Clinical outcomes of infants breastfeeding from mothers with COVID-19

1. A small study of Israeli neonates with COVID-19-positive mothers found no transmission of SARS-CoV-2 to the neonates from feeding on unpasteurized maternal breast milk both before and after hospital discharge.

2. The study results also indicate that separation of the neonate from the infectious mother postpartum may not be necessary to reduce risk of infection, as long as proper anti-infectious measures are maintained.

Evidence Rating Level: 2 (Good)

Study Rundown: SARS-CoV-2 has been reported to be minimally capable of transplacental or transvaginal transmission, though its relationship to breastfeeding has been less robustly established to date. A prospective cohort consisting of 55 neonates born to COVID-positive mothers in Israel were screened within 48 hours of delivery and again at least 14 days postpartum for COVID-19. Their mothers’ breastfeeding habits were tracked, and parents were educated on anti-infectious precautions to take at home. Infants were separated from their mothers during the initial hospitalization and fed expressed breastmilk, but mostly (85%) breastfed upon discharge from the hospital. Results of the study revealed no neonatal infections during hospitalization, and that breastfeeding at home did not lead to viral transmission from mother to neonate. These results are corroborated by other, similar studies cited by the authors, and contrasted by others, though they are all limited by their relatively small sample sizes. Collectively, however, the data points to superlative prognoses for breastfeeding neonates born to SARS-CoV-2 positive mothers who perform careful anti-infection control.

Click to read the study in Pediatrics

Click to read an accompanying editorial in Pediatrics

Relevant Reading: Transmission of SARS-CoV-2 through breast milk and breastfeeding: a living systematic review

In-Depth [prospective cohort]: The primary endpoints for this study were to determine whether separation of a neonate from their mother postpartum would reduce risk of infection, and whether breastfeeding is a possible mode of transmission either before or after discharge. Of the 55 babies included in the cohort, the vast majority were born at full term (gestational age mean: 39 ± 1 weeks; gestational age range: 31 + 1/7–41 + 1/7 weeks), with the average birth weight being 3136 g (range: 1290-4000 g). 74.5% of the neonates were fed their mothers’ unpasteurized breastmilk while separated in the hospital, and a total of 85% were breastfed after discharge. In addition to the COVID-19 positive mothers, 40% of the households had additional COVID-19 positive residents. Of the 55 babies included in the study, 60% were retested after 14 days and were found to be COVID-19 negative. Results of the study also indicate that separation of mother from neonate is less integral, and perhaps detrimental, as compared to educating patients in and practicing infection control (hand hygiene, masking, etc.).

Image: PD

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