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Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City.
JAMA Pediatr. 2021 02 01; 175(2):157-167.JP

Abstract

Importance

Limited data on vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and health outcomes of neonates born to mothers with symptomatic or asymptomatic coronavirus disease 2019 (COVID-19) are available. Studies are needed to inform evidence-based infection prevention and control (IP&C) policies.

Objective

To describe the outcomes of neonates born to mothers with perinatal SARS-CoV-2 infection and the IP&C practices associated with these outcomes.

Design, Setting, and Participants

This retrospective cohort analysis reviewed the medical records for maternal and newborn data for all 101 neonates born to 100 mothers positive for or with suspected SARS-CoV-2 infection from March 13 to April 24, 2020. Testing for SARS-CoV-2 was performed using Cobas (Roche Diagnostics) or Xpert Xpress (Cepheid) assays. Newborns were admitted to well-baby nurseries (WBNs) (82 infants) and neonatal intensive care units (NICUs) (19 infants) in 2 affiliate hospitals at a large academic medical center in New York, New York. Newborns from the WBNs roomed-in with their mothers, who were required to wear masks. Direct breastfeeding after appropriate hygiene was encouraged.

Exposures

Perinatal exposure to maternal asymptomatic/mild vs severe/critical COVID-19.

Main Outcomes and Measures

The primary outcome was newborn SARS-CoV-2 testing results. Maternal COVID-19 status was classified as asymptomatic/mildly symptomatic vs severe/critical. Newborn characteristics and clinical courses were compared across maternal COVID-19 severity.

Results

In total, 141 tests were obtained from 101 newborns (54 girls [53.5%]) on 0 to 25 days of life (DOL-0 to DOL-25) (median, DOL-1; interquartile range [IQR], DOL-1 to DOL-3). Two newborns had indeterminate test results, indicative of low viral load (2.0%; 95% CI, 0.2%-7.0%); 1 newborn never underwent retesting but remained well on follow-up, and the other had negative results on retesting. Maternal severe/critical COVID-19 was associated with newborns born approximately 1 week earlier (median gestational age, 37.9 [IQR, 37.1-38.4] vs 39.1 [IQR, 38.3-40.2] weeks; P = .02) and at increased risk of requiring phototherapy (3 of 10 [30.0%] vs 6 of 91 [7.0%]; P = .04) compared with newborns of mothers with asymptomatic/mild COVID-19. Fifty-five newborns were followed up in a new COVID-19 Newborn Follow-up Clinic at DOL-3 to DOL-10 and remained well. Twenty of these newborns plus 3 newborns followed up elsewhere had 32 nonroutine encounters documented at DOL-3 to DOL-25, and none had evidence of SARS-CoV-2 infection, including 6 with negative retesting results.

Conclusions and Relevance

No clinical evidence of vertical transmission was identified in 101 newborns of mothers positive for or with suspected SARS-CoV-2 infection, despite most newborns rooming-in and direct breastfeeding practices.

Authors+Show Affiliations

Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York. Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York. Sackler Institute, Zuckerman Institute, and the Columbia Population Research Center, Columbia University, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York. Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. NewYork-Presbyterian Hospital, New York, New York. Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York.NewYork-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33044493

Citation

Dumitriu, Dani, et al. "Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City." JAMA Pediatrics, vol. 175, no. 2, 2021, pp. 157-167.
Dumitriu D, Emeruwa UN, Hanft E, et al. Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. JAMA Pediatr. 2021;175(2):157-167.
Dumitriu, D., Emeruwa, U. N., Hanft, E., Liao, G. V., Ludwig, E., Walzer, L., Arditi, B., Saslaw, M., Andrikopoulou, M., Scripps, T., Baptiste, C., Khan, A., Breslin, N., Rubenstein, D., Simpson, L. L., Kyle, M. H., Friedman, A. M., Hirsch, D. S., Miller, R. S., ... Gyamfi-Bannerman, C. (2021). Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. JAMA Pediatrics, 175(2), 157-167. https://doi.org/10.1001/jamapediatrics.2020.4298
Dumitriu D, et al. Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. JAMA Pediatr. 2021 02 1;175(2):157-167. PubMed PMID: 33044493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. AU - Dumitriu,Dani, AU - Emeruwa,Ukachi N, AU - Hanft,Erin, AU - Liao,Grace V, AU - Ludwig,Elizabeth, AU - Walzer,Lauren, AU - Arditi,Brittany, AU - Saslaw,Minna, AU - Andrikopoulou,Maria, AU - Scripps,Tessa, AU - Baptiste,Caitlin, AU - Khan,Adrita, AU - Breslin,Noelle, AU - Rubenstein,David, AU - Simpson,Lynn L, AU - Kyle,Margaret H, AU - Friedman,Alexander M, AU - Hirsch,Daniel S, AU - Miller,Russell S, AU - Fernández,Cristina R, AU - Fuchs,Karin M, AU - Keown,M Kathleen, AU - Glassman,Melissa E, AU - Stephens,Ashley, AU - Gupta,Archana, AU - Sultan,Sally, AU - Sibblies,Caroline, AU - Whittier,Susan, AU - Abreu,Wanda, AU - Akita,Francis, AU - Penn,Anna, AU - D'Alton,Mary E, AU - Orange,Jordan S, AU - Goffman,Dena, AU - Saiman,Lisa, AU - Stockwell,Melissa S, AU - Gyamfi-Bannerman,Cynthia, PY - 2020/10/13/pubmed PY - 2021/2/12/medline PY - 2020/10/12/entrez SP - 157 EP - 167 JF - JAMA pediatrics JO - JAMA Pediatr VL - 175 IS - 2 N2 - Importance: Limited data on vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and health outcomes of neonates born to mothers with symptomatic or asymptomatic coronavirus disease 2019 (COVID-19) are available. Studies are needed to inform evidence-based infection prevention and control (IP&C) policies. Objective: To describe the outcomes of neonates born to mothers with perinatal SARS-CoV-2 infection and the IP&C practices associated with these outcomes. Design, Setting, and Participants: This retrospective cohort analysis reviewed the medical records for maternal and newborn data for all 101 neonates born to 100 mothers positive for or with suspected SARS-CoV-2 infection from March 13 to April 24, 2020. Testing for SARS-CoV-2 was performed using Cobas (Roche Diagnostics) or Xpert Xpress (Cepheid) assays. Newborns were admitted to well-baby nurseries (WBNs) (82 infants) and neonatal intensive care units (NICUs) (19 infants) in 2 affiliate hospitals at a large academic medical center in New York, New York. Newborns from the WBNs roomed-in with their mothers, who were required to wear masks. Direct breastfeeding after appropriate hygiene was encouraged. Exposures: Perinatal exposure to maternal asymptomatic/mild vs severe/critical COVID-19. Main Outcomes and Measures: The primary outcome was newborn SARS-CoV-2 testing results. Maternal COVID-19 status was classified as asymptomatic/mildly symptomatic vs severe/critical. Newborn characteristics and clinical courses were compared across maternal COVID-19 severity. Results: In total, 141 tests were obtained from 101 newborns (54 girls [53.5%]) on 0 to 25 days of life (DOL-0 to DOL-25) (median, DOL-1; interquartile range [IQR], DOL-1 to DOL-3). Two newborns had indeterminate test results, indicative of low viral load (2.0%; 95% CI, 0.2%-7.0%); 1 newborn never underwent retesting but remained well on follow-up, and the other had negative results on retesting. Maternal severe/critical COVID-19 was associated with newborns born approximately 1 week earlier (median gestational age, 37.9 [IQR, 37.1-38.4] vs 39.1 [IQR, 38.3-40.2] weeks; P = .02) and at increased risk of requiring phototherapy (3 of 10 [30.0%] vs 6 of 91 [7.0%]; P = .04) compared with newborns of mothers with asymptomatic/mild COVID-19. Fifty-five newborns were followed up in a new COVID-19 Newborn Follow-up Clinic at DOL-3 to DOL-10 and remained well. Twenty of these newborns plus 3 newborns followed up elsewhere had 32 nonroutine encounters documented at DOL-3 to DOL-25, and none had evidence of SARS-CoV-2 infection, including 6 with negative retesting results. Conclusions and Relevance: No clinical evidence of vertical transmission was identified in 101 newborns of mothers positive for or with suspected SARS-CoV-2 infection, despite most newborns rooming-in and direct breastfeeding practices. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/33044493/Outcomes_of_Neonates_Born_to_Mothers_With_Severe_Acute_Respiratory_Syndrome_Coronavirus_2_Infection_at_a_Large_Medical_Center_in_New_York_City_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2020.4298 DB - PRIME DP - Unbound Medicine ER -