The Impact of COVID-19 Infection on Labor and Delivery, Newborn Nursery, and Neonatal Intensive Care Unit: Prospective Observational Data from a Single Hospital System

Abstract

Objective Since its emergence in late 2019, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the novel coronavirus that causes novel coronavirus disease 2019 (COVID-19), has spread globally. Within the United States, some of the most affected regions have been New York, and Northern New Jersey. Our objective is to describe the impact of COVID-19 in a large delivery service in Northern New Jersey, including its effects on labor and delivery (L&D), the newborn nursery, and the neonatal intensive care unit (NICU).

Materials and Methods Between April 21, 2020 and May 5, 2020, a total of 78 mothers (3.6% of deliveries) were identified by screening history or examination to either be COVID-19 positive or possible positives (persons under investigation). Of the mothers who were tested after admission to L&D, 28% tested positive for SARS-CoV-2.

Discussion Isolation between mother and infant was recommended in 62 cases, either because the mother was positive for SARS-CoV-2 or because the test was still pending. Fifty-four families (87%) agreed to isolation and separation. The majority of infants, 51 (94%), were initially isolated on the newborn nursery. Six needed NICU admission. No infants had clinical evidence of symptomatic COVID-19 infection. Fourteen infants whose mothers were positive for SARS-CoV-2, and who had been separated from the mother at birth were tested for SARS-CoV-2 postnatally. All were negative.

Results COVID-19 posed a significant burden to mothers, infants, and staff over the 5-week study period. The yield from screening mothers for COVID-19 on L&D was high. Most families accepted the need for postnatal isolation and separation of mother and newborn.

Conclusion Our study suggests that the transmission of SARS-CoV-2 from mother to her fetus/newborn seems to be uncommon if appropriate separation measures are performed at birth.

Key Points

• The yield of targeted testing for SARS-CoV-2, on mothers on Labor and Delivery is high.

• Agreement to separation of mothers and infants to reduce transmission of SARS-CoV-2 was high.

• The incidence of symptomatic COVID-19 in newborns is low, if appropriate separation occurs at birth.

Keywords

COVID-19 - SARS-CoV-2 - vertical transmission - mother–infant dyad - horizontal transmission

• References

• 1 John Hopkins University. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Available at: https://coronavirus.jhu.edu/map.html . Accessed May 5, 2020
• 2 Han GK. COVID-19 Live Interactive Dashboard (v3). Available at: https://datastudio.google.com/reporting/f56febd8-5c42-4191-bcea-87a3396f4508/page/GQFJB . Accessed May 5, 2020
• 3 State of New Jersey Department of Health. New Jersey COVID-19 Dashboard. Available at: https://www.nj.gov/health/cd/topics/covid2019_dashboard.shtml . Accessed May 5, 2020
• 4 Mimouni F, Lakshminrusimha S, Pearlman SA, Raju T, Gallagher PG, Mendlovic J. Perinatal aspects on the covid-19 pandemic: a practical resource for perinatal-neonatal specialists. J Perinatol 2020; 40 (05) 820-826
• 5 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero?: more definitive evidence is needed. JAMA 2020 (e-pub ahead of print). Doi: 10.1001/jama.2020.4868
• 6 Li N, Han L, Peng M. , et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis 2020 (e-pub ahead of print). Doi: 10.1093/cid/ciaa352
• 7 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 (10226): 809-815
• 8 Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med 2020 (e-pub ahead of print). Doi: 10.5858/arpa.2020-0901-SA
• 9 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; (e-pub ahead of print) DOI: 10.1055/s-0040-1710050.
• 10 Society for Maternal Fetal Medicine and Society for Obstetric Anesthesia and Perinatology. Labor and Delivery COVID-19 Considerations. Available at: https://s3.amazonaws.com/cdn.smfm.org/media/2277/SMFM-SOAP_COVID_LD_Considerations_3-27-20_(final)_PDF.pdf . Accessed May 10, 2020
• 11 CDC. Considerations for Inpatient Obstetric Healthcare Settings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html . Accessed May 5, 2020
• 12 CDC. Care for Breastfeeding Women: Interim Guidance on Breastfeeding and Breast Milk Feeds in the Context of COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/care-for-breastfeeding-women.html . Accessed May 6, 2020
• 13 Puopolo KM, Kimberlin DW. Management of Infants Born to Mothers with COVID-19. Available at: https://downloads.aap.org/AAP/PDF/COVID%2019%20Initial%20Newborn%20Guidance.pdf . Accessed May 4, 2020
• 14 American Academy of Pediatrics. Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics 2010; 125 (02) 405-409
• 15 Kuzniewicz MW, Puopolo KM, Fischer A. , et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr 2017; 171 (04) 365-371
• 16 De Rose DU, Piersigilli F, Ronchetti MP. , et al; Study Group of Neonatal Infectious Diseases of The Italian Society of Neonatology (SIN). Novel Coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr 2020; 46 (01) 56
• 17 Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. 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 (e-pub ahead of print). Doi: 10.1111/mcn.13010