• Andrea Ronchi, Carlo Pietrasanta, Maurizio Zavattoni, Martina Saruggia, Federico Schena, Maria Teresa Sinelli, Massimo Agosti, Chryssoula Tzialla, Felicia Filomena Varsalone, Lea Testa, Claudia Ballerini, Stefania Ferrari, Giovanna Mangili, Maria Luisa Ventura, Simona Perniciaro, Elena Spada, Giovanna Lunghi, Antonio Piralla, Fausto Baldanti, Fabio Mosca, and Lorenza Pugni.
• Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy.
• JAMA Pediatr. 2021 Mar 1; 175 (3): 260-266.

ImportanceThe management of mother-infant dyads during the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic constitutes a major issue for neonatologists. In mothers with SARS-CoV-2 infection, current recommendations suggest either to separate the dyad or encourage protected rooming-in under appropriate precautions. No data are available regarding the risk of mother-to-infant transmission of SARS-CoV-2 during rooming-in.ObjectiveTo evaluate the risk of postnatal transmission of SARS-CoV-2 from infected mothers to their neonates following rooming-in and breastfeeding.Design, Setting, And ParticipantsA prospective, multicenter study enrolling mother-infant dyads from March 19 to May 2, 2020, followed up for 20 days of life (range, 18-22 days), was performed. The study was conducted at 6 coronavirus disease 2019 maternity centers in Lombardy, Northern Italy. Participants included 62 neonates born to 61 mothers with SARS-CoV-2 infection who were eligible for rooming-in practice based on the clinical condition of the mother and infants whose results of nasopharyngeal swabs were negative at birth.ExposuresMothers with SARS-CoV-2 infection were encouraged to practice rooming-in and breastfeeding under a standardized protocol to minimize the risk of viral transmission.Main Outcomes And MeasuresClinical characteristics and real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 on neonatal nasopharyngeal swabs at 0, 7, and 20 days of life.ResultsOf the 62 neonates enrolled (25 boys), born to 61 mothers (median age, 32 years; interquartile range, 28-36 years), only 1 infant (1.6%; 95% CI, 0%-8.7%) was diagnosed as having SARS-CoV-2 infection at postbirth checks. In that case, rooming-in was interrupted on day 5 of life because of severe worsening of the mother's clinical condition. The neonate became positive for the virus on day 7 of life and developed transient mild dyspnea. Ninety-five percent of the neonates enrolled were breastfed.Conclusions And RelevanceThe findings of this cohort study provide evidence-based information on the management of mother-infant dyads in case of SARS-CoV-2 maternal infection suggesting that rooming-in and breastfeeding can be practiced in women who are able to care for their infants.

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