Summary of recommendations for breastfeeding of infants born to mothers with COVID-19

Article type
Authors
Yang N1, Che S2, Zhang J3, Wang J3, Ma Y1, Wang M4, Chen Y1
1Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation; Cochrane China Network; Chinese GRADE Center
2Children's Hospital of Chongqing Medical University
3School of Public Health, Lanzhou University;Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation; Cochrane China Network; Chinese GRADE Center
4Department of Radiology, the First Hospital of Lanzhou University
Abstract
Background: Breast milk is the best source of nutrition for infants, and numerous studies have shown that breastfeeding has multiple benefits. Cases of COVID-19 among pregnant and lactating women have also been confirmed. Physicians and lactating women need to make decisions whether or not to continue to breastfeed.
Objectives: To review existing recommendations form national or international authorities for breastfeeding of infants born to mothers with COVID-19.
Methods: Two reviewers searched the Medline (via PubMed), EMBASE, Web of Science, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang Data. And also searched the following websites for relevant publications: World Health Organization (WHO), US Center for Disease Control (CDC), China National Health Commission (NHC), Google Scholar from January 1 until Aril 4, 2020. Two reviewers independently screened the titles, abstracts and full-text articles; to identify and extract potentially guidelines.
Results: Overall, ten guidelines from 5 countries and WHO were included in the final review. China NHC guideline recommended the mother with COVID-19 should isolated quarantined and suspend breastfeeding. Three guidelines of China CDC recommended that newborns be kept in isolation, breastfeed with a pasteurized breast from milk bank can be used. One of 2 guideline from US.CDC and the UK Royal College of Obstetricians and Gynaecologists(RCOG) guideline indicated whether and how to start or continue breastfeeding should be determined by the mother and healthcare providers. Another US.CDC guideline, the RCOG guideline, and the 3 guidelines form WHO, Italian Society of Neonatology and German Nationale Stillkommissio recommended continue to breastfeed appropriate precautions(wash hands and wear mask). If their own health not permits, mothers should support to express milk and allow healthy caregivers to breastfeed.
Conclusions: There is no consensus on whether mothers with COVID-19 should continue breastfeeding. The high-quality evidence of from systematic review of breastfeeding for COVID-19 mothers is in need to support recommendations.