Part 2: COVID-19 and knowledge for midwifery practice—impact and care of the baby
It is well-known that newborn infants are more susceptible to infection due to their immature host defence mechanisms. However, in relation to the COVID-19 virus, it appears that the naivete of the neonatal immune system has afforded some protection against the inflammatory response experienced by adolescents and adults.
The first article, published in volume 29, issue 4 of the British Journal of Midwifery, in this two-part series focusing on the care implications of COVID-19 in maternal health addressed the effect on the mother along with subsequent issues relating to parenting and support. This second article now turns to newborn care.
The world is still learning the specifics of how SARS-CoV-2 is spread, and this is a particularly important area of knowledge in the field of maternal and neonatal care (Green et al, 2020a). While it has been shown that people with SARS-CoV-2 symptoms spread the disease, evidence is emerging that asymptomatic patients should not be underestimated (Heneghan et al, 2020; de Rose et al, 2020). Transmission of SARS-CoV-2 mainly occurs through droplets and aerosols but it can also be transferred through skin contact, faecal-oral transmission and ocular surface contact (de Rose et al, 2020). The evidence on maternal-infant vertical transmission, however, is still unclear. Pregnant women may be more susceptible to the virus (Favre et al, 2020) as evidenced by Alfaraj et al's (2019) analysis from previous viral SARS-CoV and MERS-CoV outbreaks, suggesting a greater risk of adverse outcomes. It is not known definitively whether a pregnant woman with SARS-CoV-2 could pass the infection to her fetus or baby during pregnancy or delivery. Currently, the emerging evidence to support vertical transmission of SARS-CoV-2 during pregnancy remains low (Knight et al, 2020) and the existing data shows a low incidence of infection in amniotic fluid, cord blood, neonatal throat swab, placental tissue and breastmilk samples (Yang et al, 2020a).
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