Transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) through infant feeding and early care practices: A systematic review

Abstract

BACKGROUND: Perinatal practices such as breast-feeding, kangaroo mother care, rooming-in, and delayed cord clamping have varied by institution during the COVID-19 pandemic. The goal of this systematic review was to examine the success of different practices in preventing viral transmission between SARS-CoV-2 positive mothers and their infants. METHODS: Electronic searches were performed in the Ovid MEDLINE, Ovid Embase, Cochrane Library, EBSCOhost CINAHL Plus, Web of Science, and Scopus databases. Studies involving pregnant or breastfeeding patients who tested positive for SARS-CoV-2 by RT-PCR were included. Infants tested within 48 hours of birth who had two tests before hospital discharge were included. Infants older than one week with a single test were also included. RESULTS: Twenty eight studies were included. In the aggregated data, among 190 breastfeeding infants, 22 tested positive for SARS-CoV-2 (11.5%), while 4 of 152 (2.63%) among bottle-fed (Fisher’s exact test p = 0.0006). The positivity rates for roomed in infants (20/103, 19.4%) were significantly higher than those isolated (5/300, 1.67%) (P < 0.0001). There was no significant difference in positivity rate among infants who received kangaroo care (25%vs 9%, p = 0.2170), or delayed cord clamping (3.62%vs 0.9%, p = 0.1116). CONCLUSIONS: Lack of robust studies involving large patient population does not allow meaningful conclusions from this systematic review. Aggregated data showed increased positivity rates of SARS-CoV-2 among infants who were breast fed and roomed-in. There were no differences in SARS-CoV-2 positivity rates in infants received skin to skin care or delayed cord clamping.

Efficacy of kangaroo mother care combined with neonatal phototherapy in newborns with non-pathological jaundice: A meta-analysis

“…If COVID-19 is suspected or diagnosed, the World Health Organization recommends that mothers and infants could use skin-to-skin contact and other measures (80). However, there was no evidence of vertical transmission from a coronavirusinfected mother (81), and increased virus transmission was not observed in newborns receiving skin-to-skin care (82). As a result, the World Health Organization recommendations for neonatal skin care could be followed (80).…”

Clinical practice guideline for kangaroo mother care in preterm and low birth weight infants

“…Evidence summary: One systematic review, 2 guidelines, and 1 observational study were included here 149–152 . One systematic review (28 studies) found no significant difference in COVID‐19 positivity rates in newborns receiving KMC versus controls among mothers with confirmed COVID‐19 152 .…”

“…Evidence summary: One systematic review, 2 guidelines, and 1 observational study were included here 149–152 . One systematic review (28 studies) found no significant difference in COVID‐19 positivity rates in newborns receiving KMC versus controls among mothers with confirmed COVID‐19 152 . The observational study found that the survival benefit of KMC far outweighed the small risk of COVID‐19 death in preterm and LBWIs, especially in low‐ and middle‐income countries 151 .…”

Exclusive Breastfeeding and Vitamin D Supplementation: A Positive Synergistic Effect on Prevention of Childhood Infections?

“…If mother–baby separation is unavoidable due to poor mother’s health condition, newborn should be fed with pumped breast milk or pasteurized donor breast milk until breastfeeding can be resumed [ 96 ]. Another recent systematic review showed increased positivity rates of SARS-CoV-2 among newborns who were breastfed and roomed-in (almost all remained asymptomatic), but there were no differences in SARS-CoV-2 positivity rates in neonates who received skin to skin care or delayed cord clamping [ 97 ]. A recent Italian study confirmed that vertical and perinatal SARS-CoV-2 infection is rare, and breastfeeding does not increase the risk of COVID-19 [ 98 ].…”