In February 2020, China’s National Health Commission recommended the isolate of women not only with a confirmed coVID-19 diagnosis, but even in suspicious cases from newborns for at least 14 days. Accordingly, breastfeeding for such women was also not recommended because of the high risk of infection. Breastfeeding and/or feeding expressed breast milk should only be allowed in the case of negative PCR test results for COVID-19 in mother and breast milk (Wang L, Shi Y, Xiao T, Fu J, Feng X, Mu D, et al. Consensus of Chinese experts on perinatal and neonatal management to prevent and control the new coronavirus infection 2019 (first edition) Ann Transl Med.2020).
As for the requirement of a negative test result for the presence of the virus in breast milk, it is not about expressed milk of the mother, but about donor milk. The fact that Chinese experts considered the possibility of the virus in breast milk during the incubation period, therefore, assumed that donor milk can be used only after screening for SARS-CoV-2 (virus causing COVID-19 infection) (R. Hethyshi, 2020).
Thus, the newborn should be fed donor breast milk or mixture until his mother receives a negative test result for SARS-CoV-2. At the same time, preference will be given to breast milk from a healthy donor.
Of course, donor milk can be offered only after pasteurization. It should be noted that the process of pasteurization supports the nutritional value of milk, but reduces its immunological properties by about 30-40%. As for nutrient components, pasteurized milk inactivates lipase and some thermolael vitamins (Valdenise Martins Laurindo Tuma Calil et al., 2020).
The problem with donor breast milk is also the fact that both donations and demand for donor milk have decreased as a result of the pandemic in China. This is probably because women choose not to go to the hospital. Lack of donor breast milk makes the need for breastfeeding even more obvious when possible (Chiara Giuliani et al., 2020). And according to a study by Kee Thai Yeo et al., published in July 2020, China still allowed the use of pasteurized expressed milk of the mother with suspected or confirmed COVID-19 infection.
In addition to mother isolation, it is assumed that all children suspected of COVID-19 should also be isolated, regardless of whether they have symptoms (Li F et al., 2020). Information about the way these babies are fed is not provided.
At the same time, Chinese experts themselves recognize in their Consensus that separation of mother and child can cause concern for parents and maternal depression, so they consider it necessary to provide psychological comfort to parents, the help of social workers or supportive counselors.
However, it must be recognized that this is not all the negative consequences of separation of mother and child in the current situation and refusal to breastfeed.
Some authors also note that such strict recommendations may help reduce breastfeeding in general, even in women who have not been exposed to the virus (but panicked after studying such terrible recommendations), which can lead to a deterioration in the child’s health (Ricardo Martins-Filho et al., 2020).
Many authors (Riccardo Davanzo et al., 2020; Fahri Ovalı, 2020; Giulia Trippella et al., 2020 and others) note that the experts who developed the Consensus do not give any specific reasons for choosing such strict recommendations. It can be assumed that they fear that newborns may be more at risk of developing (severe) complications of COVID-19, given their immature immune system (Francesca Donders et al., 2020). However, no analysis of the global risks and benefits of breastfeeding compared to neonatal infection has been carried out. While most international organizations and medical organizations in individual countries say that the benefits of breastfeeding are obvious, while the risk of transmission with safety measures is minimal, and the few cases of newborn COVID-19 are largely asymptomatic or mild.
Riccardo Davanzo, 2020 suggests as possible reasons for such rigid recommendations the usual separation between an infected mother and her child, the need for organizational simplification during a new emergency. The question arises: is the price for organizational simplification too high?
Wang SS et al., 2020 is not recommended to breastfeed due to the fact that the antiviral drug lopinavir / ritonavir, chosen for the treatment of COVID-19, is excreted with breast milk.
However, this is also difficult to call a good reason for strict restriction of breastfeeding. If we turn to the e-lactancia.org handbook, which contains the maximum amount of information on the compatibility of various drugs with breast-feeding, we will see that the drugs lopinavir and ritonavir are safe and compatible with breast-feeding.
Pharmacokinetic data (moderately high molecular mass and very high percentage of binding with proteins) explain the observed very low penetration of these drugs in breast milk (Corbett 2014, Palombi 2012 — ritonavir; Oumar 2018, Corbett 2014, Shapiro 2013, Palombi 2012 — lopinavir). Oumar 2018, Corbett 2014, Gandhi 2013, Shapiro 2013 — lopinavir) or very low (Gandhi 2013, Palombi 2012).
What these strict recommendations lead to, for example, Guan-jing Lang and Hong zhao. They recount the case of a thirty-year-old woman who, on 1 February 2020, went to a local hospital at 35 weeks of pregnancy complaining of a dry cough. There were no other symptoms, however, the sputum test on SARS-CoV-2 was positive. On February 6, the patient was transferred to the first branch hospital of the University of zhejiang, Hangzhou, China.
On the third day of hospitalization, she underwent an emergency C-section due to a reduction in the fetal heart rate to 110 beats per minute.At this time, the test of her sputum on SARS-CoV-2 still tested positive.According to the rules of the Consensus, the boy was immediately separated from his mother.
It is reported that in childbirth, tests of maternal serum, urine, feces, umbilical cord blood, amniotic fluid and placenta on SARS-CoV-2 gave negative results. The baby was not detected immediately after birth, but he was sent to an isolation cell. All subsequent tests of smears from the oropharyncha to, blood, stool and urine of the child remained negative on SARS-CoV-2.
Moreover, in the mother herself from the fourth day of hospitalization (respectively, from the day after birth or from February 9-10), repeated tests of sputum and breast milk on SARS-CoV-2 were consistently negative. However, it was issued only on February 19 on the basis of the current expert consensus (Xu et al.,2020). Then another two-week quarantine and follow-up was required.
At the same time, samples of breast milk have never shown signs of SARS-CoV-2 infection.In addition, the patient was re-examined a week after discharge, and no viral RNA was found in her phlegm or breast milk. However, all this time the mother was not allowed to breastfeed!
This is not the first time that the virus has been confirmed in breast milk. However, the authors of the article conclude: «Existing evidence indicates that SARS-CoV-2 cannot be transmitted through breast milk.To minimize the risk of neonatal transmission, the mother must be isolated from the newborn until she is cured of COVID-19 and is no longer considered contagious, which requires a two-week quarantine after discharge from the hospital… our results show that breastfeeding can be practiced after the end of the isolation period if the retest is negative.At the same time, it is recommended to express milk so that you can start breastfeeding after the end of the isolation period» (Guan-jing Lang and Hong zhao, 2020).
Thus, regardless of what the results of tests of sputum and breast milk in the mother, she can not feed (and generally approach the child) until it is 2 weeks after discharge from the hospital. Very tough and incomprehensible conclusions.
Fortunately, there are more recent articles with analysis of observations from China, the authors of which come to completely different conclusions. For example, on 1 September 2020, a study was published at a specialized centre in Wuhan, China.
The study included pregnant patients with laboratory-confirmed COVID-19 who gave birth during hospitalization. Clinical characteristics and serial samples of 14 mother-infant couples were studied. At the same time, four patients were breastfed, observing precautions. No child has experienced COVID-19 development during breastfeeding. SARS-CoV-2 was also not found in breast milk or vaginal discharge of the mother. At the same time, antibodies to SARS-CoV-2 were found in breast milk, cord blood and neonatal serum!
The authors of the study concluded that breastfeeding at low risk of SARS-CoV-2 transmission allows the child to passively obtain antibodies against the virus. Accordingly, mothers with COVID-19 should breastfeed, taking precautions (Xuan Gao, 2020).
I would like to believe that such studies will help to change the current situation in China, and after it in Russia, which follows in his footsteps in this matter.