Subscribe to RSS
Longitudinal Survey of COVID-19 Burden and Related Policies in U.S. Neonatal Intensive Care Units
Objective This study aimed to determine the prevalence of confirmed novel coronavirus disease 2019 (COVID-19) disease or infants under investigation among a cohort of U.S. neonatal intensive care units (NICUs). Secondarily, to evaluate hospital policies regarding maternal COVID-19 screening and related to those infants born to mothers under investigation or confirmed to have COVID-19.
Study Design Serial cross-sectional surveys of MEDNAX-affiliated NICUs from March 26 to April 3, April 8 to April 19, May 4 to May 22, and July 13 to August 2, 2020. The surveys included questions regarding COVID-19 patient burden and policies regarding infant separation, feeding practices, and universal maternal screening.
Results Among 386 MEDNAX-affiliated NICUs, responses were received from 153 (42%), 160 (44%), 165 (45%), 148 (38%) across four rounds representing an active patient census of 3,465, 3,486, 3,452, and 3,442 NICU admitted patients on the day of survey completion. Confirmed COVID-19 disease in NICU admitted infants was rare, with the prevalence rising from 0.03 (1 patient) to 0.44% (15 patients) across the four survey rounds, while the prevalence of patients under investigation increased from 0.8 to 2.6%. Hospitals isolating infants from COVID-19-positive mothers fell from 46 to 20% between the second and fourth surveys, while centers permitting direct maternal breastfeeding increased 17 to 47% over the same period. Centers reporting universal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) screening for all expectant mothers increased from 52 to 69%.
Conclusion Among a large cohort of NICU infants, the prevalence of infants under investigation or with confirmed neonatal COVID-19 disease was low. Policies regarding universal maternal screening for SARS-CoV-2, infant isolation from positive mothers, and direct maternal breastfeeding for infants born to positive mothers are rapidly evolving. As universal maternal screening for SARS-CoV-2 becomes more common, the impact of these policies requires further investigation.
In this cohort, neonatal COVID-19 is rare.
Policies regarding isolation and breastfeeding for infants are rapidly evolving.
Most hospitals are now providing universal screening for expectant mothers for SARS-CoV-2.
Received: 04 June 2020
Accepted: 25 September 2020
19 October 2020 (online)
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. United States COVID-19 Cases and Deaths by State. Accessed May 31, 2020 at: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
- 2 CDC COVID-19 Response Team. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (14) 422-426
- 3 Dong Y, Mo X, Hu Y. et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020; 145 (06) e20200702
- 4 American Academy of Pediatrics. Children and COVID-19: State-Level Data Report. Accessed October 6, 2020 at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/
- 5 Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020; 12 (02) 194
- 6 Zeng L, Xia S, Yuan W. et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; 174 (07) 722-725
- 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 Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease (NCIRD), Division of Viral Diseases. Evaluation and management considerations for neonates at risk for COVID-19. Accessed October 6, 2020 at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-newborns.html
- 9 Vivanti AJ, Vauloup-Fellous C, Prevot S. et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun 2020; 11 (01) 3572
- 10 Sisman J, Jaleel MA, Moreno W. et al. Intrauterine transmission of SARS-COV-2 infection in a preterm infant. Pediatr Infect Dis J 2020; 39 (09) e265-e267
- 11 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero?: More definitive evidence is needed. JAMA 2020; 323 (18) 1788-1789
- 12 United States Census Bureau. Census Regions and Divisions of the United States. Accessed April 8, 2020 at: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf
- 13 Sutton D, Fuchs K, D'Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020; 382 (22) 2163-2164
- 14 Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129 (03) e827-e841
- 15 Chantry CJ, Eglash A, Labbok M. ABM position on breastfeeding-revised 2015. Breastfeed Med 2015; 10 (09) 407-411
- 16 Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Breastfeeding Report Card. Accessed October 6, 2020 at: https://www.cdc.gov/breastfeeding/data/reportcard.htm
- 17 American Academy of Pediatrics. FAQs: Management of Infants Born to Mothers with Suspected or Confirmed COVID-19. [updated April 2, 2020]. Accessed May 31, 2020 at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/faqs-management-of-infants-born-to-covid-19-mothers/
- 18 American Academy of Pediatrics. FAQs: Management of Infants Born to Mothers with Suspected or Confirmed COVID-19. [updated July 22, 2020]. Accessed August 18, 2020 at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/faqs-management-of-infants-born-to-covid-19-mothers/