Breast milk feeding (BMF) is associated with lower neonatal morbidity in the very preterm infant (<32 weeks gestation) and breastfeeding is beneficial for maternal health. Previous studies show large variations in BMF after very preterm birth and recognize the need for targeted breastfeeding support in the neonatal intensive care units (NICU). In a European collaboration project about evidence-based practices after very preterm birth, we examined the association between maternal, obstetric, and infant clinical factors; neonatal and maternal care unit policies; and BMF at discharge from the NICU. In multivariable analyses, covariates associated with feeding at discharge were first investigated as predictors of any BMF and in further analysis as predictors of exclusive or partial BMF. Overall, 58% (3,826/6,592) of the infants received any BMF at discharge, but there were large variations between regions (range 36-80%). Primiparity, administration of antenatal corticosteroids, first enteral feed <24 hr after birth, and mother's own milk at first enteral feed were predictors positively associated with any BMF at discharge. Vaginal delivery, singleton birth, and receiving mother's own milk at first enteral feed were associated with exclusive BMF at discharge. Units with a Baby Friendly Hospital accreditation improved any BMF at discharge; units with protocols for BMF and units using donor milk had higher rates of exclusive BMF at discharge. This study suggests that there is a high potential for improving BMF through policies and support in the NICU.

Breastfeeding confers multiple benefits for the health and development of very preterm infants, but there is scarce information on the duration of breastfeeding after discharge from the neonatal intensive care unit (NICU). We used data from the Effective Perinatal Intensive Care in Europe population-based cohort of births below 32 weeks of gestation in 11 European countries in 2011-2012 to investigate breastfeeding continuation until 6 months. Clinical and sociodemographic characteristics were collected from obstetric and neonatal medical records as well as parental questionnaires at 2 years of corrected age. Among 3,217 ever-breastfed infants, 34% were breastfeeding at 6 months of age (range across countries from 25% to 56%); younger and less educated mothers were more likely to stop before 6 months (adjusted relative risk [aRR] <25 years: 0.68, 95% CI [0.53, 0.88], vs. 25-34 years; lower secondary: 0.58, 95% CI [0.45, 0.76] vs. postgraduate education). Multiple birth, bronchopulmonary dysplasia (BPD), and several neonatal transfers reduced the probability of continuation but not low gestational age, fetal growth restriction, congenital anomalies, or severe neonatal morbidities. Among infants breastfeeding at discharge, mixed versus exclusive breast milk feeding at discharge was associated with stopping before 6 months: aRR = 0.60, 95% CI [0.48, 0.74]. Low breastfeeding continuation rates in this high-risk population call for more support to breastfeeding mothers during and after the neonatal hospitalization, especially for families with low socio-economic status, multiples, and infants with BPD. Promotion of exclusive breastfeeding in the NICU may constitute a lever for improving breastfeeding continuation after discharge.

Objective To synthesise what is known about the parents' views on factors that help or hinder breast milk supply during their infants' hospitalisation in neonatal intensive care units (NICU). Methods A systematic search of PubMed, ISI WoK, PsycINFO and SciELO, targeting studies presenting original empirical data that examined parents' perspectives regarding breast milk supply experiences in NICU, was performed. Based on content analysis, three independent researchers synthesised the findings of seven studies. Categories of facilitators and barriers were identified using quotations stated in the studies: parents' breast milk supply experience; parents-professionals relationships; characteristics of the NICU; and parents' social background and expectations. Results The studies, five qualitative and two mixed methods, were published between 1994 and 2011. With heterogeneous study designs, fathers' perspectives were analysed in one article. Only one study defined breastfeeding. According to parents' perspectives, successful breast milk supply in NICU depends on coherent and accurate knowledge about its techniques and benefits, reinforcement of mothers' motivation and alignment between NICU's routines and parents' needs. Parents perceived issues related to their own current breast milk supply experience, simultaneously, as main facilitators and barriers. Parents-professionals relationship constituted the second group of facilitators, but the fourth of barriers. The characteristics of the NICU were more relevant as a barrier than as a facilitator. Conclusions Although parents' perspectives are grounded on individual child-focused experiences, their emphasis on learning and motivation guided by shortterm goals opens room to the collective intervention of experts. This may facilitate the engagement of mothers, fathers and health professionals on family-centred care.

26Background: The COVID-19 pandemic is an emerging concern regarding the potential 27 adverse effects during pregnancy. This study reviews knowledge on the impact of 28 COVID-19 on pregnancy and describes the outcome of published cases of pregnant 29 women diagnosed with Methods: Searches were conducted in PubMed® up to 8 April 2020, using PRISMA 31 standards, to identify original published studies describing pregnant women at any 32 gestational age diagnosed COVID-19. There were no date or language restrictions on the 33 search. All identified studies were included irrespective of assumptions on study quality. 34 Results: We identified 30 original studies reporting 212 cases of pregnant women with 35 COVID-19 (30 discharged while pregnant), 200 from China and 12 from other countries. 36The 182 published deliveries resulted in one stillbirth and 185 live births. Four women 37 with severe COVID-19 required admission to an intensive care unit but no cases of 38 maternal death were reported. There was one neonatal death. Preterm births occurred in 39 28.7% of cases, but it is unclear whether this was iatrogenic. All cases with amniotic fluid, 40 placenta, and/or cord blood analyzed for the SARS-CoV-2 virus were negative. Four 41 newborns were positive for SARS-CoV-2 and three newborns had high levels of IgM 42 antibodies. Breast milk samples from 13 mothers and described in seven studies showed 43 no evidence of SARS-CoV-2. 44 Conclusion: The evidence related to the effect of COVID-19 on pregnant women is still 45 limited. Pregnant women and newborns should be considered particularly vulnerable 46 populations regarding COVID-19 prevention and management strategies.47 48 Wuhan, China, 1 and can present from asymptomatic to a severe acute respiratory infection 55 requiring intensive care. 2, 3 The infection can occur at any age, but COVID-19 is 56 proportionally uncommon in children (<1% of the total cases). The infection fatality rate 57 is around 1% but much higher in older people or those with pre-existing medical 58 conditions (such as heart disease, diabetes, COPD). 2, 4 59Person-to-person transmission of COVID-19 is well established and can occur when an 60 infected person coughs, sneezes or speaks and scattered droplets are inhaled or reach the 61 mucous membranes of the mouth, nose or eyes of susceptible. COVID-19 can also be 62 transmitted through direct hand contact with surfaces or objects contaminated with 63 SARS-CoV-2 followed by contact with the mouth, nose or eyes. 2 64Pregnant women and newborns receive special attention and there is an emerging concern 65 with the potential risk of SARS-COV-2 vertical transmission (from mother to fetus) or 66 associated malformations, and contagion during delivery and breastfeeding; likewise, it 67 is important to determine the potential adverse effects of COVID-19 in pregnant women. 5-68 8 However, in general, the available information remains scarce. 312The authors are grateful to the health professionals who provided and confirmed the cases 313 of pregnant women ...

Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19.Methods: Searches were conducted in PubMed®, Scopus®, Web of Science®, and MedRxiv® up to 26th June 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality.Results: We identified 161 original studies reporting 3,985 cases of pregnant women with COVID-19 (1,007 discharged while pregnant). The 2,059 published cases with pregnancy outcomes resulted in 42 abortions, 21 stillbirths, and 2,015 live births. Preterm birth occurred in 23% of cases. Around 6% of pregnant women required admission to an intensive care unit and 28 died. There were 10 neonatal deaths. From the 163 cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus, 10 were positive. Sixty-one newborns were positive for SARS-CoV-2. Four breast milk samples from 92 cases showed evidence of SARS-CoV-2.Conclusion: Emerging evidence suggests that vertical transmission is possible, however, there is still a limited number of reported cases with intrapartum samples. Information, counseling and adequate monitoring are essential to prevent and manage adverse effects of SARS-CoV-2 infection during pregnancy.

The duration of breast milk feeding among Portuguese very preterm infants was shorter than recommended. However, this appears to be common globally. Research is needed to inform strategies to promote continued breast milk feeding.

Aim To (1) determine the proportion of 5‐year‐old children born extremely preterm (EPT) with movement difficulties including cerebral palsy (CP) and the proportion of these children receiving motor‐related health care (MRHC), and (2) describe factors associated with receiving MRHC. Method Children born before 28 weeks’ gestation in 2011 to 2012 in 11 European countries were assessed with the Movement Assessment Battery for Children, Second Edition (MABC‐2) at 5 years of age. Information on family characteristics, child health including CP diagnosis, and health care use were collected using parent‐report questionnaires. MRHC was defined as visits in the previous year with health care providers (physical and occupational therapists) specialized in assessing/treating motor problems. We analysed receipt of MRHC and associated factors among children at risk of movement difficulties (MABC‐2 score 6th–15th centiles), with significant movement difficulties (SMD; ≤5th centile) or with CP. Results Of 807 children assessed at 5 years 7 months (SD 4 months; 4 years 7 months–7 years 1 month), 412 were males (51.1%), 170 (21.1%) were at risk of movement difficulties, 201 (24.9%) had SMD, and 92 (11.4%) had CP. Those who received MRHC comprised 89.1% of children with CP, 42.8% with SMD, and 25.9% at risk of movement difficulties. MRHC for children with SMD varied from 23.3% to 66.7% between countries. Children were more likely to receive MRHC if they had other developmental problems or socioemotional, conduct, or attention difficulties. Interpretation Efforts are needed to increase MRHC for 5‐year‐old children born EPT with movement difficulties. What this paper adds Children born extremely preterm without cerebral palsy frequently experienced motor difficulties. Most of these children were not receiving motor‐related health care (MRHC). Large geographical differences throughout Europe were observed in receipt of MRHC. Socioemotional problems were related to MRHC use.

Unit policies promoting parental presence and involvement in care may increase the likelihood of successful breastfeeding at discharge for very preterm infants.