Coronavirus

Evaluation and Management Considerations for Neonates At Risk for COVID-19

This guidance is intended to inform healthcare providers in the United States about the diagnosis, evaluation, infection prevention and control practices, and disposition of neonates (≤28 days old) with suspected or confirmed SARS-CoV-2 infection or known SARS-CoV-2 exposure, including birth to a mother with suspected or confirmed COVID-19.Updates as of August 3, 2020 Updated guidance…

This guidance is intended to inform healthcare providers in the United States about the diagnosis, evaluation, infection prevention and control practices, and disposition of neonates (≤28 days old) with suspected or confirmed SARS-CoV-2 infection or known SARS-CoV-2 exposure, including birth to a mother with suspected or confirmed COVID-19.

Updates as of August 3, 2020

  • Updated guidance on mother-neonate contact, emphasizing the importance of maternal autonomy in the medical decision-making process.
  • Updated evidence about routes of SARS-CoV-2 transmission to neonates.
  • Updated guidance on infection prevention and control.

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Since the May 2020 posting of this guidance, several publications have reported the outcomes of neonates born to mothers with suspected or confirmed SARS-CoV-2 infection. These publications have been used to inform this guidance update. CDC will continue to examine data on the risk of infection and outcomes for neonates born to mothers with SARS-CoV-2 infection and will update this guidance as new information becomes available.

Routes of transmission

Transmission of SARS-CoV-2, the virus that causes COVID-19, to neonates is thought to occur primarily through respiratory droplets during the postnatal period when neonates are exposed to mothers or other caregivers with SARS-CoV-2 infection. Limited reports in the literature have raised concern of possible intrauterine, intrapartum, or peripartum transmission, but the extent and clinical significance of vertical transmission, which appears to be rare, is unclear. At this time, there are insufficient data to make recommendations on routine delayed cord clamping or immediate skin-to-skin care for the purpose of preventing SARS-CoV-2 transmission to the neonate.

Clinical presentation and disease severity

Reported signs among neonates with SARS-CoV-2 infection include fever, lethargy, rhinorrhea, cough, tachypnea, increased work of breathing, vomiting, diarrhea, and poor feeding. The extent to which SARS-CoV-2 infection contributed to the reported signs of infection and complications is unclear, as many of these findings are common in term and preterm infants for other reasons (e.g., transient tachypnea of the newborn, neonatal respiratory distress syndrome).

Current evidence suggests that SARS-CoV-2 infections in neonates are uncommon. If neonates do become infected, the majority have either asymptomatic infections or mild disease (i.e., do not require respiratory support), and they recover. Severe illness in neonates, including illness requiring mechanical ventilation, has been reported but appears to be rare. Neonates with underlying medical conditions and preterm infants (<37 weeks gestational age) may be at higher risk of severe illness from COVID-19.

Testing recommendations

Testing is recommended for all neonates born to mothers with suspected or confirmed COVID-19, regardless of whether there are signs of infection in the neonate. For neonates presenting with signs of infection suggestive of COVID-19, as described above, providers should also consider alternative diagnoses.

Recommended testing

  • Diagnosis should be confirmed by testing for SARS-CoV-2 RNA by reverse transcription polymerase chain reaction (RT-PCR). Detection of SARS-CoV-2 RNA can be collected using nasopharynx, oropharynx, or nasal swab samples.
  • Serologic testing is not recommended at this time to diagnose acute infection in neonates.

When to test

  • Both symptomatic and asymptomatic neonates born to mothers with suspected or confirmed COVID-19, regardless of mother’s symptoms, should have testing performed at approximately 24 hours of age. If initial test results are negative, or not available, testing should be repeated at 48 hours of age.
  • For asymptomatic neonates expected to be discharged at <48 hours of age, a single test can be performed prior to discharge, between 24-48 hours of age.

Prioritization of testing

  • In areas with limited testing capacity

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