Breastfeeding in COVID-19: A Pragmatic Approach

Abstract

The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in changes to perinatal and neonatal care, concentrating on minimizing risks of transmission to the newborn and health care staff while ensuring medical care is not compromised for both mother and infant. Current recommendations on infant care and feeding when mother has COVID-19 ranges from mother–infant separation and avoidance of human milk feeding, to initiation of early skin-to-skin contact and direct breastfeeding. Health care providers fearing risks of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) maternal–infant transmission may veer toward restricted breastfeeding practices. We reviewed guidelines and published literature and propose three options for infant feeding depending on various scenarios. Option A involves direct breastfeeding with the infant being cared for by the mother or caregiver. In option B, the infant is cared for by another caregiver and receives mother's expressed milk. In the third option, the infant is not breastfed directly and does not receive mother's expressed milk. We recommend joint decision making by parents and the health care team. This decision is also flexible as situation changes. We also provide a framework for counseling mothers on these options using a visual aid and a corresponding structured training program for health care providers. Future research questions are also proposed. We conclude that evidence and knowledge about COVID-19 and breastfeeding are still evolving. Our options can provide a quick and flexible reference guide that can be adapted to local needs. Key Points

Titres and neutralising capacity of SARS-CoV-2-specific antibodies in human milk: a systematic review

“…A thorough understanding of SARS-CoV-2 antibodies in human milk would provide support to the recommendation for infected individuals to continue breast feeding. [10][11][12] An overview of the functional and kinetic features of COVID-19 infection-induced antibodies secreted will help investigators design studies to investigate antibody production induced by vaccination. This would guide recommendations on vaccination of lactating individuals and if human milk in vaccinated mothers may confer protection to their infants.…”

Aleitamento materno no contexto da pandemia de COVID-19: uma revisão de escopo

“…Quanto às publicações selecionadas, 50% tinham amostras da Europa (Bertino et al, 2020;Ceulemans et al, 2020;Davanzo et al, 2020;Dimopoulou et al, 2020;Fernández-Carrasco et al, 2020;Genoni et al, 2020;Pereira et al, 2020;Vassilopoulou et al, 2021;Williams et al, 2020), 27,8% da Ásia (Ng et al, 2020;Ranganathan et al, 2020;Thanigainathan et al, 2021;Yang et al, 2020) e 22,2% com participantes dos EUA (Patil et al, 2020;Salvatore et al, 2020), da Austrália (G. J. e do Brasil (Organização Pan-Americana da Saúde, 2020). A população estudada foi predominantemente composta por gestantes, puérperas e recém-nascidos.…”

“…A população estudada foi predominantemente composta por gestantes, puérperas e recém-nascidos. De acordo com os desenhos dos estudos, 55,5% foram revisões (Dimopoulou et al, 2020;Fernández-Carrasco et al, 2020;Genoni et al, 2020;Ng et al, 2020;Vassilopoulou et al, 2021;K. Walker et al, 2020;Yang et al, 2020).…”

“…E a terceira indicação é o uso de fórmulas. Os autores avaliam que a tomada de decisão sobre o aleitamento materno deve ser feita de forma conjunta entre pais e equipe de saúde (Ng et al, 2020 (Pereira et al, 2020).…”

Breastfeeding in the context of the COVID-19 pandemic: A discussion paper

“…Given these circumstances, it is essential that neonatal nurses and midwives are aware of recommended guidance from global organizations and current research to be able to support mothers in a sensitive, person-centred but also pragmatic way ( Ng et al, 2020 ). These recommendations are as follows: WHO (2018) advocates exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond, along with early and uninterrupted skin-to-skin contact, rooming-in and kangaroo mother care.…”