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1.
International breastfeeding journal ; 18(1):3, 2023.
Article in English | EMBASE | ID: covidwho-2196366

ABSTRACT

BACKGROUND: Our main objective was to determine the evolution of IgG and IgA antibodies directed against SARS-CoV-2 protein S in the blood of lactating women and in breast milk. METHOD(S): A cohort of 110 uninfected and vaccinated breastfeeding women was followed-up for 6 months at the Marques de Valdecilla University Hospital, Spain, in 2020. An additional group of 23 breastfeeding mothers who had no previously documented infection and had not been vaccinated against SARS-CoV-2 were included as a control group. The antibodies in blood and breast milk and their evolution at 6 months post-vaccination were analysed. RESULT(S): One hundred ten breastfeeding mothers were included;70 women (63.6%) were vaccinated with two doses of BNT162b2, 20 women (18.2%) received two doses of mRNA-1273, and 20 women (18.2%) received a single dose of ChAdOx1-S. No evidence of differences between concentrations of antibodies was found according to the type of vaccine, with the exception of serum IgA antibodies, which was higher in women vaccinated with mRNA-1273: mean [95%CI]: 0.05AU/mL [0.03,0.06] with mRNA-1273, 0.02AU/mL [0.01,0.03] with BNT162b2 and 0.01AU/mL [0.00,0.03] with ChAdOx1-S, ANOVA p value=0.03. The lack of difference between vaccines was also found when anti-S1 specific IgG in serum and breast milk were measured. CONCLUSION(S): In lactating women vaccinated against COVID-19, anti-SARS-CoV-2 antibodies can be detected in both serum and breastmilk 6 months after receiving the second dose, although their concentrations decreased when compared with concentrations reached immediately after vaccination. Copyright © 2023. The Author(s).

2.
Open Forum Infectious Diseases ; 9(Supplement 2):S780-S781, 2022.
Article in English | EMBASE | ID: covidwho-2189976

ABSTRACT

Background. Worldwide, attempts to understand the neonatal response and the benefits of immunity conferred by the mother to continue preventing COVID-19 infection in vulnerable groups. Therefore, research on the efficacy of vaccination against SARS-CoV-2 in pregnancy remains as an important tool to prevention of complications. Methods. Cross-sectional study in which blood samples from 379 neonates taken from the umbilical cord. The inclusion criteria were: newborns of mothers with a history of vaccination against SARS-CoV-2 during pregnancy. Infants whose mothers had COVID-19 infection at birth, or receiving any immunosuppressive treatment during pregnancy were excluded. Results. 379 neonates were studied for their antispike IgG levels. The majority were full-term female neonates were of adequate weight for their gestational age and without complications during their birth, 28 neonates required NICU care for their. Antispike IgG levels were obtained in 94.9% . Mothers received first dose at first trimester in 28.4%, second trimester in 51.9% and in the third trimester 19.6). A total of 318 mothers (87.8%) completed the two-dose schedule receiving the same vaccine, six (1.6%) received another anti-COVID vaccine, and the remaining 39 (10.7%) received only one dose of vaccine. 64.9% were vaccinated with the BNT162b2 vaccine, were higher leves when received two vaccine doses compared to only one. Vaccines that stimulated highest levels were mRNA-1273 and BNT162b2, lowest levels were found in the CoronaVac and Ad5-nCoV vaccines. Finally, it should be noted that only four neonates presented levels below 0.8 BAU/ mL (non-positive). Conclusion. This study provides evidence on timing of maternal anti-COVID vaccination, antibody production, and transplacentary transfer ensuring maternal and neonatal protection through vaccination is key to encourage women to be vaccinated against COVID-19 during pregnancy. Follow-up studies in infants are needed to understand the persistence of placental-transferred antispike IgG and the role of breast milk antibodies in maximizing the protection of infants at this stage of risk of severe SARS-Cov-2 disease. These findings have implications for determining new public health and vaccination strategies for pregnant women.

3.
Pharmazeutische Zeitung ; 167(40):44, 2022.
Article in German | EMBASE | ID: covidwho-2169562
4.
Sri Lanka Journal of Child Health ; 51(4):525-534, 2022.
Article in English | Scopus | ID: covidwho-2201345

ABSTRACT

Introduction: Covid-19 pandemic has raised queries regarding implications for breastfeeding (BF). Data are limited and recommendations for initial days after birth differ. Parents count on paediatricians for optimal information about feeding their infants, especially when the mother is infected. Objectives: To estimate knowledge of paediatricians about BF in suspected or confirmed maternal cases of Covid-19, its association with demographic variables, and participants' opinions about factors influencing their guidance to parents regarding infant nutrition in Covid-19 infected mothers. Method: This was a prospective cross-sectional study based on an online questionnaire administered to paediatricians in Uttar Pradesh, India, from February to March 2021. A total of 389 paediatricians participated. Knowledge questions were based on the World Health Organization guidance on BF for Covid-19. Results: Among the 389 participants, 44.5% had adequate knowledge, 38.3% had average knowledge, and 17.2% had inadequate knowledge;96.4% paediatricians preferred mothers' milk for infants with Covid-19 infected mothers. Fear of transmission of infection to infant was the major restraint, while the low risk of transmission to the infant if infection prevention and control practices were followed was the most useful factor perceived while counselling an infected mother for BF.Conclusions: Knowledge of paediatricians about BF in suspected or confirmed maternal cases of Covid-19 was adequate in 44.5%, average in 38.3% and inadequate in 17.2%. Majority (96.4%) of paediatricians favoured BF in maternal Covid-19 cases. © 2022,Sri Lanka Journal of Child Health. All Rights Reserved.

5.
Vaccines ; 10(12) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2200928

ABSTRACT

Vaccination against pertussis in pregnancy is safe for pregnant women and newborns. Vaccination against pertussis during the second or early third trimester of pregnancy is highly protective against pertussis in young infants. Vaccination early in the third trimester versus vaccination late in the third trimester is associated with higher newborn anti-B. pertussis antibody levels. Infants whose mothers were vaccinated in pregnancy have less boosting of anti-B. pertussis antibody concentrations after their own vaccination, but this is not clinically significant. More immunogenicity and vaccine effectiveness studies are needed in countries using whole-cell pertussis vaccines. Vaccination in pregnancy induces anti-B. pertussis antibodies in breast milk. COVID-19 mitigation strategies have resulted in a significant decrease in B. pertussis circulation, which could negatively affect population immunity against B. pertussis. Highlights: Infants are at high risk for severe morbidity and mortality from pertussis disease during early infancy. Vaccination against pertussis in pregnancy has emerged as the ideal strategy to protect infants during these early, vulnerable, first months of life. On 30 November and 1 December 2021, the Global Pertussis Initiative held a meeting that aimed to discuss and review the most up-to-date scientific literature supporting vaccination against pertussis in pregnancy and outstanding scientific questions. Herein, we review the current and historically published literature and summarize the findings as consensus statements on vaccination against pertussis in pregnancy on behalf of the Global Pertussis Initiative. Copyright © 2022 by the authors.

6.
Perinatology ; 23(2):87-91, 2022.
Article in English | EMBASE | ID: covidwho-2157164

ABSTRACT

Background and Aim: Although breastfeeding is highly important and has numerous health benefits, COVID-19 makes it difficult for mothers with suspected or confirmed COVID-19 to breastfeed their neonates. Various breastfeeding guidelines can confuse mothers and harm both mothers and their neonates. This study aims to evaluate the SARS-CoV-2 transmission from mothers to neonates and to encourage mothers with suspected or confirmed COVID-19 to breastfeed. Material(s) and Method(s): We searched PubMed and Google Scholar for literature on guidelines on COVID-19 and breastfeeding. We included English, free, and full-text articles. Result(s): SARS-CoV-2 is rarely transmitted via breast milk. The recommended strategy for breastfeeding is for parents and the health care team to make a joint decision. Mothers can breastfeed safely with strict infection prevention protocols. Breastfeeding mothers are advised to take the COVID-19 vaccination. It benefits both the mother and the neonate. Conclusion(s): The knowledge on COVID-19 and breastfeeding is continuously evolving. Our suggestions may serve as brief and flexible recommendations that can be customized based on local requirements. Copyright © 2022, Himalaya Wellness Company. All rights reserved.

7.
Medical Journal of Malaysia ; 77(Supplement 4):54, 2022.
Article in English | EMBASE | ID: covidwho-2147555

ABSTRACT

Introduction: Despite improvement of sanitation and economical status of many countries, exclusive breastfeeding remained an established and important public health strategy to prevent infectious diseases, especially acute multiple respiratory and gastrointestinal diseases among infants. Mothers need effective motivation and support from healthcare professionals to opt for and maintain breastfeeding. Objective(s): This study aimed to assess the knowledge and attitudes regarding exclusive breastfeeding among senior medical and nursing students of Universiti Kuala Lumpur Royal College of Medicine Perak (UniKL RCMP). Material(s) and Method(s): A total of 195 seniors (97 medical and 98 nursing students) participated in this cross-sectional study using a validated self-administered online questionnaire, between 19th Oct 2020 and 27th Nov 2020, in the time of COVID-19. Result(s) and Conclusion(s): The participants had moderate knowledge (mean = 20.32 +/- 3.405, 70.08% correct), and positive attitudes regarding exclusive breastfeeding (mean = 64.34 +/- 6.816). However, only 32.8% of the students knew that formula milk cannot be given to infants less than six months old and a lack of knowledge regarding expression and storage of breast milk was evident. Only less than half of the students strongly disagreed or disagreed with five out of nine negative statements which reflected a deficiency in positive attitudes. Using the means as cut-off point, only 63.1% and 56.9% of the students demonstrated good knowledge and positive attitudes, respectively. Against the impact of COVID-19 pandemic on medical education, overall, the students had moderate knowledge and positive attitudes towards exclusive breastfeeding. However, specific knowledge gaps and misconceptions were identified, and only less than two-thirds of the health professional students had good knowledge and positive attitudes, indicating an urgent need for interventions to promote exclusive breastfeeding skills of our future doctors and nurses to efficiently motivate and support mothers in exclusive breastfeeding which is crucial in infectious disease prevention amongst infants worldwide.

8.
Cureus ; 14(10): e30555, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2145105

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus originated in Wuhan, China, and spread all over the world, causing the worst pandemic of the century. The disease has a broad continuum of clinical presentations, from mild to life-threatening. The virus is highly contagious and transmittable to humans. Emerging evidence of its effects on pregnant women and newborns is inconsistent and ever-evolving. Therefore, the objective of this review is to compile the scientific literature on the effects of SARS-CoV-2 coronavirus on pregnancy, pregnant women, and newborns. Data were obtained by several authors using PubMed, MEDLINE, Google Scholar, and Web of Science. "COVID-19", "pregnancy", "vertical transmission", and "newborn" were the search words used to find relevant articles. Most studies suggested pregnant women and newborns are not at additional risk for unfavorable outcomes. Besides, very few studies found newborns who tested positive for SARS-CoV-2 upon delivery from a COVID-positive mother. However, several studies showed no evidence of intrauterine or transplacental transmission of COVID-19 infection. Studies had mixed findings with a few showing the presence of the virus in breastmilk. In conclusion, there is no concrete evidence of additional adverse effects of SARS-CoV-2 on pregnant women and newborns.

10.
Journal of Basic and Clinical Health Sciences ; 6(3):798-804, 2022.
Article in English | Web of Science | ID: covidwho-2111576

ABSTRACT

Purpose: Breastfeeding is considered the strongest postnatal bond between mother and infant and is the best source of nutrition that that affects infant health and development. However, the global COVID-19 epidemic and the lack of understanding of the vertical transmission of SARS-CoV-2 have significantly limited breastfeeding practices. The aim of this study is to investigate the presence of SARS-CoV-2 virus in the milk of breastfeeding mothers with COVID-19 disease and to provide scientific evidence on whether Material and Methods: For this purpose, breast milk samples were collected from 60 women with COVID19 in the Turkish city of, and analyzed for the presence of SARS-CoV-2 RNA by RT-PCRs. Results: The result of the analysis, SARS-CoV-2 RNA was not detected in any breast milk. According to the results obtained in this study;that there is no evidence of mother-to-child transmission of SARS-CoV2 through breast milk and that mothers can safely breastfeed their infants. Conclusion: We believe that with deeper analysis and comprehensive studies, it will be possible to fully understand whether the SARS-CoV-2 virus is transmitted to infants through breast milk.

11.
Journal of the Pakistan Medical Association ; 72(10):2145, 2022.
Article in English | EMBASE | ID: covidwho-2081609
12.
Biomedicines ; 10(10)2022 Oct 13.
Article in English | MEDLINE | ID: covidwho-2071218

ABSTRACT

Pregnant women are included in the COVID-19 risk groups even if they do not have any pathology. This requires an analysis of research focused on pregnant women to understand the impact of SARS-CoV-2 on their condition. There is also a need to know whether there is vertical mother-to-child transmission, as well as other consequences in case the pregnant woman is infected and COVID-19 positive. A systematic review was carried out to analyze the existing information on the complications of a pregnant woman infected with the SARS-CoV-2 coronavirus and the possibility of vertical transmission from mother to child, registered in the PROSPERO website and searched in the PubMed, Scopus, CINAHL, and Cochrane Library databases. Finally, 22 articles were included in the review. The review suggests that vertical transmission from mother to child could be exceptionally possible at the time of delivery or breastfeeding, but not through the placenta. It is interesting to point out the good acceptance of vaccination by pregnant women, which may be the reason for the low infectivity. Further research on pregnant women should be carried out to provide evidence on vertical mother-to-child transmission and the role of breast milk in relation to SARS-CoV-2.

13.
Current Pediatric Reviews ; 18(2):83, 2022.
Article in English | EMBASE | ID: covidwho-2065272
14.
Archives of Disease in Childhood ; 107(Supplement 2):A183, 2022.
Article in English | EMBASE | ID: covidwho-2064026

ABSTRACT

Aims At the time of publication, there was limited evidence on outcomes of breastfeeding mother-child dyads on breastfeeding after COVID-19 vaccination. The aim of this study is to systematically quantify the incidence of local and systemic adverse events in lactating women and their children to allow clinicians to appropriately counsel lactating women on the risks-benefit ratio of WHO-approved COVID-19 vaccinations. Methods A cross sectional survey was conducted from 14th August 2021 to 5th January 2022 in Singapore and Malaysia. Data including demographic information, maternal and child symptoms, and vaccine history were collected through an online questionnaire. The survey was distributed online through social media and advertisements. Women more than 21 years of age who received at least one dose of the WHOapproved COVID-19 vaccines Pfizer-BioNTech, Moderna, AstraZeneca, Sinovac while pregnant or lactating were eligible for the survey. Results Responses of 2043 breastfeeding mothers were analysed. 1747 mothers received mRNA vaccines and 296 mothers received non-mRNA vaccines. Overall in terms of maternal reactogenicity, 79.3% and 79.5% of mothers reported any reactions to the first and second dose respectively, primarily local reactions (64.1% dose 1, 57.0% dose 2). 91.8% of mothers breastfed their child uninterrupted after receiving the COVID-19 vaccination. 89.2% of breastfed infants had no symptoms reported following maternal COVID-19 vaccination. More than half (54.8%) of lactating respondents reported no change in milk supply or production. Among those experiencing changes in lactation, symptoms lasted for an average of 4.2 +/- 6.9 days. Conclusion Our findings suggest that the vaccine resulted in minimal disruption of lactation or adverse impact on the breastfed child in mothers receiving COVID-19 vaccination. Breastfeeding mothers may experience a change in breast milk supply when receiving COVID-19 vaccinations, which may be mitigated by proactive measures to ensure adequate rest and hydration. There is minimal severe reactogenicity with COVID-19 vaccination in lactating motherchild dyads.

15.
Clinical Toxicology ; 60(Supplement 2):112, 2022.
Article in English | EMBASE | ID: covidwho-2062725

ABSTRACT

Background: More and more, young children are victims of the ongoing epidemic of opioid use disorder. Xylazine, an alpha-2 adrenergic agonist with notorious use as a veterinary tranquilizer, is an increasingly encountered component of the illicit opioid supply in the US, but has been rarely documented in biological samples obtained from children. We report a 19-day-old infant with classic manifestations of central nervous system and respiratory depression associated with fentanyl and xylazine poisoning. Case report: A 19-day-old boy was taken to the emergency department (ED) by his parents for episodes of straining, breathholding, and his eyes rolling backwards. The formula-fed boy was born of an uncomplicated full-term spontaneous vaginal delivery and had previously been thriving. During ED triage assessment he had a period of apnea, then bradypnea, with pulse-oximetric oxygen saturation drop to 55%. He was supported with stimulation and supplemental oxygen via nonrebreather mask but remained lethargic, with temperature 96F, heart rate 166/min, and brisk capillary refill. Point of care blood dextrose testing was 88mg/dL. Analysis of respiratory secretions for common viruses by polymerase chain reaction was negative for respiratory syncytial virus, influenza, or SARS-CoV-2. Computed tomography imaging of the brain was unremarkable. A urine drug immunoassay (Vitros 4600 Chemistry , Ortho- Clinical Diagnostics) resulted positive for fentanyl (cutoff 1 ng/ mL), but negative for amphetamine, barbiturate, benzodiazepine, cannabinoids, cocaine, heroin, morphine, buprenorphine, methadone, or oxycodone. Liquid chromatography tandem mass spectroscopy analysis of the urine confirmed the presence of fentanyl (25 ng/mL) and norfentanyl (245 ng/mL). Gas chromatography with mass spectrometry also detected the presence of xylazine (qualitative result based on spectra matching). Over the ensuing hours the boy recovered fully and the family was connected with child protection services;an exposure route was not identified. Discussion(s): This 19-day-old infant suffered fentanyl/xylazine poisoning. The infant's age and urine fentanyl concentrations exclude pre-natal exposure as an explanation for the drug test findings, and the baby was bottle-fed excluding drug transmission through breast milk. Xylazine has been known to be in this hospital's regional heroin supply since the early 2000s, and in 2019 xylazine was implicated in more than 31% of opioid-associated deaths at the city's medical examiner's office. In 2022, many fentanyl samples tested by regional law enforcement find more xylazine than fentanyl. Until recently, xylazine was an uncommon finding in our testing of pediatric opioid poisoning victims. Similar to fentanyl, xylazine may cause pupillary miosis and CNS depression;unfortunately it may be resistant to reversal with naloxone. Conclusion(s): This case is remarkable for the young age of this infant ill from post-natal fentanyl poisoning and for the detection of xylazine in his urine. Healthcare providers may not immediately consider opioid poisoning in the differential diagnosis of infants with altered mental status, and proper toxicological testing is important for appropriate child protection support. Detection of xylazine is a marker for a non-medical, or "street," source of fentanyl.

16.
Clin Perinatol ; 49(1): 73-92, 2022 03.
Article in English | MEDLINE | ID: covidwho-2049039

ABSTRACT

Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can present with or without symptoms at the time of birth. Symptomatic mothers are more likely be associated with preterm births. Population studies demonstrate a consistent association of SARS-CoV-2 infection and a reduction in preterm birth rate. Newborns with positive SARS-CoV-2 test results appear to have minimal burden of illness that is directly associated with a viral infection. Neonatal mortality directly related to SARS-CoV-2 is extremely rare. Maternal vaccination in pregnant women leads to maternal antibody production, and this can occur as early as 5 days after the first vaccination dose.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Premature Birth , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , SARS-CoV-2
17.
Front Immunol ; 13: 985226, 2022.
Article in English | MEDLINE | ID: covidwho-2043450

ABSTRACT

Background: Given that only 25% of pregnant women elect to receive a COVID-19 vaccine, maternal SARS-CoV-2 infection remains an important route of conferring protective passive immunity to breastfed infants of mothers who are not vaccinated. Methods: We enrolled 30 lactating participants between December 2020 and March 2021 who had a positive PCR-test and their first COVID-19 symptoms within the previous 21 days. Participants were asked to provide serial bilateral milk samples at 12 timepoints (~ every 3 days) over a period of 35 days. A second set of samples was collected at least four months after the beginning of the first set. Participants also were asked to provide their dried blood spots and infant stool samples. All samples were tested for receptor-binding domain (RBD)-specific immunoglobulin (Ig)A, IgG, and IgM. Milk samples were assessed for neutralizing ability against the spike protein and four SARS-CoV-2 variants: D614G, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1). Permeability of the breast epithelium was assessed by measuring the sodium to potassium ions (Na:K) in milk. Using flow cytometry, memory CD4 and CD8 T cells (CD45RO+ and CCR7+/-) and mucosal-homing CD4 and CD8 T cells (CD103+) were determined in cells from milk expressed at 35 days and at least 4 months after their first milk donation. Results: Milk antibodies from SARS-CoV-2 positive participants neutralized the spike complex. Milk from 73, 90, and 53% of participants had binding reactivities to RBD-specific IgA, IgG, and IgM, respectively. In contrast to blood spots, which showed increased levels of IgG, but not IgA or IgM, the COVID-19 response in milk was associated with a robust IgA response. Twenty-seven percent of participants had increased breast-epithelium permeability, as indicated by Na:K ≥ 0.6. The percentage of CD45RO+CCR7- effector-memory T cells in the day ≥120 milk samples was significantly higher than day 35 samples (P< 0.05). Conclusions: Antibodies in milk from participants with recent SARS-CoV-2 infection and those who recovered can neutralize the spike complex. For the first time we show that breastmilk T cells are enriched for mucosal memory T cells, further emphasizing the passive protection against SARS-CoV-2 conferred to infants via breastmilk.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19 Vaccines , Female , Humans , Immunoglobulin A , Immunoglobulin G , Immunoglobulin M , Infant , Lactation , Memory T Cells , Milk, Human , Potassium , Pregnancy , Receptors, CCR7 , Sodium , Spike Glycoprotein, Coronavirus
18.
Indian Pediatrics ; 59(5):424-425, 2022.
Article in English | CAB Abstracts | ID: covidwho-2035429

ABSTRACT

Lactating mothers (n=126) residing in Pune, Maharashtra were interviewed to assess the prevalence of stress, rate of exclusive breastfeeding (EBF), and its association with different demographic factors. 75.4% mothers were found to be moderately stressed. Rate of EBF was 62.7%. Moderate stress and testing positive for COVID-19 were significantly negatively associated with EBF (P < 0.001).

20.
Archives of Disease in Childhood ; 107(Suppl 2):A333, 2022.
Article in English | ProQuest Central | ID: covidwho-2019893

ABSTRACT

AimsTo assess the feasibility and acceptability of using trained peer mothers to deliver breastfeeding support to mothers of low-birth-weight (LBW, <2500g) infants in healthcare facilities in rural, western Kenya.MethodsThe study was conducted in Homa Bay County. Seventeen peer mothers attended a 4-day training programme that focussed on communication skills, breastfeeding support, Kangaroo Mother Care, hygiene and identification of danger signs. Competency-based scenarios were used to select the 10 (59%) peer mothers, who delivered the interventions to the mother-LBW infant pairs (<28 post-delivery) across 8 healthcare facilities in Homa Bay County. A mixed methods approach was employed using structured observations and post-intervention semi-structured interviews with mothers, healthcare providers and peer mothers. Descriptive statistics were used to analyse the quantitative data. A thematic framework was used to analyse the qualitative data.ResultsFrom September-November 2021, 23 mother-LBW infant pairs (3 sets of twins so 26 infants) were recruited and received the intervention. The median maternal age was 25 years (Interquartile range, IQR 22, 29) and all infants were born in hospital. The median age of the infants was 1 day (IQR 1,3), median birth weight 2100g (IQR 1900, 2260) and median gestation was 34 weeks (IQR 34,36). Although all the mothers who received the intervention looked well, worryingly 4 (17%) showed no signs for bonding with the infant. Peer mothers consistently explored mothers’ wellbeing (25, 100%), positioning on the breast (21, 87%) and supported mothers with expressing breast milk but were less consistent with supporting and observing infant breast attachment (15, 63%) and suckling (13, 54%) during feeds. Only one infant was noted to be too weak to suckle and was referred to the health care providers. Key themes from the interviews were the promotion of resilience in infant feeding decision making among mothers, against community misconceptions of practices such as expressing breast milk;and the enhancement of positive interactions between mothers, peer mothers and health care providers in the context of healthcare facility restrictions on visitors due to COVID-19 and staff shortages. Insufficient breastmilk was a recurrent theme sometimes attributed to poor maternal diet.ConclusionFacility-based breastfeeding peer support for mothers of LBW infants has the potential to improve uptake of appropriate infant feeding practices and their post-discharge survival and growth outcomes in rural communities in Kenya. These preliminary data, including the observed implementation challenges will be used to inform the design of a future trial to rigorously evaluate this potentially sustainable approach to addressing adverse post discharge outcomes of these vulnerable infants.

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