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Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study

BACKGROUND: The risk of vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, which causes COVID-19), the most appropriate management, and the neonate's risk of developing COVID-19 during the perinatal period are unknown. Therefore, we aimed to eluc...

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Autores principales: Salvatore, Christine M, Han, Jin-Young, Acker, Karen P, Tiwari, Priyanka, Jin, Jenny, Brandler, Michael, Cangemi, Carla, Gordon, Laurie, Parow, Aimee, DiPace, Jennifer, DeLaMora, Patricia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377726/
https://www.ncbi.nlm.nih.gov/pubmed/32711687
http://dx.doi.org/10.1016/S2352-4642(20)30235-2
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author Salvatore, Christine M
Han, Jin-Young
Acker, Karen P
Tiwari, Priyanka
Jin, Jenny
Brandler, Michael
Cangemi, Carla
Gordon, Laurie
Parow, Aimee
DiPace, Jennifer
DeLaMora, Patricia
author_facet Salvatore, Christine M
Han, Jin-Young
Acker, Karen P
Tiwari, Priyanka
Jin, Jenny
Brandler, Michael
Cangemi, Carla
Gordon, Laurie
Parow, Aimee
DiPace, Jennifer
DeLaMora, Patricia
author_sort Salvatore, Christine M
collection PubMed
description BACKGROUND: The risk of vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, which causes COVID-19), the most appropriate management, and the neonate's risk of developing COVID-19 during the perinatal period are unknown. Therefore, we aimed to elucidate best practices regarding infection control in mother–newborn dyads, and identify potential risk factors associated with transmission. METHODS: In this observational cohort study, we identified all neonates born between March 22 and May 17, 2020, at three New York Presbyterian Hospitals in New York City (NY, USA) to mothers positive for SARS-CoV-2 at delivery. Mothers could practice skin-to-skin care and breastfeed in the delivery room, but had to wear a surgical mask when near their neonate and practice proper hand hygiene before skin-to-skin contact, breastfeeding, and routine care. Unless medically required, neonates were kept in a closed Giraffe isolette in the same room as their mothers, and were held by mothers for feeding after appropriate hand hygiene, breast cleansing, and placement of a surgical mask. Neonates were tested for SARS-CoV-2 by use of real-time PCR on nasopharyngeal swabs taken at 24 h, 5–7 days, and 14 days of life, and were clinically evaluated by telemedicine at 1 month of age. We recorded demographics, neonatal, and maternal clinical presentation, as well as infection control practices in the hospital and at home. FINDINGS: Of 1481 deliveries, 116 (8%) mothers tested positive for SARS-CoV-2; 120 neonates were identified. All neonates were tested at 24 h of life and none were positive for SARS-CoV-2. 82 (68%) neonates completed follow-up at day 5–7 of life. Of the 82 neonates, 68 (83%) roomed in with the mothers. All mothers were allowed to breastfeed; at 5–7 days of life, 64 (78%) were still breastfeeding. 79 (96%) of 82 neonates had a repeat PCR at 5–7 days of life, which was negative in all; 72 (88%) neonates were also tested at 14 days of life and none were positive. None of the neonates had symptoms of COVID-19. INTERPRETATION: 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. FUNDING: None.
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spelling pubmed-73777262020-07-24 Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study Salvatore, Christine M Han, Jin-Young Acker, Karen P Tiwari, Priyanka Jin, Jenny Brandler, Michael Cangemi, Carla Gordon, Laurie Parow, Aimee DiPace, Jennifer DeLaMora, Patricia Lancet Child Adolesc Health Articles BACKGROUND: The risk of vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, which causes COVID-19), the most appropriate management, and the neonate's risk of developing COVID-19 during the perinatal period are unknown. Therefore, we aimed to elucidate best practices regarding infection control in mother–newborn dyads, and identify potential risk factors associated with transmission. METHODS: In this observational cohort study, we identified all neonates born between March 22 and May 17, 2020, at three New York Presbyterian Hospitals in New York City (NY, USA) to mothers positive for SARS-CoV-2 at delivery. Mothers could practice skin-to-skin care and breastfeed in the delivery room, but had to wear a surgical mask when near their neonate and practice proper hand hygiene before skin-to-skin contact, breastfeeding, and routine care. Unless medically required, neonates were kept in a closed Giraffe isolette in the same room as their mothers, and were held by mothers for feeding after appropriate hand hygiene, breast cleansing, and placement of a surgical mask. Neonates were tested for SARS-CoV-2 by use of real-time PCR on nasopharyngeal swabs taken at 24 h, 5–7 days, and 14 days of life, and were clinically evaluated by telemedicine at 1 month of age. We recorded demographics, neonatal, and maternal clinical presentation, as well as infection control practices in the hospital and at home. FINDINGS: Of 1481 deliveries, 116 (8%) mothers tested positive for SARS-CoV-2; 120 neonates were identified. All neonates were tested at 24 h of life and none were positive for SARS-CoV-2. 82 (68%) neonates completed follow-up at day 5–7 of life. Of the 82 neonates, 68 (83%) roomed in with the mothers. All mothers were allowed to breastfeed; at 5–7 days of life, 64 (78%) were still breastfeeding. 79 (96%) of 82 neonates had a repeat PCR at 5–7 days of life, which was negative in all; 72 (88%) neonates were also tested at 14 days of life and none were positive. None of the neonates had symptoms of COVID-19. INTERPRETATION: 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. FUNDING: None. Elsevier Ltd. 2020-10 2020-07-23 /pmc/articles/PMC7377726/ /pubmed/32711687 http://dx.doi.org/10.1016/S2352-4642(20)30235-2 Text en © 2020 Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Articles
Salvatore, Christine M
Han, Jin-Young
Acker, Karen P
Tiwari, Priyanka
Jin, Jenny
Brandler, Michael
Cangemi, Carla
Gordon, Laurie
Parow, Aimee
DiPace, Jennifer
DeLaMora, Patricia
Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study
title Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study
title_full Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study
title_fullStr Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study
title_full_unstemmed Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study
title_short Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study
title_sort neonatal management and outcomes during the covid-19 pandemic: an observation cohort study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377726/
https://www.ncbi.nlm.nih.gov/pubmed/32711687
http://dx.doi.org/10.1016/S2352-4642(20)30235-2
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