We evaluated inpatient management, transition to home, breastfeeding, growth, and clinical outcomes of infants born to mothers diagnosed with SARS-CoV-2 infection in pregnancy and followed in a Federally Qualified Health Center (FQHC), that serves a diverse and low-income patient population, from birth through 6 months of life.
Infants born between 4/3/20 and 7/26/20 at Prentice Women’s Hospital with mothers who received prenatal care at Erie Family Health Center (Erie), the second largest FQHC in Illinois, and had confirmed SARS-CoV-2 during pregnancy were included. Data were abstracted from delivery hospital admission and outpatient follow-up appointments between 4/8/20 and 2/4/21.
Thirty-three infants met inclusion criteria. Average gestational age was 38.9 weeks (IQR 37.6–40.4), 3 (10%) were premature and 5 (15%) required NICU admission. Nearly all (97%) mothers expressed intent to breastfeed. Outpatient follow-up rates were similar to historical cohorts and 82% (23/28) of infants were vaccination compliant. Growth parameters showed normal distributions at all time points. At 6 months, any and exclusive breast milk feeding rates were lower compared to historic cohorts (18 vs. 36%, p<0.05, 0 vs. 21%, p<0.01). Three infants (10%) received development-related referrals, one carried an underlying genetic diagnosis. Outpatient visits were predominantly face-to-face with telemedicine use comprising only 6% of visits (11/182).
Longitudinal follow-up of 33 publicly insured infants born to mothers with SARS-CoV-2 infection in pregnancy followed in an FQHC showed high rates of follow-up and vaccination compliance, normal growth patterns and reassuring clinical status, and lower than expected rates of breastfeeding.
Funding source: National Institutes of Health
Award Identifier / Grant number: UL1TR001422
Award Identifier / Grant number: K23 AI13933
Authors would like to acknowledge Stephanie Bararth and Laura Hurley for support in data abstraction, Erie’s Infection control team for keeping everyone safe, and the Northwestern University Clinical and Translational Sciences Institute for funding.
Research funding: This work was supported by National Institutes of Health (UL1TR001422 and K23 AI13933).
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not Applicable.
Ethical approval: The local Institutional Review Board approved the study.
1. Gold, JAW, Rossen, LM, Ahmad, FB, Sutton, P, Li, Z, Salvatore, PP, et al.. Race, ethnicity, and age trends in persons who died from COVID-19 – United States, May–August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1517–21. https://doi.org/10.15585/mmwr.mm6942e1.Search in Google Scholar PubMed PubMed Central
2. Johnson-Agbakwu, CE, Ali, NS, Oxford, CM, Wingo, S, Manin, E, Coonrod, DV. Racism, COVID-19, and health inequity in the USA: a call to action. J Racial Ethn Health Disparities 2020. https://doi.org/10.1007/s40615-020-00928-y [Epub ahead of print].Search in Google Scholar PubMed PubMed Central
4. Kaufman, HW, Niles, JK, Nash, DB. Disparities in SARS-CoV-2 positivity rates: associations with race and ethnicity. Popul Health Manag 2021;24:20–6. https://doi.org/10.1089/pop.2020.0163.Search in Google Scholar PubMed PubMed Central
5. Wortham, JM, Lee, JT, Althomsons, S, Latash, J, Davidson, A, Guerra, K, et al.. Characteristics of persons who died with COVID-19 – United States, February 12–May 18, 2020. MMWR Morb Mortal Wkly Rep 2020;69:923–9. https://doi.org/10.15585/mmwr.mm6928e1.Search in Google Scholar PubMed
6. Boserup, B, McKenney, M, Elkbuli, A. Disproportionate impact of COVID-19 pandemic on racial and ethnic minorities. Am Surg 2020;86:1615–22. https://doi.org/10.1177/0003134820973356.Search in Google Scholar PubMed PubMed Central
8. Wyckoff, AS, Associate editor. AAP issues guidance on infants born to mothers with suspected or confirmed COVID-19. Available from: https://publications.aap.org/aapnews/news/6713 [Cited 26 Nov 2021].Search in Google Scholar
9. Chen, D, Yang, H, Cao, Y, Cheng, W, Duan, T, Fan, C, et al.. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet 2020;149:130–6. https://doi.org/10.1002/ijgo.13146.Search in Google Scholar PubMed PubMed Central
10. Centers for Disease Control and Prevention. Healthcare facilities: managing operations during the COVID-19 pandemic; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html.Search in Google Scholar
11. Marin Gabriel, MA, Reyne Vergeli, M, Caserio Carbonero, S, Sole, L, Carrizosa Molina, T, Rivero Calle, I, et al.. Maternal, perinatal and neonatal outcomes with COVID-19: a multicenter study of 242 pregnancies and their 248 infant newborns during their first month of life. Pediatr Infect Dis J 2020;39:e393–7. https://doi.org/10.1097/inf.0000000000002902.Search in Google Scholar
12. Gao, YJ, Ye, L, Zhang, JS, Yin, YX, Liu, M, Yu, HB, et al.. Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2020;20:564. https://doi.org/10.1186/s12879-020-05274-2.Search in Google Scholar PubMed PubMed Central
13. Zimmermann, P, Curtis, N. COVID-19 in children, pregnancy and neonates: a review of epidemiologic and clinical features. Pediatr Infect Dis J 2020;39:469–77. https://doi.org/10.1097/inf.0000000000002700.Search in Google Scholar
14. Verd, S, Ponce-Taylor, J, Ginovart, G. Vertical transmission of severe acute respiratory syndrome coronavirus 2 from the mother to the infant. JAMA Pediatr 2020;174:1005–6. https://doi.org/10.1001/jamapediatrics.2020.2141.Search in Google Scholar PubMed
15. Ronchi, A, Pietrasanta, C, Zavattoni, M, Saruggia, M, Schena, F, Sinelli, MT, et al.. Evaluation of rooming-in practice for neonates born to mothers with severe acute respiratory syndrome coronavirus 2 infection in Italy. JAMA Pediatr 2021;175:260–6. https://doi.org/10.1001/jamapediatrics.2020.5086.Search in Google Scholar PubMed PubMed Central
16. Kaufman, DA, Puopolo, KM. Infants born to mothers with COVID-19-making room for rooming-in. JAMA Pediatr 2021;175:240–2. https://doi.org/10.1001/jamapediatrics.2020.5100.Search in Google Scholar PubMed
17. Flaherman, VJ, Afshar, Y, Boscardin, J, Keller, RL, Mardy, A, Prahl, MK, et al.. Infant outcomes following maternal infection with SARS-CoV-2: first report from the PRIORITY study. Clin Infect Dis 2021;73:e2810–3. https://doi.org/10.1093/cid/ciaa1411.Search in Google Scholar PubMed PubMed Central
18. Dumitriu, D, Emeruwa, UN, Hanft, E, Liao, GV, Ludwig, E, Walzer, L, et al.. Outcomes of neonates born to mothers with severe acute respiratory syndrome coronavirus 2 infection at a large medical center in New York city. JAMA Pediatr 2021;175:157–67. https://doi.org/10.1001/jamapediatrics.2020.4298.Search in Google Scholar PubMed PubMed Central
19. Christakis, DA, Van Cleve, W, Zimmerman, FJ. Estimation of US children’s educational attainment and years of life lost associated with primary school closures during the coronavirus disease 2019 pandemic. JAMA Netw Open 2020;3:e2028786. https://doi.org/10.1001/jamanetworkopen.2020.28786.Search in Google Scholar PubMed PubMed Central
20. Perrine, CG, Chiang, KV, Anstey, EH, Grossniklaus, DA, Boundy, EO, Sauber-Schatz, EK, et al.. Implementation of hospital practices supportive of breastfeeding in the context of COVID-19 – United States, July 15–August 20, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1767–70. https://doi.org/10.15585/mmwr.mm6947a3.Search in Google Scholar PubMed PubMed Central
21. Lackland, DT, Sims-Robinson, C, Jones Buie, JN, Voeks, JH. Impact of COVID-19 on clinical research and inclusion of diverse populations. Ethn Dis;30:429–32. https://doi.org/10.18865/ed.30.3.429.Search in Google Scholar PubMed PubMed Central
22. Group WHOMGRS. W. H. O. Multicentre Growth Reference Study Group, WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006;450:76–85. https://doi.org/10.1111/j.1651-2227.2006.tb02378.x.Search in Google Scholar PubMed
23. Ages & Stages Questionnaires®, 3rd ed. (ASQ®-3) [Internet]. Brookespublishing.com. Available from: https://products.brookespublishing.com/Ages-Stages-Questionnaires-Third-Edition-ASQ-3-P569.aspx?_ga=2.75255249.2123938382.1638037973-2045974131.1638037973 [Cited 27 Nov 2021].Search in Google Scholar
25. Ortega, AN, McKenna, RM, Chen, J, Alcala, HE, Langellier, BA, Roby, DH. Insurance coverage and well-child visits improved for youth under the affordable care act, but latino youth still lag behind. Acad Pediatr 2018;18:35–42. https://doi.org/10.1016/j.acap.2017.07.006.Search in Google Scholar PubMed
26. Schiltz, NK, Finkelstein Rosenthal, B, Crowley, MA, Koroukian, SM, Nevar, A, Meropol, SB, et al.. Rehospitalization during the first year of life by insurance status. Clin Pediatr (Phila). 2014;53:845–53. https://doi.org/10.1177/0009922814536924.Search in Google Scholar PubMed PubMed Central
27. Ko, M, Ponce, NA. Community residential segregation and the local supply of federally qualified health centers. Health Serv Res 2013;48:253–70. https://doi.org/10.1111/j.1475-6773.2012.01444.x.Search in Google Scholar PubMed PubMed Central
28. Kuthy, RA, Jones, M, Kavand, G, Momany, E, Askelson, N, Chi, D, et al.. Time until first dental caries for young children first seen in Federally Qualified Health Centers: a retrospective cohort study. Community Dent Oral Epidemiol 2014;42:300–10. https://doi.org/10.1111/cdoe.12096.Search in Google Scholar PubMed PubMed Central
29. Crall, JJ, Pourat, N, Inkelas, M, Lampron, C, Scoville, R. Improving the oral health care capacity of federally qualified health centers. Health Aff 2016;35:2216–23. https://doi.org/10.1377/hlthaff.2016.0880.Search in Google Scholar PubMed
30. Nath, JB, Costigan, S, Lin, F, Vittinghoff, E, Hsia, RY. Federally qualified health center access and emergency department use among children. Pediatrics 2016;138 [Internet]. Available from: https://publications.aap.org/pediatrics/article-lookup/doi/10.1542/peds.2016-0479.10.1542/peds.2016-0479Search in Google Scholar PubMed
31. Sodhi, M. Telehealth policies impacting federally qualified health centers in face of COVID-19. J Rural Health 2021;37:158–60. https://doi.org/10.1111/jrh.12445.Search in Google Scholar PubMed PubMed Central
32. Simon, J, Mohanty, N, Masinter, L, Hamilton, A, Jain, A. COVID-19: exploring the repercussions on federally qualified health center service delivery and quality. J Health Care Poor Underserved 2021;32:137–44. https://doi.org/10.1353/hpu.2021.0013.Search in Google Scholar PubMed
33. Abrams, SA, Avalos, A, Gray, M, Hawthorne, KM. High level of food insecurity among families with children seeking routine care at federally qualified health centers during the coronavirus disease 2019 pandemic. J Pediatr X 2020;4:100044. https://doi.org/10.1016/j.ympdx.2020.100044.Search in Google Scholar PubMed PubMed Central
34. Health center program: impact and growth [Internet]. Hrsa.gov. Available from: https://bphc.hrsa.gov/about/healthcenterprogram/index.html [Cited 26 Nov 2021].Search in Google Scholar
35. Cunarro-Lopez, Y, Cano-Valderrama, O, Pintado-Recarte, P, Cueto-Hernandez, I, Gonzalez-Garzon, B, Garcia-Tizon, S, et al.. Maternal and perinatal outcomes in patients with suspected COVID-19 and their relationship with a negative RT-PCR result. J Clin Med 2020;9:3552. https://doi.org/10.3390/jcm9113552.Search in Google Scholar PubMed PubMed Central
36. Shanes, ED, Mithal, LB, Otero, S, Azad, HA, Miller, ES, Goldstein, JA. Placental pathology in COVID-19. Am J Clin Pathol 2020;154:23–32. https://doi.org/10.1093/ajcp/aqaa089.Search in Google Scholar PubMed PubMed Central
37. Li, R, Perrine, CG, Anstey, EH, Chen, J, MacGowan, CA, Elam-Evans, LD. Breastfeeding trends by race/ethnicity among US children born from 2009 to 2015. JAMA Pediatr 2019;173:e193319. https://doi.org/10.1001/jamapediatrics.2019.3319.Search in Google Scholar PubMed PubMed Central
38. Fryer, K, Santos, HPJr., Pedersen, C, Stuebe, AM. The hispanic paradox: socioeconomic factors and race/ethnicity in breastfeeding outcomes. Breastfeed Med 2018;13:174–80. https://doi.org/10.1089/bfm.2017.0157.Search in Google Scholar PubMed PubMed Central
39. Witt, AM, Witt, R, Lasko, L, Flocke, S. Translating team-based breastfeeding support into primary care practice. J Am Board Fam Med 2019;32:818–26. https://doi.org/10.3122/jabfm.2019.06.190118.Search in Google Scholar PubMed
40. Mercier, RJ, Burcher, TA, Horowitz, R, Wolf, A. Differences in breastfeeding among medicaid and commercially insured patients: a retrospective cohort study. Breastfeed Med 2018;13:286–91. https://doi.org/10.1089/bfm.2017.0228.Search in Google Scholar PubMed
41. Stuebe, A. Protect pregnant and lactating women with COVID-19 through research, not from research. Breastfeed Med 2020;15:423–4. https://doi.org/10.1089/bfm.2020.29155.ams.Search in Google Scholar PubMed
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