Neonatal management and testing
Mothers with suspected or confirmed COVID-19 should be supported and enabled to remain together with their infants when the mother is well enough, and to practise skin-to-skin/'kangaroo' care, if the newborn does not require additional medical care at this time.
For a mother who has suspected or confirmed COVID-19 and whose baby needs to be cared for on the neonatal unit, a precautionary approach should be adopted to minimise any risk of mother-to-infant transmission, while at the same time, taking steps to involve parents in decisions and to mitigate potential problems for the baby’s health and wellbeing, and for breastfeeding and attachment.
Please also refer to Royal College of Paediatrics and Child Health guidance(link is external) for advice on neonatal management and testing.
Women who have suspected, probable or confirmed COVID-19 should be enabled and supported to breastfeed. In the light of the current evidence, we advise that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breast milk (although a small Chinese case series of six women suggests breast milk has tested negative for COVID-19). The main risk for infants of breastfeeding is the close contact with the mother, who is likely to share infective airborne droplets. The risks and benefits of breastfeeding, including the risk of holding the baby in close proximity to the mother, should be discussed with her. This guidance may change as knowledge evolves.
For women wishing to breastfeed, precautions should be taken to limit viral spread to the baby, such as:
- handwashing before touching the baby, breast pump or bottles
- avoiding coughing or sneezing on the baby
- considering wearing a face mask where available for feeding at the breast
- following recommendations for pump cleaning after each use
- considering asking someone who is well to feed expressed milk to the baby.
When a woman is not well enough to care for her own infant or where direct breastfeeding is not possible, she should be supported to express her breast milk by hand expression or by pump, and/or be offered access to donor breast milk. When women are expressing breast milk in hospital, a dedicated breast pump should be used. Where a breast pump is used, follow recommendations for pump cleaning after each use.
For babies who are bottle-fed with formula or expressed milk, strict adherence to sterilisation guidelines is recommended.
So far, children are a small minority of those who test positive. However, attention has now shifted to the vulnerability of children due to new concerns about a novel severe Kawasaki-like disease in children related to COVID-19 (Dunning, 2020).
Viner RM, Whittaker E. Kawasaki-like disease: emerging complication during the COVID-19 pandemic. The Lancet 2020;1-2.
Dunning H. Kawasaki-like Syndrome Linked to COVID-19 in Children is a New Condition. London; Imperial College London: 08 June 2020 [Accessed October 2020].