The COVID-19 pandemic has affected every possible area of life. She did not bypass both pregnant women and nursing mothers, who, often, at the slightest sign of ARVI, are seized by fear: what if this is it? And immediately a lot of questions arise in my head, including: can I breastfeed my baby if I get sick?
When COVID-19 is suspected or confirmed in an already nursing mother
In a situation where a nursing mother is under suspicion or with an already confirmed diagnosis of COVID-19, most experts agree that feeding the child can and even should be continued, subject to appropriate preventive measures. As with any ARVI, this is due to the fact that even before the first symptoms appear, a person can transmit the virus to others. Accordingly, a child who is in close contact with the mother most likely has already received some portion of the virus. At the same time, with breast milk, the baby receives antibodies to the corresponding disease. It turns out that when a mother, upon detecting symptoms, deprives the baby of milk, he does not receive antibodies, but the virus has already been received.
If the mother’s illness is severe, when she is not able to care for and breastfeed the baby herself, feeding expressed milk in accordance with preventive measures is an excellent option .
When COVID-19 is suspected or confirmed in a pregnant woman before childbirth
Things are more complicated when COVID-19 is suspected or confirmed in a pregnant woman just before childbirth. The optimal diet for a child born to a mother with suspected or confirmed COVID-19 is still a matter of controversy. At the moment, most countries are inclined to believe that the decision on how to feed the newborn should be made by the mother of the baby in conjunction with the medical staff. Moreover, if a mother plans to breastfeed her baby, then any decision should involve maintaining lactation.
It is important to consider the following when making a decision:
- The viable SARS-CoV-2 virus (the virus that causes COVID-19 disease) has not been found in breast milk. At the moment, there are already many studies, as a result of which the maximum was found non-viable particles, RNA, virus. This fact is recognized all over the world, which is why breastfeeding in one form or another is allowed in most countries.
- Antibodies to SARS-CoV-2 have been found in breast milk according to reports from several studies. Accordingly, breast milk can protect a baby, including from COVID-19. This is also recognized all over the world.
- The benefits of breastfeeding for both members of the dyad have long been known and supported by research . In particular, breastfeeding reduces morbidity and mortality for both mothers and babies.
- SARS-CoV-2 can be transmitted to a baby through the mother’s respiratory secretions. This fact has prompted some countries to limit direct contact between mother and child. It should be noted that compliance with preventive measures while breastfeeding or expressed milk significantly reduces the risk of such transmission of the virus.
- If a mother is breastfeeding or breastfeeding, she should take appropriate preventive measures (including wearing a mask and washing her hands) to minimize the risk of transmission of the virus during breastfeeding.
- The risk of mother-to-neonatal transmission may differ from one dyad to another. It is important to weigh the benefits of breastfeeding against the risk of transmitting SARS-CoV-2 in a given situation. Accordingly, it is important to assess, inter alia, the severity of the mother’s illness, the possibility of observing preventive measures when caring for and feeding a newborn, the parents’ understanding of the potential risk of infection and the need to comply with appropriate measures, etc.
- COVID-19 is rare in newborns, and if it does, it is asymptomatic or mild in most casesin which respiratory support is not required. However, newborns with underlying medical conditions and children born prematurely (gestational age <37 weeks) may have a higher risk of severe COVID-19. In this regard, there is some disagreement in the guidelines. For example, the World Health Organization (WHO) believes that a baby born prematurely should still be breastfed. But the Centers for Disease Control and Prevention (CDC) is inclined to believe that expressed milk of the mother for newborns at increased risk of severe disease (for example, for babies born prematurely, babies with underlying medical conditions) may be preferable.
- The CDC says that the available evidence suggests no difference in the risk of contracting SARS-CoV-2 to a newborn, whether the newborn is in a separate room or stays in the mother’s room when preventive measures are followed.
- The severity of the course of the infection also affects the decision-making process, since the viral load and infectivity depend on this . In addition, the severity of the mother’s illness affects the ability to directly breastfeed or express, and to care for her baby. Most guidelines allow mothers with no or mild symptoms to breastfeed as preventive measures . While in a severe course of the disease, it is recommended to express milk in compliance with preventive measures for further feeding the child by a healthy guardian or medical staff.
- In order to make a decision, the medical staff must tell the mother all the advantages and disadvantages of different options, taking into account the circumstances in this particular dyad.
- Particular attention should be paid to instructing and counseling the mother on measures for the prevention of infectious diseases aimed at protecting against respiratory secretions and, as a result, at preventing transmission of the virus to the infant.
- Consideration should be given to the mother’s preference for breastfeeding.
- The mother needs support regardless of the feeding option she chooses. Accordingly, such support should be available to the mother.
- It is necessary to take into account not only the mother’s test result for COVID-19, but also the child’s test result . Separation is definitely not required if the newborn also tests positive for SARS-CoV-2.
- Consideration should be given to the availability of resources for isolation, volume / patient flow.
- Mothers with suspected or confirmed SARS-CoV-2 infection should not be considered as posing a potential risk of transmitting the virus to their newborns if they meet the criteria for termination of isolation (which must be a combination of all three) and may not follow the precautions further.
These CDC criteria include the following:
At least 10 days have passed since the first symptoms of the disease appeared (up to 20 days if the mother has a severe course of the disease or seriously weakened immunity), and
At least 24 hours have passed since the last fever without taking antipyretics or other means of lowering body temperature, and
· Other symptoms of the disease have decreased.
Some guidelines also refer to the criterion for non-infectiousness as two negative tests for SARS-CoV-2 at an interval of at least 24 hours.
Mothers who do not meet these criteria may be temporarily separated from their newborn babies in order to reduce the risk of transmission of the virus. However, if after discharge they are unable to maintain separation from the child until they meet the above criteria, the effectiveness of such separation is questionable . With all of the above in mind, for mothers with suspected or confirmed COVID-19 infection, whose babies test negative or are awaiting a test result, there are three approaches to consider, which will be discussed in the next article .