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Among 120 babies born to mothers with covid-19, none were born infected

All were born between March 22 and May 17, in three hospitals in New York, USA. There are “only” 120 babies, but they are a sufficient sample for the research team to conclude that the transmission of SARS-CoV-2 infection between mother and child “is unlikely” and to support recommendations in favor of breastfeeding. Situations that, however, always require mothers to wear a mask and other protective measures, stress the scientists. The study, published this Thursday in The Lancet Child & Adolescent Health, reports that tests were carried out on covid-19 in this group of more than a hundred newborns at three different times and that all results were negative.

Less than a week ago, there was news in Portugal about a baby who was born this month and who was infected with the new coronavirus during pregnancy. “It was a pregnancy that had a confirmed infection, we knew that the pregnant woman had covid-19. As such, the raising of suspicion regarding the baby allowed the samples to be taken immediately ”, Fernando Cirurgião, director of the obstetrics service at the São Francisco Xavier hospital in Lisbon, explained to the PUBLIC, adding that the blood sample taken from the child shortly after birth it indicated that there was congenital vertical transmission in utero. Before that, on 10 July, a study carried out in Italy revealed that infected mothers can transmit the new coronavirus (SARS-CoV-2) to their children in the womb. The study was presented this week at the 23rd International AIDS Conference, which was held online for the first time due to the covid-19 pandemic. Although little is known about the risk of transmission of SARS-CoV-2 during pregnancy, the authors of that study detected the presence of antibodies against the new coronavirus in two newborns.

Now, a new study that followed the birth of 120 babies of women infected with covid-19 points to an "unlikely mother-child transmission" during pregnancy and even after birth when they share the same space and women choose to breastfeed.

The guidelines for mothers infected with covid-19 are, of course, confusing. As if the studies that are being published were not enough, the recommendations of collegiate bodies and health authorities also do not always coincide and sometimes change from day to day. Since April and until yesterday, for example, the American Academy of Pediatrics recommended that mothers and newborns be temporarily separated at birth until the woman has a negative test result. But the guidance of the experts changed this Wednesday and, after all, the entity now defends that mother and child can be together and that, if possible, the woman should breastfeed the baby, with precautions such as the use of a mask.
For its part, the World Health Organization (WHO) published early recommendations that state that mothers with covid-19 should breastfeed, if the woman is not too ill to do so, with due precautions. Christine M. Salvatore, lead author of the study, at Cornell University's Komansky Weill Children's Hospital in New York, acknowledges that “data on the risk of transmission of covid-19 during pregnancy or while breastfeeding is limited to a small number of case studies ”, concluding, however, that he hopes that this work“ will provide some guarantee to new mothers that the risk of passing covid-19 to their babies is very low ”.

Of 1481 deliveries, 116 (8%) mothers tested positive for SARS-CoV-2, reveals the article that presents the results of monitoring 120 babies born in three hospitals in New York City. Mothers and children were able to share the same space using precautionary measures, such as wearing a mask, and babies were kept in cribs, at a distance of about two meters, except during breastfeeding. In addition to wearing a mask whenever they picked up babies, mothers were advised to wash their hands and breasts frequently.

Swabs performed on 120 newborns in the first 24 hours of life had a negative result. The authors of the study report that from this moment on, the group of monitored babies ended up decreasing progressively, speculating that the abandonment of some parents may have been related to the fear of exposure of their children during visits to the hospital lasts
pandemic. The data thus show that 82 babies “were available” to repeat the test after five to seven days. All had a negative result, with 83% of mothers (corresponding to 68 babies) sharing the room with their child and 64 babies were breastfed. After another five to seven days, the babies were again called for a new test. This time, 72 babies were taken to the hospital and tested. And, again, no results were positive. The researchers also report that 52 babies who were accompanied by videoconference over another month were still clinically well.
The study, obviously, has limitations and the team recognizes that despite these results, which indicate that close contact between mother and newborn can be safe, the sample studied is small. In addition, the dropout rate also did not contribute to the solidity of the results, since almost a third of the babies ended up leaving the project (38 out of 120). . "The researchers were unable to trace the presence of the virus in blood, urine or feces samples, because these tests were not validated at the time of the study," adds the statement.

Melissa Medvedev, an expert at the University of California and who did not participate in this study, argues that the work provides important data that show that “perinatal transmission of SARS-CoV-2 is unlikely”. But, note, there are still many doubts to be clarified. More data is needed to help "quantify the incidence of complications among pregnant women and newborns and to understand rates and routes of vertical and horizontal transmission, including asymptomatic transmission". There is also a lack of detailed analysis, says the specialist, of the effectiveness of infection prevention and control practices in the neonatal care environment.

Andrea Cunha Freitas
July 2020 in Jornal O Público
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