Baby Friendly Hospital Initiative Breastfeeding Outcomes in Mothers with COVID-19 Infection During the First Weeks of the Pandemic in Spain

Abstract

Background: Adherence to the Ten Steps of the Baby-Friendly Hospital Initiative has been shown to have a protective role for the initiation and maintenance of breastfeeding. Research Aims: (1) To determine the breastfeeding rate during the first 6 months of life in children of mothers diagnosed with COVID-19 infection at the time of birth; and (2) to assess the possible influence of being born in a center with Baby-Friendly Hospital Initiative accreditation. Methods: This was a two-group comparative longitudinal observational study of infants born to mothers with COVID-19 at the time of birth, between March 13–May 31, 2020 (the first wave of the pandemic) in Spain. Fourteen Spanish hospitals participated, five (35.7%) were Baby-Friendly Hospital Initiative accredited. Type of feeding was assessed prospectively at discharge, 1, 3, and 6 months of age. A total of 248 newborns were included in the study. Results: A total of 117 (47.3%) newborns were born in Baby-Friendly Hospital Initiative (BFHI) accredited centers. These centers applied skin-to-skin contact with greater probability ( OR = 1.9; 95% CI [1.18, 3.29]) and separated the newborns from their mothers less frequently ( OR = 0.46; 95% CI [0.26, 0.81]) than non-accredited centers. No differences were observed in relation to the presence of a companion at the time of birth. At discharge, 49.1% ( n = 57) of newborns born in BFHI-accredited centers received exclusive breastfeeding versus 35.3% ( n = 46) in non-accredited centers ( p = .03). No differences were observed in breastfeeding rates throughout follow-up. Conclusions: The exclusive breastfeeding rate at discharge in children of mothers with COVID-19 infection at birth was higher in Baby-Friendly Hospital Initiative accredited centers, which most frequently applied skin-to-skin contact at birth as well as rooming-in.

Breastfeeding rates fell in an Italian baby friendly hospital during the 2020 COVID‐19 pandemic year and difficulties increased

“…However, given the small number of similar studies, we think that our results may still make a useful contribution. The low exclusive breastfeeding rate among the mothers with COVID‐19 in our study (50.0%) confirms the results of other studies 19,20 . Breastfeeding has always been indicated in our hospital, but, having seen the findings by Indrio et al, 21 we hypothesised that the restrictions on skin‐to‐skin contact and rooming‐in may have contributed to reduce breastfeeding in this group.…”

“…The low exclusive breastfeeding rate among the mothers with COVID-19 in our study (50.0%) confirms the results of other studies. 19,20 Breastfeeding has always been indicated in our hospital, but, having seen the findings by Indrio et al, 21 we hypothesised that the restrictions on skin-to-skin contact and rooming-in may have contributed to reduce breastfeeding in this group. The low rates for these practices were similar to those found in other studies.…”

Association of the presence of a COVID-19 infection at the time of birth and the rates of exclusive breastfeeding upon discharge in BFHI hospitals: a multicenter, prospective cohort study

“…To date, in these types of hospitals, there is not enough evidence about the impact that a maternal COVID-19 infection at the time of the birth could have, even more so when the application of measures such as immediate skin-to-skin care or rooming-in have been reinstated after the initial controversy [ 5 , 6 ]. In a study conducted in the first weeks of the pandemic in Spain [ 14 ], the rates of exclusive breastfeeding upon discharge for the newborns of mothers with a COVID-19 infection were 49.1% in BFHI-accredited hospitals versus 35.3% in non-accredited hospitals; figures that are lower than those obtained in our study due, primarily, to the initial difficulty found in adapting the perinatal care measures recommended by the WHO [ 7 ]. Likewise, in three BFHI-accredited hospitals in the first weeks of the pandemic, Popofsky et al observed a reduction in the rates of exclusive breastfeeding in those mothers who had a COVID-19 infection [ 25 ].…”

“…During the first waves of the pandemic and due, on many occasions, to the pressure on healthcare and the reorganization of hospital activities, it became more difficult to comply with perinatal care protocols, even in BFHI-accredited hospital centers [ 14 , 15 ]. This resulted in a reduction in the rates of exclusive breastfeeding upon discharge with figures below the requirements established by the BFHI compared to historical cohorts (prior to COVID-19) [ 14 , 16 – 18 ].…”

“…During the first waves of the pandemic and due, on many occasions, to the pressure on healthcare and the reorganization of hospital activities, it became more difficult to comply with perinatal care protocols, even in BFHI-accredited hospital centers [ 14 , 15 ]. This resulted in a reduction in the rates of exclusive breastfeeding upon discharge with figures below the requirements established by the BFHI compared to historical cohorts (prior to COVID-19) [ 14 , 16 – 18 ]. To date, there have been very few prospective studies conducted that compare the rates of exclusive breastfeeding in mother-infant pairs whose mothers presented with a positive diagnosis for a COVID-19 infection at the time of the birth versus those who did not present with such a diagnosis following the first waves of the pandemic and after changes began at a preventative level with the initiation of vaccination.…”