Researchers also found that of all the newborns born in the study period, premature newborns and Black, Asian, and other Minority Ethnic groups (BAME) were more likely to experience a COVID-19 infection. The exact reason for this is not known. Overall, the risk of babies developing COVID-19 is considered so low, even among babies of COVID-19 positive parents, that researchers recommend parents and babies remain together after birth wherever possible. Separating parent and baby for the sole purpose of trying to reduce transmission of COVID-19 is not beneficial.
What the Study Shows
Researchers in London reviewed the data from cases of COVID-19 that occurred in March and April of 2020. They looked specifically at babies who were admitted to the hospital within the first 28 days of life due to a diagnosis of SARS-CoV-2 (COVID-19). Study co-author Christopher Gale, PhD, explains some results. “SARS-CoV-2 infection is very rare in newborn babies: over the study period during the first UK pandemic peak in March and April about 120,000 babies were born in the UK and only 66 of these had SARS-CoV-2 infection in hospital.“ Of the 66 newborns that were confirmed to have COVID-19, 17 had gestational parents who were also positive for COVID-19 within seven days before or after the birth. Only two cases were thought to be directly passed to the baby during pregnancy. The study reports that approximately 300 parents with confirmed COVID-19 infection gave birth during this time period and most remained with their babies after birth. Seven babies who were separated from their parents still contracted COVID-19.
How Newborns Get COVID-19
These rates suggest that it is best to keep parent and baby together where possible because separation for the purposes of trying to avoid infection is not effective. From the data, researchers reviewed how babies became infected and when, which babies were most likely to get COVID-19, what COVID-19 looked like in babies, what treatment they needed, and how quickly they recovered. Dr. Gale says, “Keeping mother and her newborn baby together and encouraging breastfeeding, even if the mother has COVID-19, is safe. This supports international guidance from the World Health Organization.” Of the 66 positive COVID-19 babies, 34 had a close contact or family member who had signs and symptoms of COVID-19 (but not necessarily a confirmed case). These results show the importance of avoiding contact with anyone who is unwell with any symptoms of COVID-19, no matter how mild. Dr. Patrick Clements, medical director of the Well Baby Unit at Riley Children’s Health, reminds new parents to avoid contact with anyone who is unwell. “No one should visit baby if they are having a fever, cough, runny nose, or any other symptoms concerning for COVID. Encouraging visitors to wash hands can reduce the spread of infections, and some families may opt to have visitors wear a mask if they are holding the newborn.” Eight of the confirmed newborn cases were thought to be hospital-acquired infections. None of these babies had gestational parents with COVID-19 and most of them were in a neonatal unit or pediatric intensive care unit for reasons other than COVID-19.
What COVID-19 Looks Like in Newborns
Not all babies showed signs of infection. Babies who were tested within seven days of birth because of maternal infection usually showed no symptoms prior to testing. Babies who did show symptoms most commonly had fevers, poor feeding, and signs of a cold such as nasal stuffiness, discharge, and inflammation of the mucosa in the nose or throat. Lethargy and respiratory distress were also commonly reported. Respiratory distress is when you see the skin between and around the ribs sink in with an inhale. Other things you may notice include very rapid breathing (more than 60 breaths per minute), nostrils flaring out with every inhale, or a small noise with every exhale. Of these 66 COVID-19 positive babies, 28 were classified as having “severe” COVID-19, which means they had symptoms as mentioned above, but they also had abnormal chest X-rays or abnormal blood test results consistent with more serious cases of COVID-19.
Onset of COVID-19 in Newborns
For babies who had parents with COVID-19, babies were generally diagnosed with COVID-19 within seven days of birth. It is important to note that these babies were being tested even if they did not show symptoms.
Fever equal to or greater than 100.4 F (37.9 C)Any signs of respiratory distress Poor feedingLethargyNasal stuffiness or dischargeCoughPoor tone (floppiness)Persistent body temperature below 97.7 F (36.5 C)
For babies who had a hospital-acquired COVID-19 infection, most of these babies showed symptoms and were diagnosed after seven days of birth. The majority of babies with severe COVID-19 infection were diagnosed 10 to 12 days after birth. However, some babies were diagnosed as late as 28 days after birth. This data suggests that the incubation period for COVID-19 in newborns is the same as the general population—two to 14 days.
Treatment and Recovery of Newborns With COVID-19
The majority of babies who had COVID-19 were full-term babies who were cared for in a pediatric or postnatal hospital wards and kept with their parent. On average, these babies were discharged after two days in the hospital with no further support needed. Babies admitted to a pediatric intensive care unit also stayed an average of two days before discharge. Babies in neonatal units generally stayed longer, but this is likely due to prematurity rather than COVID-19. In the study, 22 of the 66 babies required additional support with breathing. Of these 22, only three required invasive ventilation, 10 required non-invasive ventilation, and all of these babies received supplemental oxygen. Five of these 22 babies were born preterm, which means that they may have needed oxygen even if they did not have COVID-19. Gale reports, “While about one in three of these babies needed some breathing support (mainly just with oxygen, and some may have needed this for other reasons like prematurity) these babies did very well. No baby died of SARS-CoV-2 in this study.” Other treatments provided included two instances of antiviral therapy, two instances of corticosteroids, and one instance of immunoglobulin therapy. There is no evidence in this study about the effect of these therapies.
Newborns Most at Risk
Researchers report an over-representation of premature babies with COVID-19. The exact reasons are not known, but it may be due to altered immune function in premature babies which causes them to be more susceptible to infections. There was also a large proportion of hospital-acquired COVID-19 infections that occurred in the neonatal units, suggesting that hospitals need to reconsider their infection control protocols in relation to this COVID-19 data. There were 36 COVID-19 positive babies of White ethnic groups, 14 from Asian ethnic groups, 8 from Black ethnic groups, and 7 from other Minority Ethnic groups. Although it appears that the White ethnic groups were the highest prevalence, when calculated against the total number of live births from each of these ethnic groups, newborns of BAME populations had a higher incidence of COVID-19 infection. The higher incidence of COVID-19 in BAME populations is consistent across all age groups. It may be due to higher BAME population numbers that live in locations of an outbreak, but researchers admit that the true reasons are unknown and that more research is urgently needed in this area.
What to Do If You Suspect COVID-19 in Your Baby
If you are worried that your baby has been exposed to COVID-19, monitor them for signs and symptoms of the illness. If your baby shows any signs of illness it is best to see your doctor or local hospital for advice as soon as possible. Dr. Clements suggests, “Contact your child’s doctor if there is ever a concern. Newborns should be monitored for fever. In babies, a fever is a temperature of 100.4 F. Any time a baby has a fever they should see their regular doctor right away, or come to the emergency department at the hospital. “Families should also monitor baby for signs of breathing problems. If baby is breathing very fast, using the muscles between the ribs to breathe (retractions), or looking like they are having difficulty, parents should seek medical care right away.” If you suspect your baby has been exposed to COVID-19, phone ahead so that staff can be ready to attend appropriately. Clements reminds parents that “If there is concern for COVID-19, healthcare workers will wear special protective equipment when they are caring for baby.”
How to Protect Your Baby
Regular hand washing, especially before and after feeds or diaper changes, is very important. If a parent has COVID-19, Clements also advises “the best way to keep the baby safe is to protect the baby from infectious respiratory particles. This means distancing from baby when possible. Any time mother is less than 6 feet away from baby, she should wear her mask.” Breastfeeding is considered safe with COVID-19 and is encouraged by the World Health Organization. Avoid contact with people who are unwell. If a member of the household is unwell, cleaning surfaces such as countertops, faucets, and door handles regularly is important. It is also important to try to keep those people away from the baby where possible. Keeping your circle of contacts limited is advised, but very challenging for new parents. Support networks are so important for parents with a newborn. Clements reminds parents to reach out to their doctor if they are feeling overwhelmed. He also offers some suggestions for friends and family to offer support to new parents from a distance. “I encourage families to get creative in keeping in contact with family and friends, such as having a grandparent read a book over video to an older child while mother breastfeeds baby. Or involve family and friends with delivering groceries or meals to the home.” Overall, parents can rest assured that the risk of newborns getting COVID-19 is very low. Nonetheless, all necessary precautions such as hand washing, social distancing, and avoiding contact with unwell people should still be followed. The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
