COVID-19 pandemic has brought about a huge change in our day to day habits. We are now more particular in cleaning our hands, and the surfaces we use. Proper cough etiquette and hygienic disposal of used tissues are some desirable practices to help prevent the spread of COVID-19, and should continue even after the pandemic is over.
We now have enough data on COVID-19 and its manifestations in the newborn period and during infancy. This blog is a brief description of the signs and symptoms of COVID-19 disease, its transmission and its possible effects on the developing fetus.
How can a baby get infected with Corona virus?: The main source of infection for a baby is usually an adult who is carrying the COVID-19 virus in his/her oral and nasal secretions. Droplet mode of transmission is most common, followed by transmission due to shared items such as towel, soap, spoons and utensils. Make sure to avoid visitors at home. Friends and family can shower love through virtual platforms. If a family member is affected, they should be isolated in every sense. Vaccines offer hope to adults, but it depends on which vaccine was administered. Those which offer >90% protection are obviously dependable.
What if mum is infected with Corona virus?: Mothers being investigated for or found to be positive with COVID-19 infection should not be separated from their infants. The primary concern is that the virus will be transmitted from mother to infant through respiratory droplets during breastfeeding. To prevent this, mum can practice skin-to-skin care and breastfeed, with some modifications. Among these precautions, practicing meticulous hand hygiene, wearing a mask when within 2 metres of their infant, and practicing hand hygiene before and after skin-to-skin contact, breastfeeding, and routine infant care are the most important ones.
Importantly, when mother’s breast feed, her antibodies to SARS-CoV-2 are likely passed to the newborn and may offer protection. When the mother has recently coughed or sneezed with chest exposed, she should cleanse the breast area with soap and water before feeding, as an added precaution. Mothers may also choose to pump—ensuring that they wash their hands, and clean all equipment—and feed the expressed milk by spoon or any method of their choice. At home, frequently touched household surfaces should be disinfected regularly.
What if a mother is too ill to breastfeed? If due to COVID-19 or other causes, mum is very ill, she should be encouraged and supported to express milk. Milk expression should ideally start within 3 hours of delivery and be performed atleast every 3 hourly. Hand expression can be started on day one , followed by pump to enable better milk output. Excess milk can be stored in a refrigerator or can be freezed, to use later.
What if infant has breathing difficulty? According to the available literature, an infant presenting with breathing difficulty at or within minutes of birth is most likely to be experiencing a non-COVID-19-related illness.
The most important signs to watch:
1. Inactive baby, not playing as usual
2. Very irritable baby crying excessively
3. Cough and difficulty in breathing
4. Running nose with nose block. Red and watery eyes
5. Unable to feed. Not waking up to feed
7. Decreased urine production
8. Swelling of abdomen
9. Vomiting and loose stools
10. Abnormal body movements
In general, these symptoms are common to many conditions during infancy and newborn period. It is important to consult a Pediatrician at the earliest and avoid self medication. Even if it is not COVID, these symptoms warrant investigation and treatment with possible hospital admission.
What is the evidence available? In a large case series conducted in China of 2143 paediatric patients infected horizontally with COVID-19, symptoms may present as mild or moderate in up to 94.4% of newborns. Fever and cough are the most common signs. A recent U.S. study of 18 infants >90 days old who tested positive for SARS-CoV-2 found that all had only a mild febrile illness. Such studies provide some reassurance that even in the context of transmission, illness severity in infants is typically mild. While mum to baby transmission of SARS-COV-2 during pregnancy or delivery is rare, it remains a risk, particularly when mothers are severely ill or immunosuppressed.
The need for obtaining reliable information cannot be over emphasized. Please look at reliable sources like WHO or CDC for updated numbers and evidence regarding COVID-19.
What is the risk for mum to baby transmission before birth? :This type of transmission called as vertical transmission is exceptionally low. Transmission from a Normal birth is also exceedingly unlikely. Although there have been reports of amniotic fluid and placental surfaces yielding positive tests for SARS-CoV-2, the rate of transmission following C-section has also been low.
One feature that all reported cases of vertical transmission have in common is that mothers were symptomatic with viral pneumonia at time of delivery, with presentations ranging from fever and breathing difficulty to pneumonia on X-ray. Based on hundreds of documented outcomes for newborns born to mothers with COVID-19 in the literature, the risk for vertical transmission of infection is considered low, but not nil.
The million dollar question is: What effect will coronavirus have on my baby if I am diagnosed with the infection?
Current evidence suggests that if you have the virus it is unlikely to cause problems with your baby’s development, and there have been no reports of this so far. There is also no evidence to suggest that coronavirus infection in early pregnancy increases the chance of a miscarriage.
What is the risk of delivering prematurely? : Across the world, reports suggest some babies have been born prematurely to women who were very unwell with coronavirus. It is unclear whether coronavirus caused these premature births, or whether it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover.
CONCLUSION: Whether or not a newborn baby gets COVID-19 is not affected by mode of birth, feeding choice or whether the woman and baby stay together. It is important to emphasise that in most of the reported cases of newborn babies developing coronavirus very soon after birth, the babies remained well.