The arrival of a newborn, typically defined as the first 28 days of life, brings joy but also heightened concern regarding exposure to the SARS-CoV-2 virus. New parents often experience anxiety about protecting their infant from infection. Understanding how this virus can affect a newborn and knowing the appropriate steps to take provides clarity during a stressful time. This information serves as a guide to understanding the context of the situation, but it should never replace direct medical advice from a healthcare provider.
Understanding Transmission Routes
A newborn may be exposed to the virus through two distinct pathways: before birth or after birth. Transmission from the mother to the fetus during pregnancy, known as vertical or in utero transmission, is possible but appears to be a rare event. The placenta generally offers a protective barrier, and studies suggest that vertical transmission occurs in only a small percentage of cases, sometimes cited around 2% to 3% of infected pregnant women.
The most common exposure route is horizontal, or postnatal, transmission, which happens after birth. This occurs when the infant comes into close contact with respiratory droplets or aerosols from an infected person. The source is often an immediate caregiver, such as the mother, father, or other household members, who may or may not be showing symptoms.
Current evidence indicates that the virus is not efficiently transmitted through breast milk. This supports the continuation of breastfeeding with appropriate precautions. Transmission is primarily through respiratory secretions that are shared during close physical interactions, such as holding, feeding, or changing the baby.
Recognizing Symptoms in Infants
Symptoms of COVID-19 in newborns are often subtle or non-specific, making them challenging to identify compared to the presentation in older children or adults. Many infected newborns may be asymptomatic, meaning they show no signs of illness at all, or they may have only very mild symptoms that are easily missed. This can complicate the initial identification of an infection.
The most common signs of illness in an infected newborn are often related to feeding and behavior. Parents might observe poor feeding, decreased wet diapers, or a general lack of interest in their surroundings, known as lethargy. Fever is a frequent symptom, but in some cases, infants may present with hypothermia, which is an abnormally low body temperature.
Respiratory symptoms can include a cough, a runny nose, or signs of mild breathing difficulty. Parents should watch for non-specific signs like nasal flaring or grunting sounds when breathing out. Gastrointestinal issues, such as vomiting and diarrhea, are also commonly reported in this age group.
Parents must be aware of severe signs that require immediate emergency medical attention.
Severe Warning Signs
- Persistent difficulty breathing or rapid breathing that seems labored and does not improve.
- Bluish discoloration around the lips or face, known as cyanosis, indicating low oxygen levels.
- Extreme sluggishness or an inability to wake up.
- Significantly decreased responsiveness.
An atypical but serious concern is Multisystem Inflammatory Syndrome in Children (MIS-C), which can develop in some children weeks after the initial infection. While rare, MIS-C involves inflammation of different body parts, including the heart, lungs, and kidneys. Symptoms of MIS-C often include a persistent fever accompanied by abdominal pain, vomiting, diarrhea, or a rash.
Testing and Care Protocols
If a newborn is exposed to a positive caregiver or begins to show symptoms, the healthcare team will likely initiate testing protocols. Standard procedure often involves collecting a nasopharyngeal swab sample from the infant for a Polymerase Chain Reaction (PCR) test. If the mother tests positive for the virus, the newborn is typically tested within the first 24 hours of life and again around 48 hours of life.
In the event of a confirmed infection, the primary focus of care for a newborn is supportive management. This care addresses the infant’s symptoms, ensuring they remain hydrated and comfortable, and that their breathing is supported if needed. The medical team will closely monitor the baby’s temperature, oxygen saturation levels, and feeding intake.
The use of specific antiviral treatments for newborns is limited and reserved for severe or life-threatening cases. In these rare instances, a medication such as intravenous remdesivir or steroids may be considered by the medical team. Most newborns with COVID-19 experience mild or asymptomatic courses that do not require specialized drug therapy.
Isolation guidelines for the newborn and caregivers involve balancing infection control with the benefits of bonding and breastfeeding. If the mother is positive, she should wear a well-fitting mask whenever she is within six feet of the baby and practice strict hand hygiene before any contact. This allows for rooming-in and direct breastfeeding, which is supported by major health organizations due to the nutritional and immunological benefits of breast milk.
If the mother is too ill to provide care, a healthy caregiver should step in to feed the baby expressed breast milk, wearing a mask and following hygiene protocols. Decisions regarding temporary separation versus rooming-in are made on a case-by-case basis, involving a shared discussion between the parents and the clinical team. After the initial hospital discharge, the pediatrician will schedule frequent follow-up appointments to monitor the infant’s recovery and ensure continued health.