The American Academy of Pediatrics (AAP) has released updated guidance for care of newborns to mothers with COVID-19, finding that evidence now suggests that babies are at low risk of becoming infected when they remain in-room with the mother after birth, if infection control practices are used.

This marks a change from the initial AAP guidance, which recommended temporary separation of newborn infants from infected mothers. Experts based the cautious approach on the limited amount of information available in April, when the initial guidance was first written. The early research came from China, where the universal protocol was to immediately separate all newborn infants from infected mothers and isolate them for 14 days.

The new interim guidance, provided in an FAQ format, can be found here.

“Since the beginning of this global pandemic, we  have learned – and continue to gain more knowledge -- about the novel coronavirus and how it affects children,” said Karen Puopolo, MD, PhD FAAP, lead author of the guidance.

“What we now know is the risk of the newborn becoming infected around the time of birth is low when safety precautions are taken to protect the baby. In fact, the risk in the short-term appears to be no greater if mother and infant room-in together using infection control measures compared to physical separation of the infant in a room separate from the mother. We do not yet know how many newborns might become ill at home following hospital discharge.”

AAP experts reviewed published evidence as well as data provided to the National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection. All AAP guidance on COVID-19 is considered interim, as evolving research informs the recommendations.

The AAP recommends that:

Mothers with COVID-19 and newborn infants may room-in according to usual center practice. During the birth hospitalization, the mother should maintain a reasonable distance from her infant when possible. When mother provides hands-on care to her infant, she should wear a mask and perform hand-hygiene. Health care workers should use gowns, gloves, standard procedural masks, and eye protection (face shields or goggles) when providing care for well infants. If noninfected partners or other family members are present during the birth hospitalization, they should use masks and hand hygiene when providing hands-on care to the infant.

A mother who is acutely ill with COVID-19 and not feeling well enough may not be able to provide all care for her infant. In this situation, it may be appropriate to temporarily separate mother and newborn infant or to have the infant cared for by noninfected caregivers in mother’s room.

The guidance also recommends that mothers with COVID-19 breastfeed after appropriate hand hygiene or express milk for the newborn, depending on the circumstances. The guidance also addresses testing an infant for infection, as well as intensive care and treatment of infants who become ill.

In most cases, infants will be discharged to families where other caregivers have been exposed to and may have acquired COVID infection. The AAP recommends that the mother and caregivers use facial coverings, hand hygiene, and take other measures to protect the infant until they meet the requirements for not being contagious.

More information for parents can be found on HealthyChildren.org.