The global COVID‐19 pandemic has been associated with high rates of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission, morbidity and mortality in the general population. Evidence‐based guidance on caring for babies born to mothers with COVID‐19 is needed. There is currently insufficient evidence to suggest vertical transmission between mothers and their newborn infants. However, transmission can happen after birth from mothers or other carers. Based on the currently available data, prolonged skin‐to‐skin contact and early and exclusive breastfeeding remain the best strategies to reduce the risks of morbidity and mortality for both the mother with COVID‐19 and her baby.

Background: Since 1979, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have recommended the use of pasteurized human milk from a human milk bank (HMB) to feed low birthweight (LBW) and preterm newborns as the ‘first alternative’ when mothers are unable to provide their own milk. However, they have not issued any guidelines for the safe establishment and operation of an HMB. This gap contributes to the demand for gathering experiences from HMB networks, especially those from lower-middle income countries. To fill this knowledge gap, this study examines the characteristics of donors, donation, pasteurization, and recipients during the first four years of operation in the first HMB in Vietnam. Methods: Data about the donors, donation, pasteurization, and recipients were extracted from the web-based electronic monitoring system of the HMB from 1 February 2017 to 31 January 2021. Results: In the first four years of operation there were 433 donors who donated 7642 L of milk (66% from the community) with an increased trend in the amount of donated milk, donation duration, and average amount of milk donated by a donor. Approximately 98% of the donated milk was pasteurized, and 82% passed both pre- and post-pasteurization tests. Although the pass rate tended to increase with time, a few dips occurred. Of 16,235 newborns who received pasteurized donor milk, two thirds were in the postnatal wards. The main reason for the prescription of pasteurized donor milk was insufficient mothers’ own milk in the first few days after birth. There was a decreased trend in the amount and duration of using pasteurized donor milk in both postnatal wards and the neonatal unit. Conclusions: The HMB has operated efficiently in the previous four years, even during the COVID-19 pandemic, to serve vulnerable newborns. Ongoing evidence-based adjustments helped to improve the operation to recruit suitable donors, to increase the access to and quality of raw donor milk, to improve the pasteurization process, and to meet the need of more newborns.

BackgroundTo improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction.MethodsMaternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics.FindingsA total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59).ConclusionThe EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.