Update: AAP Report on Initial Guidance: Management of Infants Born to Mothers with COVID-19

The AAP has recently published a new report, “Initial Guidance: Management of Infants Born to Mothers with COVID-19” addressing the care of infants whose mothers have suspected or confirmed coronavirus disease 2019 (COVID-19).
Key points:
  • Current evidence is consistent with low rates of peripartum transmission and is inconclusive about in utero transmission of SARS-CoV-2 from mothers with COVID-19 to their newborns.
  • Neonates can acquire SARS-CoV-2 after birth. Their immature immune system leaves newborns vulnerable to other serious respiratory viral infections, raising concern that SARS-CoV-2 may cause severe disease among neonates.
  • Airborne, Droplet, and Contact Precautions should be utilized when attending deliveries from women with COVID-19 due to the increased likelihood of maternal virus aerosols and the potential need to administer newborn resuscitation to infants with COVID-19 infection that can generate virus aerosol.
  • When the physical environment allows, newborns should be separated at birth from mothers with COVID-19.
  • SARS-CoV-2 has not been detected in breast milk to date. Mothers with COVID-19 can express breast milk to be fed to their infants by uninfected caregivers until specific maternal criteria are met.
  • Infants born to mothers with COVID-19 should be tested for SARS-CoV-2 at 24 hours and, if still in the birth facility, at 48 hours after birth. Centers with limited resources for testing may make individual risk/benefit decisions regarding testing. Note that there have been reports of neonates who test negative at 24 hours but positive at 48-72 hours.
  • A newborn who has a documented SARS-CoV-2 infection (or who remains at risk for postnatal acquisition of COVID-19 due to inability to test the infant) requires frequent outpatient follow-up via telephone, telemedicine, or in-person assessments through 14 days after discharge.
  • After hospital discharge, a mother with COVID-19 is advised to maintain a distance of at least 6 feet from the newborn, and when in closer proximity use a mask and hand-hygiene for newborn care until (a) she is afebrile for 72 hours without use of antipyretics, and (b) at least 7 days have passed since symptoms first appeared.
  • A mother with COVID-19 whose newborn requires ongoing hospital care should maintain separation until (a) she is afebrile for 72 hours without use of antipyretics, and (b) her respiratory symptoms are improved, and (c) negative results are obtained from at least two consecutive SARS-CoV-2 nasopharyngeal swab tests collected ?24 hours apart. These recommendations are based on the most conservative CDC recommendations for discontinuing transmission-based precautions for patients with COVID-19 in the hospital setting and are more stringent than the requirements for mothers and well newborns after hospital discharge.
For detailed information on the 2019 Novel Coronavirus (COVID-2019) outbreak, please visit the 2019 Novel Coronavirus (COVID-19) entry in the Red Book Online Outbreaks section.
Please note that this latest AAP report is specific for COVID-19. This information is NOT addressed in the Coronaviruses chapter (including SARS and MERS) in the current edition of Red Book.

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