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    3 Comments for this article
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    Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China
    Richard Banati, MD, PhD, Professor | University of Sydney, Medical Director of Mothers Milk Bank Charity
    Three of the 33 newborns tested positive for COVID-19. These 3 infants were delivered by caesarean section.

    In light of important policy decision to be made, it would be important to know whether the infants were separated from their mothers, whether breastfeeding was initiated or whether expressed or donor human milk was provided.

    Human milk contains components (free fatty acids and monoglycerides) with potent antiviral activity against enveloped viruses (SARS-CoV-2 being one such virus) but possibly also antibodies, either cross-reacting or specific if the mother had been infected with SARS-CoV-2 (1).

    Evidence from earlier epidemics indicates
    that the multiple disease risks associated infant formula feeding can be avoid through breastmilk feeding even or, case-dependent, especially in the presence of a higher pathogen exposure risk.

    REFERENCE

    1. https://www.biorxiv.org/content/10.1101/2020.03.11.987958v1
    CONFLICT OF INTEREST: None Reported
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    What Was Treatment/intervention for Each Neonate, and Did They Breastfeed?
    MoCha Vaz, RN | Trinitas RMC
    It would be most informative to have included the exact treatment ( (eg, antibiotics, caffeine) and interventions provided to these sick neonates. Also, the length of time of recovery. The report also failed to include if the newborns received the mother's breast milk or were given formula. Although the article was very vague in some areas, it is most hopeful to know the newborns survived.
    CONFLICT OF INTEREST: None Reported
    Neonatal Early-Onset Infection With COVID-19
    Rajesh Dudani, MD | John H Stroger Hospital of Cook County
    The authors have presented 3 cases of possible vertical maternal-fetal transmission of COVID-19 infection but details about postnatal care was not given regarding breast feeding, separation from mother, isolation of the infants, and precautions taken by caregivers. Shortness of breath was mentioned as the most common symptom but only one patient had shortness of breath who was positive for COVID-19 and it seems most likely it was due to prematurity-related respiratory distress syndrome or sepsis. Two of the three patients positive for COVID-19 had fever. It may be important to rule out other infections and treat empirically for possible bacterial infection or herpes which may have serious consequences in a context of patients having fever and lethargy. All three patients were diagnosed with pneumonia on the basis of chest x-ray which is generally nonspecific in newborns for pneumonia. The two patients did not have any signs and symptoms of respiratory compromise like tachypnea, cough, respiratory distress or oxygen requirement. For patients 2 and 3, it was mentioned that patients had leukocytosis but it is within normal range for age. The authors have recommended close monitoring and appropriate precautions for these neonates at risk of COVID-19 which seems important as these newborns are at risk for early and late onset infection due to COVID-19 even though outcome in general seems good in newborns (1).

    Reference:
    1. Coronado Munoz, A., Nawaratne, U., McMann, D., Ellsworth, M., Meliones, J. and Boukas, K., 2020. Late-Onset Neonatal Sepsis in a Patient with Covid-19. New England Journal of Medicine, 2020 Apr 22. doi: 10.1056/NEJMc2010614
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    March 26, 2020

    Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China

    Author Affiliations
    • 1Department of Neonatology, Institute of Maternal and Child Health, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    • 2Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
    • 3National Children's Medical Center, Children’s Hospital of Fudan University, Shanghai, China
    • 4Institute of Maternal and Child Health, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    JAMA Pediatr. Published online March 26, 2020. doi:10.1001/jamapediatrics.2020.0878

    The coronavirus disease 2019 (COVID-19) has spread rapidly across the world. With the sharp increase in the number of infections, the number of pregnant women and children with COVID-19 is also on the rise. However, only 19 neonates born to affected mothers have been investigated, and to our knowledge, no information on early-onset infection in newborns has been published in previous studies.1,2

    In this cohort study, all neonates born to mothers with COVID-19 were recruited from Wuhan Children's Hospital, in Wuhan, Hubei Province, China. This study was approved by the local medical ethics committee. Written informed consent was obtained from the neonates’ parents. The diagnosis and management of newborns with or at risk of COVID-19 were in accordance with guidelines provided by the National Health Commission and the Chinese Perinatal-Neonatal SARS-CoV-2 Committee.3,4

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