Evaluation of Rooming-in Practice for Neonates Born to Mothers with Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Italy

A. Ronchi, C. Pietrasanta, M. Zavattoni, M. Saruggia, F. Schena, M.T. Sinelli, M. Agosti, C. Tzialla, F.F. Varsalone, L. Testa, C. Ballerini, S. Ferrari, G. Mangili, M.L. Ventura, S. Perniciaro, E. Spada, G. Lunghi, A. Piralla, F. Baldanti, F. MoscaL. Pugni

Research output: Contribution to journalArticlepeer-review


Importance: The management of mother-infant dyads during the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic constitutes a major issue for neonatologists. In mothers with SARS-CoV-2 infection, current recommendations suggest either to separate the dyad or encourage protected rooming-in under appropriate precautions. No data are available regarding the risk of mother-to-infant transmission of SARS-CoV-2 during rooming-in. Objective: To evaluate the risk of postnatal transmission of SARS-CoV-2 from infected mothers to their neonates following rooming-in and breastfeeding. Design, Setting, and Participants: A prospective, multicenter study enrolling mother-infant dyads from March 19 to May 2, 2020, followed up for 20 days of life (range, 18-22 days), was performed. The study was conducted at 6 coronavirus disease 2019 maternity centers in Lombardy, Northern Italy. Participants included 62 neonates born to 61 mothers with SARS-CoV-2 infection who were eligible for rooming-in practice based on the clinical condition of the mother and infants whose results of nasopharyngeal swabs were negative at birth. Exposures: Mothers with SARS-CoV-2 infection were encouraged to practice rooming-in and breastfeeding under a standardized protocol to minimize the risk of viral transmission. Main Outcomes and Measures: Clinical characteristics and real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 on neonatal nasopharyngeal swabs at 0, 7, and 20 days of life. Results: Of the 62 neonates enrolled (25 boys), born to 61 mothers (median age, 32 years; interquartile range, 28-36 years), only 1 infant (1.6%; 95% CI, 0%-8.7%) was diagnosed as having SARS-CoV-2 infection at postbirth checks. In that case, rooming-in was interrupted on day 5 of life because of severe worsening of the mother's clinical condition. The neonate became positive for the virus on day 7 of life and developed transient mild dyspnea. Ninety-five percent of the neonates enrolled were breastfed. Conclusions and Relevance: The findings of this cohort study provide evidence-based information on the management of mother-infant dyads in case of SARS-CoV-2 maternal infection suggesting that rooming-in and breastfeeding can be practiced in women who are able to care for their infants..

Original languageEnglish
Pages (from-to)260-266
Number of pages7
JournalJAMA Pediatrics
Issue number3
Publication statusPublished - 2021


  • adult
  • ageusia
  • anosmia
  • Apgar score
  • Article
  • breast feeding
  • breast milk expression
  • cohort analysis
  • conjunctiva disease
  • coronavirus disease 2019
  • coughing
  • COVID-19 testing
  • diarrhea
  • dyspnea
  • eye protection
  • female
  • fever
  • follow up
  • gestational age
  • hand washing
  • headache
  • hemoptysis
  • human
  • infection risk
  • Italy
  • length of stay
  • major clinical study
  • malaise
  • male
  • morbidity
  • mother child relation
  • multicenter study
  • multidisciplinary team
  • myalgia
  • nasopharyngeal swab
  • nausea and vomiting
  • neonatal intensive care unit
  • newborn
  • physical examination
  • priority journal
  • prospective study
  • protective glasses
  • real time reverse transcription polymerase chain reaction
  • rhinitis
  • risk assessment
  • rooming in
  • Severe acute respiratory syndrome coronavirus 2
  • sore throat
  • thorax pain
  • virus transmission
  • clinical trial
  • enzymology
  • mother
  • pandemic
  • pregnancy
  • pregnancy complication
  • prevention and control
  • vertical transmission
  • Adult
  • COVID-19
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Newborn
  • Infectious Disease Transmission
  • Vertical
  • Male
  • Mothers
  • Pandemics
  • Pregnancy
  • Pregnancy Complications
  • Infectious
  • Prospective Studies
  • SARS-CoV-2


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