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Int Breastfeed J ; 17(1): 8, 2022 01 15.
Article in English | MEDLINE | ID: covidwho-1633794


BACKGROUND: Breastmilk hand expression (BMHE) is recommended to promote lactation, relieve breast engorgement, and collect milk for future infant feedings. Resources to teach this skill are limited and infrequently developed in partnership with the obstetrical population. In collaboration with maternity care experts and individuals with recent breastfeeding experience, we designed a one-page toolkit that describes the process of BMHE and includes step-by-step instructions and images to illustrate the technique. This study aimed to evaluate the readability, clarity of content, layout, and informational value of this BMHE toolkit. METHODS: Individuals who intended to breastfeed, were currently breastfeeding, or had recently breastfed were electronically surveyed and completed a two-part survey that consisted of radio, multi-select, Likert scale, and open-ended questions. Part one captured sociodemographic factors, obstetrical history, and breastfeeding practices. Part two collected feedback on the BMHE toolkit. Participants were recruited electronically through social media and posters were circulated in antenatal and postnatal care settings in Ottawa, Canada between November 2020 and February 2021. RESULTS: Of the 123 participants, 117 (95.1%) had heard of hand expression prior to reviewing the toolkit and 99 (80.5%) had hand expressed before. Among the 48 participants who were no longer exclusively breastfeeding at the time of the survey, 22 (45.8%) had exclusively breastfed their infant for at least six months and 7 (14.6%) had discontinued exclusive breastfeeding within the first month. When asked about the BMHE toolkit, 118 (95.9%) participants said it was informative, 115 (93.5%) said it was easy to understand, and 114 (92.7%) said it was well laid-out. When asked about information seeking behaviours, participants indicated a preference for online resources (58.5%) and video resources (22.0%). CONCLUSIONS: The BMHE toolkit was well received by participants and the feedback was favourable overall. The survey feedback will be used to create a revised version of the toolkit that has been validated by the obstetrical patient population. Future research should focus on identifying implementation strategies to optimize the use of the toolkit and increase its effectiveness as an educational resource to teach participants correctly BMHE.

Breast Milk Expression , Maternal Health Services , Breast Feeding , Female , Humans , Infant , Lactation , Milk, Human , Pregnancy
Pediatrics ; 146(6)2020 12.
Article in English | MEDLINE | ID: covidwho-742565


There are increasing concerns regarding coronavirus disease, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approaches to breastfeeding and the management of neonates born to pauci-symptomatic mothers with coronavirus disease vary worldwide, although some scientific societies across Europe and the United States have emphasized the benefits of breastfeeding, even with expressed breast milk. Because SARS-CoV-2 has been, thus far, only exceptionally detected in breast milk, the risk of disease transmission has remained hypothetical.We herein report the case of a healthy preterm newborn who was inadvertently fed SARS-CoV-2-positive breast milk. Two different samples, collected with and without strict hygiene precautions, were both confirmed to be SARS-CoV-2 positive. However, the newborn was not infected, supporting the protective role of breast milk. Furthermore, in this report, we highlight the difficulties in the practical management of a neonate whose breastfeeding mother was confirmed as positive for SARS-CoV-2 after delivery.

Breast Milk Expression , COVID-19/diagnosis , Milk, Human/virology , SARS-CoV-2/isolation & purification , Adult , Breast Feeding , COVID-19 Nucleic Acid Testing , COVID-19 Testing/methods , Female , Humans , Infant, Newborn , Infant, Premature , Pregnancy , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , Tissue Donors
Breastfeed Med ; 15(8): 492-494, 2020 08.
Article in English | MEDLINE | ID: covidwho-639739


Aim: The objective of our study was to determine whether the SARS-CoV-2-positive mothers transmit the virus to their hand-expressed colostrum. Methods: This is an observational prospective study that included pregnant women who tested positive for SARS-CoV-2 by PCR test on a nasopharyngeal swab at the moment of childbirth and who wanted to breastfeed their newborns. A colostrum sample was obtained from the mothers by manual self-extraction. To collect the samples, the mothers wore surgical masks, washed their hands with an 85% alcohol-based gel, and washed their breast with gauze that was saturated with soap and water. Results: We obtained seven colostrum samples from different mothers in the first hours postdelivery. SARS-CoV-2 was not detected in any of the colostrum samples obtained in our study. Conclusion: In our study, breast milk was not a source of SARS-CoV-2 transmission. Hand expression (assuring that a mask is used and that appropriate hygienic measures are used for the hands and the breast), when direct breastfeeding is not possible, appears to be a safe way of feeding newborns of mothers with COVID-19.

Betacoronavirus/isolation & purification , Breast Feeding/methods , Breast Milk Expression/methods , Colostrum/virology , Coronavirus Infections , Milk, Human/virology , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Adult , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Communicable Disease Control/methods , Communicable Disease Control/standards , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Male , Neonatal Screening/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , SARS-CoV-2 , Spain/epidemiology
Rev Assoc Med Bras (1992) ; 66(4): 541-546, 2020.
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-613696


SUMMARY OBJECTIVE These recommendations aim to provide guidance on breastfeeding for mothers with suspected or confirmed Covid-19. METHODS We performed a review of the recent medical literature on breastfeeding mothers with suspected or confirmed Covid-19, focusing on the neonatal period. RESULTS We analyzed 20 recent publications on breastfeeding, Covid-19, and its transmission through breastmilk. We presented possible options for breastfeeding and their consequences for the mother and the child. CONCLUSION All maternal decisions in relation to breastfeeding are justifiable since the infection by Covid-19 is still poorly known. However, puerperal women and their families must be very well informed to make a conscious choice based on the information available in the literature so far.

RESUMO OBJETIVO Estas recomendações têm como objetivo orientar o aleitamento materno de mães com Covid-19 suspeita ou confirmada. MÉTODO Foi realizada revisão da literatura médica recente sobre aleitamento materno de mães com Covid-19 suspeita ou confirmada, focando o período neonatal. RESULTADOS Foram analisadas 20 publicações recentes sobre aleitamento materno, Covid-19 e sua transmissão pelo leite. Foram apresentadas as possíveis opções maternas em relação ao aleitamento e suas consequências para o binômio mãe-filho. CONCLUSÃO Todas as opções maternas em relação à amamentação são justificáveis, porque a infecção por Covid-19 ainda é pouco conhecida. Porém, as puérperas e seus familiares devem ser muito bem orientados, realizando uma opção consciente e baseada nas informações disponíveis na literatura até o momento.

Humans , Female , Pneumonia, Viral/transmission , Breast Feeding/adverse effects , Breast Feeding/psychology , Coronavirus Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Pneumonia, Viral/prevention & control , Health Knowledge, Attitudes, Practice , Practice Guidelines as Topic , Coronavirus Infections , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Breast Milk Expression , Betacoronavirus , Mothers/psychology
BJOG ; 127(11): 1324-1336, 2020 10.
Article in English | MEDLINE | ID: covidwho-596386


BACKGROUND: Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified? OBJECTIVE: To estimate the risk of the neonate becoming infected with SARS-CoV-2 by mode of delivery, type of infant feeding and mother-infant interaction. SEARCH STRATEGY: Two biomedical databases were searched between September 2019 and June 2020. SELECTION CRITERIA: Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported. DATA COLLECTION AND ANALYSIS: Data were extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission. MAIN RESULTS: Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated. CONCLUSIONS: Neonatal COVID-19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother. TWEETABLE ABSTRACT: Risk of neonatal infection with COVID-19 by delivery route, infant feeding and mother-baby interaction.

Bottle Feeding/statistics & numerical data , Breast Feeding/statistics & numerical data , Cesarean Section/statistics & numerical data , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Infant Formula , Infectious Disease Transmission, Vertical/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pregnancy Complications, Infectious/epidemiology , Betacoronavirus , Breast Milk Expression , COVID-19 , China/epidemiology , Delivery, Obstetric/statistics & numerical data , Female , Humans , Infant, Newborn , Milk, Human , Mother-Child Relations , Pandemics , Pregnancy , Risk Factors , SARS-CoV-2
Curr Probl Pediatr Adolesc Health Care ; 50(4): 100795, 2020 04.
Article in English | MEDLINE | ID: covidwho-260604


In January 2020, China reported a cluster of cases of pneumonia associated with a novel pathogenic coronavirus provisionally named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). Since then, Coronavirus Disease 2019 (COVID-19) has been reported in more than 180 countries with approximately 6.5 million known infections and more than 380,000 deaths attributed to this disease as of June 3rd , 2020 (Johns Hopkins University COVID map; The majority of confirmed COVID-19 cases have been reported in adults, especially older individuals with co-morbidities. Children have had a relatively lower rate and a less serious course of infection as reported in the literature to date. One of the most vulnerable pediatric patient populations is cared for in the neonatal intensive care unit. There is limited data on the effect of COVID-19 in fetal life, and among neonates after birth. Therefore there is an urgent need for proactive preparation, and planning to combat COVID-19, as well as to safeguard patients, their families, and healthcare personnel. This review article is based on the Centers for Disease Control and Prevention's (CDC) current recommendations for COVID-19 and its adaptation to our local resources. The aim of this article is to provide basic consolidated guidance and checklists to clinicians in the neonatal intensive care units in key aspects of preparation needed to counter exposure or infection with COVID-19. We anticipate that CDC will continue to update their guidelines regarding COVID-19 as the situation evolves, and we recommend monitoring CDC's updates for the most current information.

Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Guideline Adherence , Infection Control/organization & administration , Intensive Care Units, Neonatal/organization & administration , Maternal-Child Health Services , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Pregnancy Complications, Infectious/virology , Adult , Breast Feeding , Breast Milk Expression , COVID-19 , Civil Defense , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Delivery Rooms , Female , Hand Hygiene/standards , Health Knowledge, Attitudes, Practice , Hospitals, Urban , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Interdisciplinary Communication , Maternal-Child Health Services/organization & administration , New York City/epidemiology , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , SARS-CoV-2 , Visitors to Patients