An initiative to evaluate the safety of maternal bonding in patients with SARS-CoV-2 infection

Abstract

Background: In the last two decades, the world faced three epidemics caused by novel coronaviruses, namely, SARS-CoV in 2002, MERS-CoV in 2012, and the ongoing SARS-CoV-2 that started in late 2019. Despite a growing understanding of SARS-CoV-2 virology, epidemiology, and clinical management strategies, other aspects, such as mode of delivery, vertical transmission, and maternal bonding, remain controversial. The question we faced upon the decision to separate the neonates of SARS-CoV-2 positive mother is whether we follow the principle of "do no harm"? Methods: This is a quality improvement project that analyzed all cases of SARS-CoV-2 positive pregnancies that delivered at a major health care system from March 1, 2020 to June, 1 2020. The article was prepared following Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. Data were prospectively collected and entered into the Research Electronic Data Capture (REDCap). Maternal bonding was defined by events such as rooming-in, skin to skin contact (STSC), and breastfeeding. Descriptive analysis was performed using the same software platform. Intervention: We compared neonatal transmission rates between those neonates who experienced bonding versus those who were separated. Results: A total of 1989 women were screened for SARS-CoV-2, from which 86 tested positive. Out of 31 analyzed pregnancies, five women (16%) were admitted to ICU and required mechanical ventilation. From the remaining 26 (84%), 17 (65%) opted for rooming-in, 12 (46%) for STSC, and 16 (61%) fed the infants with breastmilk (11 direct breastfeedings and five pumped the breast milk). All neonatal tests for SARS-CoV-2 returned negative. Conclusion:Our results have illustrated that maternal bonding appears safe in neonates born to mothers that are SARS-CoV-2 positive.

COVID-19: Problemas e cuidados no parto, no nascimento e no pós-parto / COVID-19: Problems and care in childbirth, birth and postpartum

“…A persistência de um teste positivo em amostras subsequentes é crítica para diferenciar se há contaminação superficial (resultando em um teste falso-positivo) ou infecção neonatal real. Se realizada, a presença de testes positivos adicionais de tipos de amostras normalmente estéreis (por exemplo, sangue neonatal, amostras do trato respiratório inferior, líquido cefalorraquidiano) também permite a diferenciação de contaminação de infecção neonatal 14 .…”

Recomendações para amamentação no contexto do Covid-19: uma revisão integrativa

“…É necessário que os profissionais junto com os veículos de comunicações atuem orientando essas pacientes sobre todos os cuidados que devem ser instituídos nesse período, com estímulo ao vínculo entre mãe e bebê. Uma pesquisa realizada nos Estados Unidos da América apoia o estímulo ao vínculo da mãe com o recém-nascido (RN) através do alojamento conjunto, com contato pele a pele e incentivo à amamentação (COJOCARU L, et al, 2020;NG QJ, et al, 2020) Estabelecimentos que apoiam adoção de medidas que estimulam o maior contato mãe e bebê tem maiores benefícios, pois ao separar o binômio é gerada uma cascata de efeitos prejudiciais, tais como: estresse materno e fetal, interrupção da fisiologia neonatal, além da ansiedade materna. Dentre os benefícios do manejo conjunto de mães e RNs está o início precoce da amamentação e sua continuidade, além do aumento da confiança materna e proteção contra o estresse relacionado à mudança do papel dos pais para algumas mães (COJOCARU L, et al, 2020).…”

A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19

“…In a large American cohort, perinatal COVID-19 infection was estimated at 2.6% [108]. Most studies, however, report an infrequency of neonatal SARS-CoV-2 infection at birth or thereafter despite maternal infection of varying severity [1-3, 13, 16, 19, 20, 188,191,193,196,197,213,222,228,[237][238][239][240][241][242][243][244]. The latter has also been evident despite some newborn exposure to maternal breastfeeding [82,118,127,136,241].…”

“…The latter has also been evident despite some newborn exposure to maternal breastfeeding [82,118,127,136,241]. In a small series, Cojocaro et al did not find newborn infection regardless of whether infants were bonded with mothers after birth [244]. Apart from respiratory specimens, these newborns have at times been sampled for meconium, gastric aspirates, cord blood, urine, and feces.…”