question: OBJECTIVE: The impact of evolving guidelines and clinical practices on SARS-CoV-2-positive dyads across New York City Health and Hospitals during the early peak of COVID-19. DESIGN: A retrospective cohort study of positive-positive (P/P), positive-negative (P/N), and positive-untested (P/U) dyads delivered from March 1 to May 9, 2020. Wilcoxon rank sum, Chi-squared, and Fisher exact tests were used to analyze demographics, clinical variables, and system-wide management practices. RESULT: A total of 2598 mothers delivered. 23.8% (286/1198) of mothers tested for SARS-CoV-2 were positive. 89.7% (260/290) newborns of SARS-CoV-2-positive mothers were tested and 11 were positive. Positive-positive newborns were more likely to be breastfed (81%), be admitted to NICU, and have longer length of stay (7.5 days) than P/N and P/U newborns. CONCLUSION: Our study shows that varied testing, feeding, and isolation practices resulted in favorable short-term outcomes for SARS-CoV-2-positive mothers and their newborns. High-risk populations can be safely and effectively treated in resource-limited environments.