Maternal transmission of SARS‐COV‐2 to the neonate, and possible routes for such transmission: A systematic review and critical analysis

Walker, Kate F; O’Donoghue, Keelin; Grace, Nicky; Dorling, Jon; Comeau, Jeannette L; Li, Wentao; Thornton, Jim G

BACKGROUND: Early reports of COVID‐19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding, is this practise justified? OBJECTIVE: To estimate the risk of the neonate becoming infected with SARS‐COV‐2 by mode of delivery, type of infant feeding and mother‐infant interaction SEARCH STRATEGY: Two biomedical databases were searched between September 2019 ‐ June 2020. SELECTION CRITERIA: Case reports or case series of pregnant women with confirmed COVID‐19, where neonatal outcomes were reported. DATA COLLECTION AND ANALYSIS: Data was extracted on mode of delivery, infant infection status, infant feeding and mother‐infant interaction. For reported infant infection a critical analysis was performed to evaluate the likelihood of vertical transmission. MAIN RESULTS: We included 49 studies which included 666 neonates and 655 women where information was provided on the mode of delivery and the infant’s infection status. 28/666 (4%) neonates had confirmed COVID‐19 infection postnatally. Of the 291 women who delivered vaginally, 8/292 (2.7%) neonates were positive. Of the 364 women who had a Caesarean birth, 20/374 (5.3%) neonates were positive. Of the 28 neonates with confirmed COVID‐19 infection, 7 were breast fed, 3 formula fed, 1 was given expressed breast milk and in 17 neonates the method of infant feeding was not reported. CONCLUSIONS: Neonatal COVID‐19 infection is uncommon, uncommonly symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or allowed contact with the mother.