Russian Doctors Have Made Recommendations On Breastfeeding With COVID-19

Russian doctors have made recommendations on breastfeeding with COVID-19

Professors Olga Lukoyanova and Tatiana Borovik from the National Medical Research Center for Children's Health have developed a detailed guideline for feeding expressed milk in hospital and at home. In their opinion, this is the safest way to feed newborns in the context of the spread of coronavirus.

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Breastfeeding with COVID-19 - are there risks for the baby?

In an article published in the journal Attending Physician, the authors mention that from the very beginning of the pandemic, doctors did not exclude the possibility of transmission of infection from mother to newborn. In the future, data began to appear that women with COVID-19 may have premature birth and are at risk of developing respiratory distress syndrome and pneumonia in children. The authors refer to a systematic review of 23 studies from China, the United States, South Korea and Central America, including a description of pregnancy outcomes in 178 confirmed women and 162 newborns. In 23% of cases, preterm birth was detected, 14% of infants had distress syndrome, another 14% developed pneumonia, and 11% of children were underweight. In addition, in 11% of cases, infection occurred through vertical transmission from mother to child.

At the same time, there is still no evidence of the isolation of coronavirus in breast milk and the possibility of infection of the infant during feeding. However, in a few studies it was mentioned that SARS-CoV-2 was found in two samples of breast milk from infected women, but the researchers are not sure that in both cases the child was infected not during skin-to-skin contact.

Due to the limited number of studies in some national guidelines for obstetricians and neonatologists, breastfeeding with a confirmed diagnosis of COVID-19 and postpartum maternal contact is discouraged.

“In contrast to this approach, and given the available evidence, WHO is making the statement that the multiple benefits of breastfeeding (HBs) far outweigh the potential risks of contracting and contracting coronavirus infection, so breastfeeding, skin-to-skin contact, and mother-child coexistence perhaps even with confirmed COVID-19, but subject to all anti-epidemic measures: the mother must wear a mask, disinfect her hands before and after feeding and all surfaces and accessories with which she came into contact,”the authors of the article write.

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Expressing breast milk as a preventive measure

Olga Lukoyanova and Tatyana Borovik believe that, given the lack of data on the transmission of the virus from mother to child, it is better to play it safe, since the infection can cause enormous harm to the condition of the newborn. In their opinion, during a pandemic, it is quite justified to separate the mother and child with suspected COVID-19 or a confirmed diagnosis and feeding with expressed breast milk.

Experts recommend starting the pumping procedure in the first hour after the birth of the baby in the case of a natural birth and within the first 6 hours after the caesarean section. It is necessary to repeat the procedure every 2-3 hours with a 5-6 hour night break (up to 6-8 times / day) for 10-15 minutes from each breast.

“It is important to understand that pumping is not only needed to 'deliver' breast milk to the baby, but is an effective way to support lactation, while short but frequent pumping stimulates lactation much better than long but rare ones. Our studies have convincingly demonstrated the possibility of maintaining successful lactation in women who first attach their babies to the breast at 2-3 weeks of life (for medical reasons), subject to regular expression in the postpartum period,”write Lukoyanova and Borovik.

The authors emphasize that expressing and transferring milk to the baby must be organized with careful observance of sanitary standards. Before each procedure, the woman should wash her hands and change the medical protective mask for a new one. The nurse who picks up the plastic bag with the bottle should treat it with an antiseptic and place it in a container for transporting biological samples, and then leave it outside the quarantine area. The second nurse takes the bottle and transfers it to the department where the child is. Pasteurization of expressed milk is not recommended.

“Resuming breastfeeding is possible after receiving two negative tests for COVID-19 in both the mother and the child,” the article says.

If necessary, for example, in case of illness of a mother or child, experts recommend organizing an individual breast milk bank at home. To do this, it is necessary to make stocks of frozen milk, placed in portions in sterile containers, and store them in a freezer at a temperature of -18-20 ° C. The technology for creating and using a breast milk bank is described in detail in the Program for Optimizing the Feeding of Infants in the First Year of Life, approved by the Russian Ministry of Health.