Impact of evolving practices on SARS-CoV-2 positive mothers and their newborns in the largest public healthcare system in America

Abstract

Objective The impact of evolving guidelines and clinical practices on SARS-CoV-2-positive dyads across New York City Health and Hospitals during the early peak of COVID-19. Design A retrospective cohort study of positive-positive (P/P), positive-negative (P/N), and positive-untested (P/U) dyads delivered from March 1 to May 9, 2020. Wilcoxon rank sum, Chi-squared, and Fisher exact tests were used to analyze demographics, clinical variables, and system-wide management practices. Result A total of 2598 mothers delivered. 23.8% (286/1198) of mothers tested for SARS-CoV-2 were positive. 89.7% (260/ 290) newborns of SARS-CoV-2-positive mothers were tested and 11 were positive. Positive-positive newborns were more likely to be breastfed (81%), be admitted to NICU, and have longer length of stay (7.5 days) than P/N and P/U newborns. Conclusion Our study shows that varied testing, feeding, and isolation practices resulted in favorable short-term outcomes for SARS-CoV-2-positive mothers and their newborns. High-risk populations can be safely and effectively treated in resource-limited environments.

Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review

“…On the contrary, Donati et al’s descriptive study [46] which focused on COVID positive mothers, reported a higher rate of mother-infant separation at birth (39%), a lower rate of skin-to-skin contact (26.6%) and rooming in with infant (72.1%), which align with the findings of Bartick and colleagues [36] that compared COVID positive with negative mothers. However, Maholtra [81] and Mayapoulos [39] did not find any difference in the rate of skin-to-skin contact between COVID positive and negative mothers. In Cojocaru’s study [86] , most COVID-positive mothers still opted to room in with their newborns and continue with skin-to-skin contact.…”

“…During the COVID period, more women favoured pharmacological pain relief measures such as epidurals [77] , [80] and received pethidine injections [79] . Between mothers who tested positive for COVID and those who tested negative, there was also no difference in the mode of birth [39] , [81] , [82] , induction, and use of epidural [39] , [82] .…”

“…While a minority (23%) of new mothers worried about not being able to breastfeed [30] , most mothers (50% to 94%) breastfed during their hospital stay [37] , [38] , [52] , [62] , [85] of which 48.3% to 89.3% reported receiving adequate breastfeeding support. Furthermore, a comparison of breastfeeding rates between COVID positive mothers and COVID negative mothers showed no difference between groups [39] , [73] , with 57% [81] to 69% [46] of COVID positive mothers doing direct breastfeeding during their hospital stay. However, qualitative findings revealed that mothers who were unable to get in-person breastfeeding support or had virtual lactation consultation instead reported more difficulty in breastfeeding [44] , [50] , [57] , [75] , [78] with some resorting to a change to formula feeding [43] , [45] .…”

Starting parenting in isolation a qualitative user-initiated study of parents’ experiences with hospitalization in Neonatal Intensive Care units during the COVID-19 pandemic

“…Previous research has documented the decreased availability of lactation consultants during the pandemic, restriction of donor milk utilization, and a decrease in breastfeeding rates [9]. In contrast, Malhotra et al found breastfeeding to increase by hospitalized COVID-19-positive mothers [27]. One may speculate whether isolation and more peace and quiet could positively contribute when establishing breastfeeding.…”

Breastfeeding in Mothers with COVID-19: Insights from Laboratory Tests and Follow-Up from Early Outbreak of the Pandemic in China

“…A survey from the United States reported that breastfeeding was lower in SARS-CoV-2-positive mothers than in the general population. 60 Such an outcome may be related to the early separation between mothers and neonates 61 and reduced lactation support during the pandemic. 62,63 Shorter breastfeeding duration was also associated with higher rates of depressive symptoms.…”