An Uninfected Preterm Newborn Inadvertently Fed SARS-CoV-2–P
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A female infant was delivered by emergency cesarean delivery because of placental abruption, at 32 weeks gestation. The newborn was fed with donor human or expressed breast milk and reached the full enteral feeding on day 9.

After delivery, the mother occasionally entered the ward until day 3, always wearing the face mask and gown as standard NICU precaution. On postpartum day 3, the mother was discharged from the hospital, but she developed sore throat and asthenia a few hours after discharge. Because she was no longer able to visit the NICU, a small volume of fresh expressed breast milk was carried to the hospital by a family member, and it was given to the newborn on days 3 and 6 of life.

Nine days after delivery, the mother returned to the hospital for a follow-up visit and brought the breast milk expressed at home (without precautions for SARS-CoV-2–infected mothers). This fresh breast milk was given to the newborn (8 feedings of 28 mL each). On clinical examination, the mother was febrile (temperature 37.5°C) and a nasopharyngeal swab tested positive for SARS-CoV-2 by (RT-PCR). She was then sent home for self-isolation.

The next day, the fresh expressed breast milk, which had been given to the newborn, tested positive for SARS-CoV-2 by RT-PCR, and the breast milk was immediately discontinued. In laboratory methods for SARS-CoV-2 RT-PCR, nucleic acids were extracted from 0.2 mL milk by using the ELITe InGenius instrument and were subjected to amplification by RT-PCR.

Another independent breast milk sample was collected under strict precautions for research purposes on day 9 after delivery, after knowing the result of the maternal nasopharyngeal swab. This sample also tested positive for SARS-CoV-2 after storing at ?80°C for 30 days. The cycle threshold values for the PCR runs were 38/45 and 37/45 for the first and second expressed breast milk samples, respectively.

Although inadvertently fed with SARS-CoV-2–positive breast milk, the infant did not develop COVID-19 symptoms. The infant had normal findings on chest radiograph and blood gas analysis, and the nasopharyngeal and stool swabs tested negative for the virus on days 8, 10, and 18 of life. The sera samples of the neonate tested negative for immunoglobulin G and immunoglobulin M antibodies on day 25 of life.

This is the first report of a preterm neonate who was fed SARS-CoV-2–positive breast milk and remained uninfected. Although human milk may be a vehicle of SARS-CoV-2, neonates may not necessarily become infected. The management of SARS-CoV-2–infected mothers and their newborns poses several problems for the appropriate management of neonates and their mothers, especially when the infection is unexpected.