Am J Perinatol 2020; 37(13): 1377-1384
DOI: 10.1055/s-0040-1716506
Clinical Opinion

Breastfeeding in COVID-19: A Pragmatic Approach

Yvonne Peng Mei Ng
1  Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
2  Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
,
Yi Fen Low
3  Yong Loo Lin School of Medicine, National University of Singapore, Singapore
,
Xin Lei Goh
3  Yong Loo Lin School of Medicine, National University of Singapore, Singapore
,
Doris Fok
4  Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
,
Zubair Amin
1  Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
2  Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
› Author Affiliations
Funding None

Abstract

The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in changes to perinatal and neonatal care, concentrating on minimizing risks of transmission to the newborn and health care staff while ensuring medical care is not compromised for both mother and infant. Current recommendations on infant care and feeding when mother has COVID-19 ranges from mother–infant separation and avoidance of human milk feeding, to initiation of early skin-to-skin contact and direct breastfeeding. Health care providers fearing risks of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) maternal–infant transmission may veer toward restricted breastfeeding practices. We reviewed guidelines and published literature and propose three options for infant feeding depending on various scenarios. Option A involves direct breastfeeding with the infant being cared for by the mother or caregiver. In option B, the infant is cared for by another caregiver and receives mother's expressed milk. In the third option, the infant is not breastfed directly and does not receive mother's expressed milk. We recommend joint decision making by parents and the health care team. This decision is also flexible as situation changes. We also provide a framework for counseling mothers on these options using a visual aid and a corresponding structured training program for health care providers. Future research questions are also proposed. We conclude that evidence and knowledge about COVID-19 and breastfeeding are still evolving. Our options can provide a quick and flexible reference guide that can be adapted to local needs.

Key Points

  • SARS-CoV-2 is unlikely transmitted via human milk.

  • A shared decision making on infant feeding is the preferred approach.

  • Mothers can safely breastfeed with appropriate infection control measures.



Publication History

Received: 22 July 2020

Accepted: 07 August 2020

Publication Date:
08 September 2020 (online)

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