The arrival of a newborn marks a time of significant change, and the presence of COVID-19 adds concern for new parents. The neonatal period, defined as the first 28 days of life, is a unique window where the infant’s immature immune system warrants close attention regarding infectious diseases. While most newborns who contract the virus experience only mild or asymptomatic illness, the potential for complications means vigilance is necessary. Understanding the specific risks and implementing protective measures can help families safeguard their newest member during this vulnerable stage.
How COVID-19 Affects Newborns
COVID-19 presentation in newborns often differs from symptoms seen in older children or adults. The most common signs are non-specific and can include fever (a temperature over 100.4 degrees Fahrenheit) and respiratory difficulties. These respiratory symptoms may manifest as rapid breathing, grunting, or the need for supplemental oxygen.
Gastrointestinal issues, such as decreased feeding, vomiting, or diarrhea, are frequently reported in infected neonates. Lethargy, or a marked decrease in activity, is another general symptom signaling the need for prompt medical evaluation. While most cases are mild, infants under one year of age have shown a slightly higher rate of hospitalization compared to older children.
Certain pre-existing conditions, including prematurity, congenital heart defects, and genetic or metabolic disorders, can increase the risk of severe illness. In rare instances, newborns may develop severe complications, such as Multisystem Inflammatory Syndrome in Children (MIS-C) or pneumonia. Treatment for symptomatic infants is primarily supportive, focusing on hydration, adequate breathing, and managing fever. Specific antiviral medications, such as Remdesivir, and anti-inflammatory drugs like Dexamethasone, may be used in severe cases under close medical supervision.
Understanding Transmission Routes
Newborns can acquire the virus through two primary pathways: vertical and horizontal transmission. Vertical transmission refers to the passage of the virus from the mother to the fetus before, during, or immediately after birth. This occurs when the virus crosses the placenta or is acquired during delivery through contact with maternal fluids.
Studies indicate that true vertical transmission, where the virus is definitively transferred in utero, is uncommon. The risk of this route increases if the mother experiences severe COVID-19 infection during pregnancy. Horizontal, or postnatal, transmission is the more frequent method, accounting for the vast majority of newborn infections.
This transfer happens through exposure to respiratory droplets from an infected person, typically a parent, caregiver, or household member. The close, continuous contact necessary for newborn care, such as holding, feeding, and changing, provides ample opportunity for transmission. Therefore, the health status of all caregivers represents the greatest transmission risk.
Protecting Newborns from Infection
Protecting a newborn from infection relies heavily on consistent preventative strategies implemented by all people in the home. Hand hygiene is the single most effective action; caregivers must wash their hands thoroughly with soap and water for at least 20 seconds before every interaction with the baby. If soap and water are unavailable, an alcohol-based hand sanitizer with at least 60% alcohol content should be used.
Limiting the baby’s exposure to outside contacts is important in the early weeks of life. New parents should consider restricting visitors and opting for virtual greetings instead of in-person visits. If visitors are permitted, they should be screened for symptoms, practice hand hygiene, and wear a high-quality face covering.
For caregivers who develop symptoms or test positive, temporary modifications to infant care are necessary to minimize transmission risk. The symptomatic caregiver should wear a well-fitting mask whenever they are within six feet of the infant, including during feeding. If possible, an uninfected caregiver should take over primary duties until the symptomatic individual is no longer infectious, following current public health guidelines. Cleaning and disinfecting high-touch surfaces in the home daily also helps reduce the risk of infection.
Maternal Health and Infant Care Decisions
Maternal health choices play a direct role in providing the newborn with early, passive protection against the virus. The COVID-19 vaccine is recommended for individuals who are pregnant or breastfeeding, as it is a safe method to build immunity. Vaccination during pregnancy prompts the mother’s immune system to produce antibodies, which are then transferred across the placenta to the developing fetus.
This transfer provides the newborn with passive immunity upon birth, offering protection during their first months of life. Antibodies generated by maternal vaccination or prior infection are also present in breast milk, which can be passed to the nursing infant. Current medical guidance supports continuing to breastfeed even if the mother tests positive for the virus.
To ensure safety while breastfeeding, the infected mother should wear a mask and practice hand hygiene before touching the infant or any pump parts. In the hospital setting, rooming-in is often encouraged unless the mother is severely ill or the infant requires specialized care. If rooming-in occurs with a COVID-positive mother, the infant’s bassinet is typically placed at least six feet away, and the mother must wear a mask and wash her hands before handling the baby.