• K F Walker, K O'Donoghue, N Grace, J Dorling, J L Comeau, W Li, and J G Thornton.
• Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK.
• BJOG. 2020 Oct 1; 127 (11): 1324-1336.

BackgroundEarly reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified?ObjectiveTo estimate the risk of the neonate becoming infected with SARS-CoV-2 by mode of delivery, type of infant feeding and mother-infant interaction.Search StrategyTwo biomedical databases were searched between September 2019 and June 2020.Selection CriteriaCase reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported.Data Collection And AnalysisData were extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission.Main ResultsForty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated.ConclusionsNeonatal COVID-19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother.Tweetable AbstractRisk of neonatal infection with COVID-19 by delivery route, infant feeding and mother-baby interaction.© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

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