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.

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Background The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). Methods This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil’s federal law recommendations. Results The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment’s health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. Conclusions In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.

Todas as mães devem ser encorajadas a oferecer seu próprio leite para seus filhos. Apesar do advento das fórmulas infantis, nenhuma dessas se equipara ao leite humano. O leite humano possui inúmeras vantagens: aspectos higiênicos, imunológicos, psico-sociais e cognitivo, bem como aquelas relativas à prevenção de doenças futuras; devem ser consideradas ainda as vantagens econômicas provenientes do menor custo e do efeito anticoncepcional, bem como os benefícios do aleitamento sobre o organismo materno. O leite humano possui uma composição nutricional balanceada em termos de proteínas, carboidratos e gorduras, promovendo crescimento e desenvolvimento adequados. Por isto, aalimentação de recém-nascidos e lactentes com o leite de suas próprias mães é recomendado durante dois primeiros anos de vida.

The results suggest a similar effect of the 3 types of treatment upon newborn glycemia. The correlation analysis suggests that isradipine could have effects upon newborn glycemia only after birth (correlation only in umbilical cord blood), whereas atenolol could act earlier (there was no correlation at any moment). The results also point to the need for glycemic control from the first hour postpartum of newborns of hypertensive mothers whether they have or have not undergone treatment with antihypertensive drugs.

Background: Recommended by the World Health Organization, exclusive breastfeeding is a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the severe acute respiratory syndrome coronavirus 2. Despite the Brazilian national Guideline protecting breastfeeding practice, there are many concerns about protecting babies from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). Methods: This is a descriptive cross-sectional and multicenter study collecting data from 24 Brazilian hospitals and maternity services from March to July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, Baby-Friendly Hospital Initiative, and Brazil’s federal law recommendations.Results: The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact and companions for the mother and did not support mothers to initiate breastfeeding in the first hour. In rooming-in, 98.5% of the services allowed breastfeeding and recommend care for babies following the respiratory hygiene practices to prevent transmission of COVID-19 and whether companions are forbidden (83.3%). Hospital discharge was mostly early (79.1%); the guidelines were not individualized. Additionally, a lack of support was noticed from the health community network in the home environment (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). Conclusions: In Brazil, the hospitals are not able to approach recommendations to protect, promote, and support breastfeeding properly during the COVID-19 outbreak. The scientific community needs to discuss how to improve maternal and baby care services to protect breastfeeding in the current pandemic.

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