Current recommendations of breastfeeding practices among mothers with suspected or confirmed COVID19

1. Breastfeeding in
the Context of
COVID-19
Peter O. Ubuane, MBChB, FWACPaed
Consultant Paediatrician
Neonatal Unit, Dept of Paediatrics
Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
https://news.un.org/en/story/2018/04/1007041
“support breastfeeding for a healthier planet”
Webinar presentation: 8th August, 2020

2. Conflict of interest
None
(… but I was breastfed for about 2-3 years!)

3. What we know about breastfeeding
• Breastfeeding is critical to
 Infants’ survival, growth and
neurocognitive development
 Maternal well-being
• Related practices also improve
infant’s survival:
 Early skin-to-skin contact
 Rooming-in
 Kangaroo Mother Care (KMC) https://news.un.org/en/story/2020/08/1069372

4. But then came the ‘COVID challenge…’
• COVID-19: due to a novel coronavirus-
severe acute respiratory distress
syndrome 2 (SARS-CoV-2)
• COVID-19 has resulted in:
 Hospitalisations, Deaths, Disabilities
 Socioeconomic disruptions
 Disruption of health services including
support for breastfeeding

5. Why are we scared?
• Potential transmission via:
• Breastmilk
• Contact
• Mother’s respiratory
droplets
• Transmission requires:
• Replicative viable RNA
• Access to portal of entry
in baby’s mucosa
• Overcoming baby’s
defences (mucosal, etc)
e.g. thru
CONTACT
WHILE
BREASTFEE
DING
Image Courtesy: Satyan Lakshminrusimha; Chandrasekharan P et al, Am J Perinat, 2020

6. Yet…a Reminder:

7. Breastfeeding & mothers with COVID-19
Image Courtesy: Satyan Lakshminrusimha; Chandrasekharan P et al, Am J Perinat, 2020
3 options

8. What shall we choose? Weigh…
• We weigh the risk of
infection against
benefits of
breastfeeding:
Short-term
Intermediate
Longterm
BREASTFEED DON’T
BREASTFEED

9. Weighing the available evidence:
WHO systematic review
 Observational studies, up to 15 May 2020
• Key findings
 153 mother-infant dyads
 46 mothers had breastmilk (BM) samples tested for SARS-
cov-2
 3 BM samples positive for virus (? viability)
 One of the 3 infants had COVID-19
- mode of feeding not known
- Other 2 had BM
 An author (preprint) reported anti-COVID-19 IgA in 12 of
15 BM samples
• Conclusion:
 Risk of Transmission by BM is low compared to benefit of
Breastfeeding

10. Weighing the available evidence (cont’d)
• A more recent meta-analysis of 58
observational studies published from
Dec to mid-July 2020
• Key findings:
 117 neonates with COVID-19
 Mostly postnatal
 Few vertical transmission (in-utero,
birth)
 Generally good outcome

11. Weighing the available evidence (cont’d)
• Key findings (cont’d)
 Risk factors associated with neonatal
COVID-19
 Rooming-in/Close contact was
associated with 5-fold increased
odds of neonatal COVID
(OR 5.1 (95% CI: 1.6–18);
p = 0.003)
 Breastfeeding was associated with
2-fold reduced odds of neonatal
COVID
(OR 0.49 (95% CI:0.12–1.94;p = 0.35)
• Conclusion
 Seek balance between risk of rooming-
in and benefit of breastfeeding

12. Weighing the available evidence (cont’d) :
American Academy of
Paediatrics (AAP)
Reviewed:
 Published case series
 > 1,500 mother-infant dyads in AAP’s
National Perinatal COVID-19 Registry
Key findings:
 2-5% of infants born to infected mothers tested positive in 1st 24-96 hrs of life
 No report of neonatal deaths within the birth hospitalisation periods
 Similar risk of infection between infants separated from their mothers and those
roomed-in with prevention practices
 “Several” reports of virus in BM, but ? Viability
Conclusion:
 benefits of rooming-in and breastfeeding outweighs the risk of infection

13. Weighing at the available evidence (cont’d)
A Report from Lagos, Nigeria (LUTH):
• 5 pregnant women had been
delivered of newborns (then):
 Rooming-in
 Breastfeeding
 All negative postnatally before
discharge
• Update (personal communication*):
 8 babies so far (7 deliveries)
 all negative till date
th

14. Where is the weight of evidence?
• Evidence limited but
building
• Benefits of
breastfeeding/rooming-
in outweighs the risk
• Decision requires
respectful
counselling
BREASTFEED
DON’T
BREASTFEED

15. Summary: Considerations in support of
breastfeeding despite COVID-19
• Breastmilk protective, possibly against COVID-19
IgA in breastmilk
• Few reports of SARS-CoV-2 RNA in breastmilk
? Replicative viability
• Children, including infants, tend to be at low risk of COVID-19
Mostly pauci- or asymptomatic
• Annually, over 800,000 childhood deaths are averted
through breastfeeding!

16. WHO Recommendations:
(similar to CDC, AAP, UNICEF’s, etc.)

17. But…

18. Conclusion: support…, support…, support!
• COVID-19 pandemic has disrupted healthcare
services including support for breastfeeding
• Healthcare providers have a large role to restore
optimal breastfeeding practices through adequate
knowledge
• Mothers with COVID-19 should be supported to
initiate and sustain breastfeeding after adequate
counselling and IPC measures
Where they choose otherwise, they should be
supported
• AAP Website

19. References
• 1. Chandrasekharan P, Vento M, Trevisanuto D, Partridge E, Underwood MA, Wiedeman J, et al. Neonatal Resuscitation
and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection. Am J Perinatol
[Internet]. 2020 Jun 8;37(08):813–24. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1709688
• 2. World Health Organization. Breastfeeding and COVID-19: Scientific Brief [Internet]. Available from:
www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19
• 3. American Academy of Paediatrics. FAQS: Management of Infants born to Mothers with Suspected or Confirmed
(Critical updates on COVID-19) [Internet]. 2020. Available from: https://services.aap.org/en/pages/2019-novel-coronavirus-
covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/
• 4. Okunade KS, Makwe CC, Akinajo OR, Owie E, Ohazurike EO, Ochuwa, et al. Good clinical practice advice for the
management of pregnant women with suspected or confirmed COVID-19 in Nigeria. Int J Gynecol Obs. 2020;1–7.
• 5. Centers for Disease Control and Prevention. Care for Breastfeeding Women: Interim Guidance on Breastfeeding and
Breast Milk Feeds in the Context of COVID-19 (Summary of Recent Changes) [Internet]. 2020. Available from:
https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-
breastfeeding.html

20. Thank you