separate area — or the mother chooses rooming-in despite recommendations — ensure the infant is at least six feet from the mother. A curtain or an isolette can help facilitate separation.”

In contrast, the World Health Organisation recommends that “mother and infant should be enabled to remain together while rooming-in throughout the day and night and to practice skin-to-skin contact, including kangaroo mother care, especially immediately after birth and during establishment of breastfeeding, whether they or their infants have suspected or confirmed COVID-19.”

About breastfeeding, WHO says: “Mothers with suspected or confirmed COVID-19 should be encouraged to initiate or continue to breastfeed. Mothers should be counselled that the benefits of breastfeeding substantially outweigh the potential risks for transmission.”