ACM and RANZCOG Joint Statement re: Kolikonda Review

Early skin to skin contact, delayed cord clamping, rooming in with well, healthy term babies and breastfeeding are still recommended for new mothers with COVID-19 infection.

 A review into the transmission of COVID-19 infection during birth and in the early postnatal period has just been published. The review, by Kolikonda and colleagues, looked at skin to skin contact immediately after birth, delayed cord clamping, rooming in and breastfeeding as risk factors for babies contracting COVID-19. The study has been reviewed by the National COVID-19 Clinical Evidence Taskforce and importantly, there are no subsequent changes to the current national recommendations.

The evidence in the Kolikonda review comes from observational studies, most of which are low-quality studies, with few events. Inconsistent wearing of masks, different hygiene protocols and infection prevention and control practices or inadequate ventilation may have impacted on these studies. The vaccination status of women and the COVID-19 variant/s were also not reported. Finally, testing positive did not translate into the babies becoming unwell.

The recommendations from the National COVID-19 Clinical Evidence Taskforce are supported by the Australian College of Midwives and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. These include that early skin to skin contact, delayed cord clamping, rooming in with the well, healthy term baby and breastfeeding are all still recommended for new mothers with COVID-19 infection as the benefits outweigh the risks.

 

Further Information

Early skin to skin contact, delayed cord clamping, rooming in with well, healthy term babies and breastfeeding are still recommended for new mothers with COVID-19 infection.

A new review has been published - Transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) through infant feeding and early care practices: A systematic review.

The review included 28 studies (four prospective observational, one multicentric cohort, and three retrospective chart reviews, seven case series, and thirteen case reports). Six studies were rated as good quality, 1 as fair, and 21 as poor quality.

The review included 12 studies (38 newborns) documenting early skin to skin contact (variably described as “kangaroo care”, “immediate skin-to-skin contact” or “immediate bonding”, as compared to “strict isolation measures” or “separated immediately after delivery”). There were five studies documenting early or delayed cord clamping practices. Of these, four were case reports or case series, with one observational study of 403 women with SARS-CoV-2 infection admitted for childbirth across 70 centres in Spain. The review included 23 studies (403 newborns) that assessed COVID-19 transmission in rooming in versus isolation measures. These measures were not consistently defined or applied across studies, with variable terms such as “no isolation”, “roomed-in”, “kept in separate room”, “immediate separation”, “isolation and separation” and “followed in isolation rooms” being used to define groups. A total of 25 studies (342 newborns) documented breast- or bottle-feeding practices. For all outcomes, the review pooled available data without adjustment for study size or study quality. The included studies were largely of poor quality.

Across all included studies, it was not possible to assess how rigorously infection prevention and control practices had been implemented, though it is likely that such practices varied between studies. The vaccination status of women and the COVID-19 variant/s were also not reported.

The results showed that:

·         Four of the 16 babies in the early skin to skin contact group tested positive for COVID-19, while in the comparator group 2 of 22 babies tested positive. These numbers are too small to conclude whether early skin to skin contact affects COVID-19 transmission

·         Five of 138 babies were diagnosed with COVID-19 in the delayed cord clamping group and 2 of 222 babies were diagnosed with COVID-19 in the early cord clamping group. All infants who tested positive were asymptomatic. This is insufficient evidence to conclude whether cord clamping practices affect COVID-19 transmission.

·         Fifteen babies in the rooming-in group tested positive to COVID-19 (15.5%), while three babies in the isolation group tested positive (1.0%). None of the infants tested positive for COVID-19 exhibited symptoms, indicating that transmission did not translate into newborn harms.

·         Twenty-two babies in the breastfeeding group tested positive (11.5%) compared with four babies (2.6%) in the bottle-fed group. Almost all of the infants who tested positive for COVID-19 had no symptoms (2 babies developed low grade fevers but without respiratory symptoms, and 1 preterm baby had respiratory symptoms, which were presumed to be related to prematurity rather than COVID-19) indicating that transmission did not translate into newborn harms.

This evidence comes from observational studies, most of which are low-quality studies, with few events. These are likely to be at high risk of bias. In addition, inconsistent wearing of masks or hygiene protocols or inadequate ventilation may be a contributing factor. Finally, testing positive did not translate into infants becoming unwell.

The recommendations from the National COVID-19 Clinical Evidence Taskforce are supported by the Australian College of Midwives and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. These include that early skin to skin contact, delayed cord clamping, rooming in with the well, healthy term baby and breastfeeding are all still recommended for new mothers with COVID-19 infection as the benefits outweigh the risks.