AAP no longer recommends separating newborns from mothers with COVID-19
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In updated guidance, the AAP said it no longer recommends separating newborns from mothers infected with COVID-19 — a precaution that was included in the initial guidance issued in April, when less was known about COVID-19 and newborns.
“At the beginning of the pandemic, the only data available came from China, where the universal approach was to immediately separate all newborns from the infected mother and isolate them for 14 days,” Karen M. Puopolo, MD, PhD, chief of newborn pediatrics at Pennsylvania Hospital, and colleagues wrote in the new guidance. “After months of national and international experience with newborns born to mothers who have tested positive for SARS-CoV-2, no published report has identified an infant who has died during the initial birth hospitalization as a direct result of SARS-CoV-2 infection.”
The updated guidance relied on data from the National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection to provide recommendations for mothers and their children.
“At this point, we don’t think that we need to advocate anymore that moms and babies be physically separated temporarily,” Puopolo told Healio. “We're seeing that the rate at which newborns do acquire this infection from their moms is low, probably less than 5% around the time of delivery, and we don't really have any signal in the community that babies are getting sick at home and getting readmitted to the hospital at really high rates.”
According to Puopolo, several publications have found traces of SARS-CoV-2 in breast milk, although it has not yet been determined that breast milk itself is infectious. Thus, it has not yet been determined if infants can become infected with COVID-19 through consumption.
“We continue to endorse moms who want to breastfeed their babies to breastfeed their babies, even if [infants] do get COVID-19 while breastfeeding,” Puopolo said.
Puopolo said that infants who do test positive for COVID-19 do not get very ill, and only 2% to 5% of newborns test positive a day or two after birth. Although it is true that infants can get the virus, and even experience symptoms that require rehospitalization, Puopolo said this is not common.
The AAP said “it may be appropriate to temporarily separate” a newborn from their mother if the mother is acutely ill with COVID-19 and not well enough to care for the baby.
“If you take infection prevention precautions and keep the baby from catching the virus after they're born, at least so far, it doesn't seem that it's a cause of severe illness or heaven forbid death in young babies,” she said. “I think the AAP really does not want folks to think that it's all good. That would be the wrong message. We just are saying, if [you] take some precautions, in most cases, babies are OK.”
The AAP noted that, according to CDC guidance, a person may be considered non-infectious if, in the absence of antipyretics, it has been more than 24 hours since they had a fever; at least 10 days have passed since their symptoms began, or 10 days have passed since a positive obstetric screening test in asymptomatic women; and their symptoms have improved.
“We had some heartbreaking cases of mothers who were very ill and delivered prematurely to save their life,” she said. “They got better, and they were not allowed to see their premature infant for weeks at a time, because the guidance from CDC was that you needed to test negative twice before you could assume that you are safe to be not contagious. All of that has changed as we've gotten better science and better data in.”
The AAP provided this summary of its related guidance for newborn care during the pandemic:
- Mothers with COVID-19 and newborn infants may room-in according to usual center practice.
- During the birth hospitalization, the mother should maintain a reasonable distance from her infant when possible. When mother provides hands-on care to her infant, she should wear a mask and perform hand-hygiene.
- Health care workers should use gowns, gloves, standard procedural masks, and eye protection (face shields or goggles) when providing care for well infants.
- If noninfected partners or other family members are present during the birth hospitalization, they should use masks and hand hygiene when providing hands-on care to the infant.
The AAP said it anticipates further revisions as further evidence becomes available.
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AAP. FAQs: Management of infants born to mothers with suspected or confirmed COVID-19. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/. Accessed July 27, 2020.
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