Managing COVID-19-Positive Maternal–Infant Dyads: An Italian Experience

Abstract

Breastfeeding MedicineVol. 15, No. 5 CorrespondenceFree AccessManaging COVID-19-Positive Maternal–Infant Dyads: An Italian ExperienceGuglielmo Salvatori, Domenico Umberto De Rose, Carlo Concato, Dario Alario, Nicole Olivini, Andrea Dotta, and Andrea CampanaGuglielmo SalvatoriNeonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Domenico Umberto De RoseAddress correspondence to: Domenico Umberto De Rose, MD, Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Piazza S. Onofrio 4, Rome 00165, Italy E-mail Address: [email protected]Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Carlo ConcatoVirology Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Dario AlarioPediatrics Unit, "San Paolo" Hospital, Civitavecchia (Rome), Italy.Search for more papers by this author, Nicole OliviniDepartment of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Andrea DottaNeonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, and Andrea CampanaDepartment of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this authorPublished Online:8 May 2020https://doi.org/10.1089/bfm.2020.0095AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail Dear Editor:We report our experience in Italy during COVID-19 viral outbreak. At time of writing, on April 13, 2020, the number of confirmed cases was 1,699,595 worldwide, with 106,138 deaths, resulting in a crude fatality rate of 6.2%.1Although children seem to have a milder disease than adults, newborns and infants could be more at risk than other pediatric categories; thus, they deserve special attention because of insidious and nonspecific symptoms.2Although there is currently no evidence showing a vertical transmission of SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy,3 a major concern involves the possible transmission of the infection to their fragile infants, in particular after delivery. The virus can be detected by real-time polymerase chain reaction (RT-PCR) in different biological fluids (bronchoalveolar-lavage fluid, sputum, saliva, nasopharyngeal swabs, and feces) but no positive breast milk samples have been found in different reported cohorts for a total number of 32 dyads.2Therefore, for COVID-19-positive new mothers, whenever possible, it is advisable to plan a joint management of the mother with her infant, to promote the beginning of breastfeeding, while assessing on a case-by-case basis if eventual drugs administered to infected mothers could be harmful to the infant. According to the indications of the Italian Society of Neonatology,4 if a mother previously identified as COVID-19 positive is asymptomatic or paucisymptomatic, rooming-in is a reasonable management and direct breastfeeding is prudent, ensuring strict measures of infection control (washing often mother's hands before touching the infant and wearing a face mask). In most cases, a hospital stay of ∼1 week is preferred.Herein we describe our experience in our children's hospital, which is a referral care center in Rome (Italy) for ill out born neonates, who are transferred from other institutions. We report the first two maternal–infant dyads presenting to our emergency department because of a positive nasopharyngeal swab for SARS-CoV-2 both in the mother and in the child; clinical characteristics are summarized in Table 1. They were probably infected by a third person at the same time. Neither the mothers nor the infants needed intensive care unit admission; therefore, newborns were prudently isolated from their paucisymptomatic mothers.Table 1. Clinical Features of Newborns with Postnatal Confirmed SARS-CoV-2 Infection and Their Mothers Mother 1/newborn 1Mother 2/newborn 2Maternal age, years3626Maternal symptomsAnosmia and dysgeusiaBack and thoracic painMaternal ICU admissionNoNoMaternal nasopharyngeal swabPositivePositivePositive breast milk samplesNoNoExclusive breast milkYesYesFeeding: breastfeeding or feeding bottleBreastfeedingBreastfeedingNeonatal nasopharyngeal swab on admissionPositivePositiveGestational age, weeks41 + 239Birth weight, g4,4403,120Neonatal genderMaleFemaleNeonatal age on admission, days1810Neonatal weight on admission, g5,2003,200Neonatal symptoms and complicationsNoCoughDiarrheaPoor feedingNeonatal body temperature on admission36°C36.7°CNeonatal SatO2 on admission99%100%Neonatal oxygen supportNoNoNeonatal ICU admissionNoNoNeonatal recoveryAsymptomatic patientNo more diarrhea and need of intravenous fluids on day 5ICU, intensive care unit.We analyzed expressed breast milk samples of both mothers, and SARS-CoV-2 was not detected by RT-PCR, as already described.2 Virus detection analysis after pasteurization was not performed because the virus was not found already in expressed milk.To the best of our knowledge, these are the first data on postnatal horizontal COVID-19 infection in newborns and breast milk analysis in Italy. We confirm that SARS-CoV-2 seems to spare breast milk and horizontal transmission from mother to neonate could occur through respiratory droplets rather than through milk. Therefore, when SARS-CoV-2 is identified both in the mother and in the child, there are no reason to stop breastfeeding and separate them. Whenever direct breastfeeding is not possible, the use of expressed mother's milk should be considered and promoted to take advantage of its unquestionable benefits.In conclusion, we agree that medical staff and nurses should not only focus on care of COVID-19 mothers and infants, but also protect, promote, and support breastfeeding. Breastfeeding creates a unique relationship between mother and child, thus reducing the length of hospital stay and the negative effects linked to quarantine and stress because of this pandemic viral outbreak.Authors' ContributionsAll authors participated in the conception and design of the study, acquisition and interpretation of data, and drafting the article. All authors read and approved the final version.Ethical StatementThe authors declare that they have followed the protocols of their work center on the publication of patients' data and Helsinki Declaration: no patient is recognizable with data appearing in this article. An informed consensus was obtained before enrolling patients, records were anonymized and deidentified before analysis, and all data were fully anonymized before any access by the authors.Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. World Health Organization. WHO: Novel Coronavirus (COVID-19) Situation Reports. https://who.sprinklr.com/ (accessed on April 13, 2020). Google Scholar2. De Rose DU, Piersigilli F, Ronchetti MP, et al. Novel coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr 2020 (in press). Google Scholar3. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395:809–815. Crossref, Medline, Google Scholar4. Davanzo R, Moro G, Sandri F, et al. Breastfeeding and coronavirus disease-2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr 2020:e13010. Medline, Google ScholarFiguresReferencesRelatedDetailsCited bySARS-CoV-2 detection in human milk: a systematic review8 February 2021 | The Journal of Maternal-Fetal & Neonatal Medicine, Vol. 35, No. 25The Importance of Personal and Familial Factors on Breastfeeding Intention and Practices, and Postpartum Distress during the Pandemic: A Longitudinal Observational Study4 November 2023 | Maternal and Child Health Journal, Vol. 28, No. 3Narrative Literature on Breastfeeding Counseling during COVID-19: A South African Case of Primary HealthcareThe Open Public Health Journal, Vol. 17, No. 1Breastfeeding vs. breast milk transmission during COVID-19 pandemic, which is more important?6 September 2023 | Frontiers in Pediatrics, Vol. 11Vertical transmission and maternal passive immunity post-SARS-CoV-2Future Virology, Vol. 18, No. 13Determinants of early initiation of breast feeding during COVID-19 pandemic among urban-dwelling mothers from Tigray, Northern Ethiopia: a community-based cross-sectional study10 July 2023 | BMJ Open, Vol. 13, No. 7Evaluation of the transmission of SARS-CoV-2 through breast milk: a case series22 June 2023 | Frontiers in Pediatrics, Vol. 11Knowledge, attitude, and determinants of exclusive breastfeeding during COVID-19 pandemic among lactating mothers in Mekelle, Tigrai: a cross sectional study18 November 2022 | BMC Pregnancy and Childbirth, Vol. 22, No. 1Impact of COVID-19 Infection on Maternal and Neonatal Outcomes: A Review of 11078 Pregnancies Reported in the LiteratureCurrent Women s Health Reviews, Vol. 18, No. 4Breastfeeding Practices During COVID-19: A Narrative ArticleCureus, Vol. 39Detectable SARS-CoV-2 in Human Breast Milk: A Turkey Experience29 September 2022 | Journal of Basic and Clinical Health Sciences, Vol. 6, No. 3Gut microbiota and COVID-19: An intriguing pediatric perspectiveWorld Journal of Clinical Cases, Vol. 10, No. 23Perinatal management of SARS-CoV-2 infection in a level III University Hospital23 July 2020 | The Journal of Maternal-Fetal & Neonatal Medicine, Vol. 35, No. 15An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting28 July 2022 | Frontiers in Pediatrics, Vol. 10Vertical transmission of SARS CoV-2: a systematic review21 July 2020 | The Journal of Maternal-Fetal & Neonatal Medicine, Vol. 35, No. 14Pediatrik COVID-19 Enfeksiyonu ve Hemşirelik Yaklaşımı: Güncel Gelişmeler18 July 2022 | Hemşirelik Bilimi Dergisi, Vol. 5, No. 2Breastfeeding during the COVID-19 pandemic: what do we know so far?einstein (São Paulo), Vol. 20Breastfeeding in the era of COVID-19. A narrative review14 August 2021 | Journal of Obstetrics and Gynaecology, Vol. 42, No. 4Perinatal outcomes of pregnant women with severe COVID-19 requiring extracorporeal membrane oxygenation (ECMO): a case series and literature review9 March 2022 | Archives of Gynecology and Obstetrics, Vol. 305, No. 5Breastfeeding and the COVID-19 Epidemic in Vietnam21 April 2022 | Asia Pacific Journal of Public Health, Vol. 34, No. 4Transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) through infant feeding and early care practices: A systematic reviewJournal of Neonatal-Perinatal Medicine, Vol. 15, No. 2COVID-19 in Neonates with Positive RT–PCR Test. Systematic ReviewArchives of Medical Research, Vol. 53, No. 3The course of new coronavirus infection in newborn infantsRussian Pediatric Journal, Vol. 25, No. 1Revisión de nuevas evidencias acerca de la posible transmisión vertical de la COVID-19Gaceta Sanitaria, Vol. 36, No. 2Safety of breast/chest-feeding by those infected by SARS-CoV-228 December 2021 | Current Opinion in Clinical Nutrition & Metabolic Care, Vol. 25, No. 2Italian neonatologists and SARS-CoV-2: lessons learned to face coming new waves7 April 2021 | Pediatric Research, Vol. 91, No. 3Maternal Transmission of SARS-CoV-2: Safety of Breastfeeding in Infants Born to Infected Mothers9 December 2021 | Frontiers in Pediatrics, Vol. 9Study of perinatal transmission of SARS-CoV-2 in a Mexican public hospitalInternational Journal of Infectious Diseases, Vol. 113COVID-19 during pregnancy should we really worry from vertical transmission or rather from fetal hypoxia and placental insufficiency? A systematic review12 April 2021 | Egyptian Pediatric Association Gazette, Vol. 69, No. 1Breastfeeding Experiences During the COVID-19 Lockdown in the United Kingdom: An Exploratory Study Into Maternal Opinions and Emotional States9 September 2021 | Journal of Human Lactation, Vol. 37, No. 4The Benefits of Breastfeeding Still Outweigh the Risks of COVID-19 Transmission8 September 2021 | Frontiers in Medicine, Vol. 8COVID-19: Relationship and Impact on Breastfeeding—A Systematic Review26 August 2021 | Nutrients, Vol. 13, No. 9Clinical Features and Outcome of SARS-CoV-2 Infection in Neonates: A Systematic Review28 August 2020 | Journal of Tropical Pediatrics, Vol. 67, No. 3ISIDOG Consensus Guidelines on COVID-19 Vaccination for Women before, during and after Pregnancy29 June 2021 | Journal of Clinical Medicine, Vol. 10, No. 13Reshaping neonatal intensive care units (NICUs) to avoid the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to high-risk infants24 June 2020 | Infection Control & Hospital Epidemiology, Vol. 42, No. 5Coronavirus infection in neonates: a systematic review17 September 2020 | Archives of Disease in Childhood - Fetal and Neonatal Edition, Vol. 106, No. 3Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis16 February 2021 | Archives of Disease in Childhood, Vol. 106, No. 5A Case Study Supporting Lack of SARS-CoV-2 Spread to a 3-Month Old Infant Through Exclusive Breastfeeding13 February 2021 | Journal of Human Lactation, Vol. 37, No. 2Neonatal SARS-CoV-2 Infection: Practical Tips17 May 2021 | Pathogens, Vol. 10, No. 5Clinical implications of coronavirus disease 2019 in neonatesClinical and Experimental Pediatrics, Vol. 64, No. 4Breastfeeding and COVID-19: From Nutrition to Immunity7 April 2021 | Frontiers in Immunology, Vol. 12Perinatal COVID-19: review of current evidence and practical approach towards prevention and management12 November 2020 | European Journal of Pediatrics, Vol. 180, No. 4Should COVID-19 Mother Breastfeed her Newborn Child? A Literature Review on the Safety of Breastfeeding for Pregnant Women with COVID-194 January 2021 | Current Nutrition Reports, Vol. 10, No. 1Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerationsJornal de Pediatria, Vol. 97, No. 2COVID-19 in pregnancy and the puerperium: A review for emergency physiciansThe American Journal of Emergency Medicine, Vol. 40Universal Screening for SARS-CoV-2 of all Human Milk Bank Samples22 September 2020 | Journal of Human Lactation, Vol. 37, No. 1Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Positive Newborns of COVID-19 Mothers After Dyad-Care: A Case SeriesCureusMaternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysisEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 256Risk transmission through breastfeeding and antibody in COVID-19 motherGaceta Sanitaria, Vol. 35Community-Onset Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Young Infants: A Systematic ReviewThe Journal of Pediatrics, Vol. 228Transmission of SARS‐CoV‐2 through breast milk and breastfeeding: a living systematic review28 August 2020 | Annals of the New York Academy of Sciences, Vol. 1484, No. 1Synthesis and systematic review of reported neonatal SARS-CoV-2 infections15 October 2020 | Nature Communications, Vol. 11, No. 1Breastfeeding mothers with COVID-19 infection: a case series8 August 2020 | International Breastfeeding Journal, Vol. 15, No. 1Coronavirus global pandemic: An overview of current findings among pediatric patients7 October 2020 | Pediatric Pulmonology, Vol. 55, No. 12Maternal, Perinatal and Neonatal Outcomes With COVID-19: A Multicenter Study of 242 Pregnancies and Their 248 Infant Newborns During Their First Month of Life11 September 2020 | Pediatric Infectious Disease Journal, Vol. 39, No. 12Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at BirthThe Journal of Pediatrics, Vol. 226A study of breastfeeding practices, SARS-CoV-2 and its antibodies in the breast milk of mothers confirmed with COVID-19The Lancet Regional Health - Western Pacific, Vol. 4Breastfeeding in COVID-19: A Pragmatic Approach8 September 2020 | American Journal of Perinatology, Vol. 37, No. 13Implications of the COVID-19 Pandemic Response for Breastfeeding, Maternal Caregiving Capacity and Infant Mental Health6 August 2020 | Journal of Human Lactation, Vol. 36, No. 4Lack of viral transmission to preterm newborn from a COVID‐19 positive breastfeeding mother at 11 days postpartum2 June 2020 | Journal of Medical Virology, Vol. 92, No. 11The clinical course of SARS-CoV-2 positive neonates6 July 2020 | Journal of Perinatology, Vol. 40, No. 10Covid-19 and breastfeeding: what's the risk?13 July 2020 | Journal of Perinatology, Vol. 40, No. 10SARS‐CoV‐2 and human milk: What is the evidence?30 May 2020 | Maternal & Child Nutrition, Vol. 16, No. 4Covid-19 in pregnant women and babies: What pediatricians need to knowPaediatric Respiratory Reviews, Vol. 35Vertical Transmission of SARS-CoV-2 (COVID-19): Are Hypotheses More than Evidences?5 August 2020 | American Journal of Perinatology, Vol. 37, No. S 02Management and Nutrition of Neonates during the COVID-19 Pandemic: A Review of the Existing Guidelines and Recommendations8 September 2020 | American Journal of Perinatology, Vol. 37, No. S 02Negative Transmission of SARS-CoV-2 to Hand-Expressed Colostrum from SARS-CoV-2–Positive Mothers Miguel Ángel Marín Gabriel, Ana María Malalana Martínez, María Eugenia Marín Martínez, and Jorge Anel Pedroche6 August 2020 | Breastfeeding Medicine, Vol. 15, No. 8Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic24 June 2020 | BMJ Global Health, Vol. 5, No. 6Coronavirus disease-2019 (COVID-19) infection in a 3-month-old infant: Clinical features, treatment and probable route of transmissionIDCases, Vol. 22 Volume 15Issue 5May 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Guglielmo Salvatori, Domenico Umberto De Rose, Carlo Concato, Dario Alario, Nicole Olivini, Andrea Dotta, and Andrea Campana.Managing COVID-19-Positive Maternal–Infant Dyads: An Italian Experience.Breastfeeding Medicine.May 2020.347-348.http://doi.org/10.1089/bfm.2020.0095Published in Volume: 15 Issue 5: May 8, 2020Online Ahead of Print:April 21, 2020 TopicsCOVID-19 PDF download

Topics & Concepts