The COVID-19 pandemic has affected and disturbed the normal phase of life in all spheres. One such field is the birth of a baby. It is a natural process and the new relationship builds up more strongly the more the mother and the newborn are in close physical contact. The Baby’s immunity is triggered by mother milk and is the best and optimum source of nutrients for the baby to develop the immune system, which helps to fight against various diseases later in life.¹

During the pandemic, a higher rate was observed in the C-sections in COVID-19 positive women. Studies have demonstrated the significant impact of C-sections on the neonatal microbiome and an increased incidence of obesity, autoimmune disease, and atopic disorders. During the early stages of a pandemic, it was advised to prevent COVID-19 positive mothers from breastfeeding and keeping close contact with the newborn, having skin-to-skin contact, and recommending them to isolate during the infection window. These changes have largely affected the growth of the newborn impacting the development of the neonatal microbiome.²

For a newborn, the first few weeks are very crucial and characterized by highly dynamic and intricate host-microbe interactions. The intestinal microbiome of newborns starts evolving and approaches to that of an adult flora by three years of age. Hence, changes and adjusting in perinatal care after the pandemic, different environmental exposures for newborns and infants, reduced social interactions, decreased role in daycare, and travel restrictions also impacted the microbial diversity.³ Disturbances in bacterial colonization during this early development phase among neonates has also been associated with inflammatory bowel diseases, cardiometabolic syndrome, and respiratory illnesses.⁴

The health status of the mother and close family members affected by COVID, decides the discharge of infants to settings outside primary residences, which introduces them to different microbial communities other than close relations, decreased physical contact with caregivers, involvement of pets in the residing place, may also affect the microbial diversity in the gut of the neonate.²

Additional factors due to COVID such as frequent use of sanitisers, and surface disinfectants by the caretakers handling the baby may also lead to a loss in microbial diversity. Very few studies have concluded on how to promote immune development of newborns and infants to retain and support their relative immunity to COVID-19. Reports disclose that preterm babies who didn’t receive skin to skincare (SSC) OR oral flora due to any clinical reason either of the baby or mother and were kept away from their mothers suffered from  less developed neonatal GI microbiome  and immunity.⁵

It was also studied that Breast milk is the best natural and most important booster of normal gut colonization. Hence, revised guidelines for COVID-19 prevention has included breastfeeding and stated that breast milk was an unlikely source of transmission.¹

To conclude, COVID-19 has to a great extent affected and impacted the composition and diversity of early life gut microbiota of neonates due to changes in the normal daily routines, daycares, less travelling and reduced geographic exposures both during and after the pandemic, which may in future complicate and disrupt intestinal maturation, but studies are not adequate. Hence, a better understanding, studying the dynamics between viruses and bacterias, their transmission among newborns, the safety priority of mother-newborn and guidelines for their care may serve as key practices to protect the children and newborns from covid-19.

References:

1. Emilia Vassilopoulou, G. F., Lemonica Koumbi1, Christina Mesiari, Elena Camelia Berghea, and George N. Konstantinou. Breastfeeding and COVID-19: From Nutrition to Immunity. Front. Immunol. 2021, 12, article 661806, 1-10.
2. Joann Romano-Keeler, J. Z. J. S. COVID-19 and the neonatal microbiome: will the pandemic cost infants their microbes? Gut Microbes, 2021, 13:1, .
3. Ruairi C Robertson , A. R. M., B Brett Finlay , Andrew J Prendergast The Human Microbiome and Child Growth - First 1000 Days and Beyond. Trends Microbiol 2019, 27(2):, 131-147.
4. Juliana Durack , S. V. L. The gut microbiome: Relationships with disease and opportunities for therapy, J Exp Med 2019, 216(1), 20-40.
5. Karen D Hendricks-Muñoz , J. X., Hardik IParikh , Ping Xu, Jennifer M Fettweis , Yang Kim , Moi Louie , Gregory A Buck , Leroy R Thacker , Nihar U Sheth Skin-to-Skin Care and the Development of the Preterm Infant Oral Microbiome, Am J Perinatol 2015, 32(13):1, 205-216.