Research Article
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Published Online: 8 May 2020

Managing COVID-19-Positive Maternal–Infant Dyads: An Italian Experience

Publication: Breastfeeding Medicine
Volume 15, Issue Number 5
Dear Editor:
We report our experience in Italy during COVID-19 viral outbreak. At time of writing, on April 13, 2020, the number of confirmed cases was 1,699,595 worldwide, with 106,138 deaths, resulting in a crude fatality rate of 6.2%.1
Although children seem to have a milder disease than adults, newborns and infants could be more at risk than other pediatric categories; thus, they deserve special attention because of insidious and nonspecific symptoms.2
Although there is currently no evidence showing a vertical transmission of SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy,3 a major concern involves the possible transmission of the infection to their fragile infants, in particular after delivery. The virus can be detected by real-time polymerase chain reaction (RT-PCR) in different biological fluids (bronchoalveolar-lavage fluid, sputum, saliva, nasopharyngeal swabs, and feces) but no positive breast milk samples have been found in different reported cohorts for a total number of 32 dyads.2
Therefore, for COVID-19-positive new mothers, whenever possible, it is advisable to plan a joint management of the mother with her infant, to promote the beginning of breastfeeding, while assessing on a case-by-case basis if eventual drugs administered to infected mothers could be harmful to the infant. According to the indications of the Italian Society of Neonatology,4 if a mother previously identified as COVID-19 positive is asymptomatic or paucisymptomatic, rooming-in is a reasonable management and direct breastfeeding is prudent, ensuring strict measures of infection control (washing often mother's hands before touching the infant and wearing a face mask). In most cases, a hospital stay of ∼1 week is preferred.
Herein we describe our experience in our children's hospital, which is a referral care center in Rome (Italy) for ill out born neonates, who are transferred from other institutions. We report the first two maternal–infant dyads presenting to our emergency department because of a positive nasopharyngeal swab for SARS-CoV-2 both in the mother and in the child; clinical characteristics are summarized in Table 1. They were probably infected by a third person at the same time. Neither the mothers nor the infants needed intensive care unit admission; therefore, newborns were prudently isolated from their paucisymptomatic mothers.
Table 1. Clinical Features of Newborns with Postnatal Confirmed SARS-CoV-2 Infection and Their Mothers
 Mother 1/newborn 1Mother 2/newborn 2
Maternal age, years3626
Maternal symptomsAnosmia and dysgeusiaBack and thoracic pain
Maternal ICU admissionNoNo
Maternal nasopharyngeal swabPositivePositive
Positive breast milk samplesNoNo
Exclusive breast milkYesYes
Feeding: breastfeeding or feeding bottleBreastfeedingBreastfeeding
Neonatal nasopharyngeal swab on admissionPositivePositive
Gestational age, weeks41 + 239
Birth weight, g4,4403,120
Neonatal genderMaleFemale
Neonatal age on admission, days1810
Neonatal weight on admission, g5,2003,200
Neonatal symptoms and complicationsNoCough
Poor feeding
Neonatal body temperature on admission36°C36.7°C
Neonatal SatO2 on admission99%100%
Neonatal oxygen supportNoNo
Neonatal ICU admissionNoNo
Neonatal recoveryAsymptomatic patientNo more diarrhea and need of intravenous fluids on day 5
ICU, intensive care unit.
We analyzed expressed breast milk samples of both mothers, and SARS-CoV-2 was not detected by RT-PCR, as already described.2 Virus detection analysis after pasteurization was not performed because the virus was not found already in expressed milk.
To the best of our knowledge, these are the first data on postnatal horizontal COVID-19 infection in newborns and breast milk analysis in Italy. We confirm that SARS-CoV-2 seems to spare breast milk and horizontal transmission from mother to neonate could occur through respiratory droplets rather than through milk. Therefore, when SARS-CoV-2 is identified both in the mother and in the child, there are no reason to stop breastfeeding and separate them. Whenever direct breastfeeding is not possible, the use of expressed mother's milk should be considered and promoted to take advantage of its unquestionable benefits.
In conclusion, we agree that medical staff and nurses should not only focus on care of COVID-19 mothers and infants, but also protect, promote, and support breastfeeding. Breastfeeding creates a unique relationship between mother and child, thus reducing the length of hospital stay and the negative effects linked to quarantine and stress because of this pandemic viral outbreak.


1. World Health Organization. WHO: Novel Coronavirus (COVID-19) Situation Reports. (accessed on April 13, 2020).
2. De Rose DU, Piersigilli F, Ronchetti MP, et al. Novel coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr 2020 (in press).
3. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395:809–815.
4. Davanzo R, Moro G, Sandri F, et al. Breastfeeding and coronavirus disease-2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr 2020:e13010.

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Published In

cover image Breastfeeding Medicine
Breastfeeding Medicine
Volume 15Issue Number 5May 2020
Pages: 347 - 348
PubMed: 32311273


Published online: 8 May 2020
Published in print: May 2020
Published ahead of print: 21 April 2020


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Guglielmo Salvatori
Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy.
Domenico Umberto De Rose [email protected]
Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy.
Carlo Concato
Virology Unit, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy.
Dario Alario
Pediatrics Unit, “San Paolo” Hospital, Civitavecchia (Rome), Italy.
Nicole Olivini
Department of Pediatrics, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy.
Andrea Dotta
Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy.
Andrea Campana
Department of Pediatrics, IRCCS “Bambino Gesù” Children's Hospital, Rome, Italy.


Address correspondence to: Domenico Umberto De Rose, MD, Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS “Bambino Gesù” Children's Hospital, Piazza S. Onofrio 4, Rome 00165, Italy [email protected]

Authors' Contributions

All authors participated in the conception and design of the study, acquisition and interpretation of data, and drafting the article. All authors read and approved the final version.

Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

Ethical Statement

The authors declare that they have followed the protocols of their work center on the publication of patients' data and Helsinki Declaration: no patient is recognizable with data appearing in this article. An informed consensus was obtained before enrolling patients, records were anonymized and deidentified before analysis, and all data were fully anonymized before any access by the authors.

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