Evaluation of Rooming-in Practice for Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Italy
Evaluation of Rooming-in Practice for Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Italy
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DOI：
10.1001/jamapediatrics.2020.5086
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发表时间：
2020-12-07
期刊：
影响因子：
26.1
通讯作者：
Pugni, Lorenza
中科院分区：
文献类型：
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作者：
Ronchi, Andrea;Pietrasanta, Carlo;Pugni, Lorenza
在持续的严重急性呼吸综合征冠状病毒2(SARS-CoV-2)大流行期间，母婴二联体的管理是新生儿科医生面临的一个主要问题。在感染了SARS-CoV-2的母亲中，目前的建议建议要么分离二联体，要么鼓励在适当的预防措施下有保护的同居。没有关于在同住期间SARS-CoV-2通过母婴传播的风险的数据。目的探讨非典型肺炎冠状病毒2型(SARS-CoV-2)母婴同居和哺乳后传播的危险性。设计、环境和参与者一项前瞻性的多中心研究，从2020年3月19日至5月2日登记了母婴双胞胎，随访20天(范围为18-22天)。这项研究是在意大利北部伦巴第市的6个冠状病毒病2019产科中心进行的。研究对象包括61名感染SARS-CoV-2的母亲所生的62名新生儿和出生时鼻咽拭子结果为阴性的婴儿，根据母亲的临床情况符合入住同室实践的条件。感染SARS-CoV-2的母亲被鼓励在标准化的方案下进行同居和母乳喂养，以将病毒传播的风险降至最低。主要结果和指标出生第0、7、20天新生儿鼻咽拭子中SARS-CoV-2的临床特征和实时逆转录-聚合酶链式反应。结果在入选的62名新生儿(男25名)中，61名母亲(中位年龄32岁；四分位数范围28-36岁)的新生儿中，只有1名婴儿(1.6%；95%可信区间，0%-8.7%)在产后检查中被诊断为SARS-CoV-2感染。在这种情况下，由于母亲的临床情况严重恶化，在生命的第5天，寄宿被中断。新生儿在出生7天时病毒检测呈阳性，并出现一过性轻度呼吸困难。登记的新生儿中有95%是母乳喂养的。结论和相关性这项队列研究的结果为在SARS-CoV-2母亲感染的情况下母婴双方的管理提供了循证信息，表明有能力照顾婴儿的妇女可以实行同住和母乳喂养。这项队列研究调查了在冠状病毒病2019专用产科病房住院期间严重急性呼吸综合征冠状病毒2从妇女向其新生儿的传播。对于感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的母亲所生婴儿来说，与婴儿同住和母乳喂养是否安全？在这项多中心队列研究中，61名感染SARS-CoV-2的母亲所生的62名新生儿被安排在同一房间，并采取了适当的预防措施；没有新生儿在出生时鼻咽拭子检测出SARS-CoV-2阳性，其中95%是母乳喂养的。所有新生儿都被跟踪到3周大，只有1名新生儿在随访期间被诊断为SARS-CoV-2感染。这项研究的结果表明，如果采取了足够的飞沫和接触预防措施，SARS-CoV-2在同住实践中的母婴传播是罕见的。
Importance The management of mother-infant dyads during the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic constitutes a major issue for neonatologists. In mothers with SARS-CoV-2 infection, current recommendations suggest either to separate the dyad or encourage protected rooming-in under appropriate precautions. No data are available regarding the risk of mother-to-infant transmission of SARS-CoV-2 during rooming-in. Objective To evaluate the risk of postnatal transmission of SARS-CoV-2 from infected mothers to their neonates following rooming-in and breastfeeding. Design, Setting, and Participants A prospective, multicenter study enrolling mother-infant dyads from March 19 to May 2, 2020, followed up for 20 days of life (range, 18-22 days), was performed. The study was conducted at 6 coronavirus disease 2019 maternity centers in Lombardy, Northern Italy. Participants included 62 neonates born to 61 mothers with SARS-CoV-2 infection who were eligible for rooming-in practice based on the clinical condition of the mother and infants whose results of nasopharyngeal swabs were negative at birth. Exposures Mothers with SARS-CoV-2 infection were encouraged to practice rooming-in and breastfeeding under a standardized protocol to minimize the risk of viral transmission. Main Outcomes and Measures Clinical characteristics and real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 on neonatal nasopharyngeal swabs at 0, 7, and 20 days of life. Results Of the 62 neonates enrolled (25 boys), born to 61 mothers (median age, 32 years; interquartile range, 28-36 years), only 1 infant (1.6%; 95% CI, 0%-8.7%) was diagnosed as having SARS-CoV-2 infection at postbirth checks. In that case, rooming-in was interrupted on day 5 of life because of severe worsening of the mother's clinical condition. The neonate became positive for the virus on day 7 of life and developed transient mild dyspnea. Ninety-five percent of the neonates enrolled were breastfed. Conclusions and Relevance The findings of this cohort study provide evidence-based information on the management of mother-infant dyads in case of SARS-CoV-2 maternal infection suggesting that rooming-in and breastfeeding can be practiced in women who are able to care for their infants.This cohort study examines transmission of severe acute respiratory syndrome coronavirus 2 from women to their neonates during the rooming-in practice in coronavirus disease 2019-dedicated maternity units.Question Are rooming-in and breastfeeding safe for neonates born to mothers infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)? Findings In this multicenter cohort study, 62 neonates born to 61 mothers with SARS-CoV-2 infection were roomed-in with appropriate precautions; no neonate tested positive for SARS-CoV-2 on nasopharyngeal swab at birth, and 95% of them were breastfed. All neonates were followed up until age 3 weeks; only 1 neonate was diagnosed as having SARS-CoV-2 infection during follow-up. Meaning The findings of this study suggest that mother-to-infant transmission of SARS-CoV-2 during rooming-in practice is rare, provided that adequate droplet and contact precautions are taken.