SARS-CoV-2 Transmission Risk through Expressed Breast Milk Feeding in Neonates Born to COVID 19 Positive Mothers: A Prospective Observational Study

Document Type : Original Article

Authors

Department of Paediatrics, Maharshi Vashishtha Autonomous State Medical College, District- Basti, Uttar Pradesh, India

Abstract

Background: Mother-to-child transmission of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) has become a matter of great concern in post-partum wards and neonatal units. With little prior experience of this novel infection, there are contradictory findings in the literature regarding breastfeeding androoming-in for newborns of mothers with COVID-19 disease. To assess the transmission risk of SARS-CoV- 2 in neonates who were fed expressed breast milk of COVID-19 positive mothers.
Methods: This prospective study included 16 neonates born to COVID-19 positive mothers. The neonates were nursed in a neonatal unit separate from their mother. Expressed breast milk was fed by health care givers ensuring proper safety measures. Nasal and throat swabs of neonates were tested twice for SARS CoV-2, firstly, at 48 h of life and secondly, before discharge.
Results: Pneumonia was present in 3 (20%) mothers, and C- reactive protein was raised in 9 (60 %) mothers. Birth weight was low in 8 (50%) neonates. Respiratory distress syndrome and meconium aspiration syndrome were present in two and one newborns, respectively. Nasal and throat swabs of all 16 newborns tested negative for SARS-CoV- 2 infection twice, at 48 h of life and before discharge.
Conclusion: Expressed breast milk feeding can be considered safe in neonates born to COVID-19 positive mothers. Even sick mothers with COVID-19 can continue to express breast milk after ensuring proper safety measures.
 
 

Keywords


  1. Huang C, Wang Y, Li X, Ren L, Zhao J, Fan G, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506.
  2. World Health Organization. Director-general's opening remarks at the media briefing on COVID19. Geneva: World Health Organization; 2020.
  3. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226):809-15.
  4. World Health Organization. Clinical management of COVID-19: interim guidance. Geneva: World Health Organization; 2020.
  5. Coronavirus disease (COVID-19): what parents should know. UNICEF. Available at: URL: https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know; 2020.
  6. Royal College of Obstetricians & Gynaecologists. Coronavirus (COVID-19) infection in pregnancy. Information for Healthcare Professionals. London: Merchant logo Royal College of Obstetricians and Gynaecologists; 2020.
  7. Centers for Disease Control and Prevention. Evaluation and management considerations for neonates at risk for COVID-19. Georgia: Centers for Disease Control and Prevention; 2020.
  8. Centers for Disease Control and Prevention. Care for breastfeeding women. Georgia: Centers for Disease Control and Prevention; 2020.
  9. Favre G, Pomar L, Qi X, Nielsen-Saines K, Musso D, Baud D. Guidelines for pregnant women with suspected SARS-CoV-2 infection. Lancet Infect Dis. 2020; 20(6):652-3.

10. Wang L, Shi Y, Xiao T, Fu J, Feng X, Mu D, et al. Chinese expert consensus on the perinatal and neonatal management for the prevention and control of the 2019 novel coronavirus infection (First edition). Ann Transl Med. 2020; 8(3):47.

11. Levonorgestrel I. Drugs and Lactation Database (LactMed). Bethesda (MD): National Library of Medicine (US); 2020.

12. Indian Council of Medical Research Department of Health Research. Press release ICMR validates completely indigenous diagnostic platform for COVID-19 diagnosis. Available at: URL: https://www.
icmr.gov.in/pdf/press_realease_files/ICMR_Press_Release_TruNat_21052020.pdf
; 2020.

13. World Health Organization. Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: World Health Organization; 2017.

14. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016; 387(10017):475-90.

15. Kamali A, Jamieson DJ, Kpaduwa J, Schrier S, Kim M, Green NM, et al. Pregnancy, labor, and delivery after Ebola virus disease and implications for infection control in obstetric services, United States. Emerg Infect Dis. 2016; 22(7):1156-61.

16. Centers for Disease Control and Prevention. Contraindications to breastfeeding or feeding expressed breast milk to infants. Georgia: Centers for Disease Control and Prevention; 2020.

17. Committee on Pediatric Aids. Infant feeding and transmission of human immunodeficiency virus in the United States. Pediatrics. 2013; 131(2):391-6.

18. World Health Organization. Guideline: updates
on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva: World Health Organization; 2020.

19. Lawrence R, Lawrence R. Premature infants and breastfeeding. Breastfeeding: a guide for the medical profession. 8th ed. Philadelphia: Saunders; 2016. P. 553-63.

20. Szucs KA. American academy of pediatrics section on breastfeeding. J Hum Lact. 2011; 27(4):378-9.

21. Centers for Disease Control and Prevention. Breastfeeding and special circumstances: influenza. Georgia: Centers for Disease Control and Prevention; 2020. 

22. Lei D, Wang C, Li C, Fang C, Yang W, Chen B, et al. Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases. Chin J Perinat Med. 2020; 23(3):159-65.

23. Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, et al. Infants born to mothers with a new coronavirus (COVID-19). Front Pediatr. 2020; 8:104.

24. Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020; 323(18):1846-8.

25. Chen W, Zheng KI, Liu S, Yan Z, Xu C, Qiao Z. Plasma CRP level is positively associated with the severity of COVID-19. Ann Clin Microbiol Antimicrob. 2020; 19(1):18.