Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at Birth

Abstract

Objective To assess the impact of separation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-positive mother-newborn dyads on breastfeeding outcomes. Study design This observational longitudinal cohort study of mothers with SARS-CoV-2 PCR-and their infants at 3 NYU Langone Health hospitals was conducted between March 25, 2020, and May 30, 2020. Mothers were surveyed by telephone regarding predelivery feeding plans, in-hospital feeding, and home feeding of their neonates. Any change prompted an additional question to determine whether this change was due to coronavirus disease-2019 (COVID-19). Results Of the 160 mother-newborn dyads, 103 mothers were reached by telephone, and 85 consented to participate. There was no significant difference in the predelivery feeding plan between the separated and unseparated dyads (P = .268). Higher rates of breastfeeding were observed in the unseparated dyads compared with the separated dyads both in the hospital (P < .001) and at home (P = .012). Only 2 mothers in each group reported expressed breast milk as the hospital feeding source (5.6% of unseparated vs 4.1% of separated). COVID-19 was more commonly cited as the reason for change in the separated group (49.0% vs 16.7%; P < .001). When the dyads were further stratified by symptom status into 4 groups-asymptomatic separated, asymptomatic unseparated, symptomatic separated, and symptomatic unseparated-the results remained unchanged. Conclusions In the setting of COVID-19, separation of mother-newborn dyads impacts breastfeeding outcomes, with lower rates of breastfeeding both during hospitalization and at home following discharge compared with unseparated mothers and infants. No evidence of vertical transmission was observed; 1 case of postnatal transmission occurred from an unmasked symptomatic mother who held her infant at birth.

Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020

“…During a 5-week period (July 15–August 20) when many areas of the country were experiencing substantial community transmission of SARS-CoV-2, hospitals were implementing a variety of practices intended to balance evidence-based maternity care with COVID-19-related IPC. Hospital practices are likely evolving along with the pandemic ( 7 ), potentially driven by multiple factors, including level of community transmission, guidance from public health and medical professional organizations, and a hospital’s own experience in preparation for or caring for pregnant women and newborns with COVID-19.…”

“…One third of hospitals in this study reported not having cared for any neonates born to mothers with COVID-19; however, others had extensive experience, including 17 hospitals reporting caring for at least 100 of these newborns. Follow-up of mothers with COVID-19 delivering at three large New York birth hospitals found reduced breastfeeding rates both in the hospital and after returning home among mothers who had been separated from their newborns ( 7 ). After identification of this finding, and the observed stress among mothers and newborns as a result of separation, the hospital system revised its policy and began to allow asymptomatic mothers with laboratory-confirmed COVID-19 to room-in and breastfeed.…”

Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations

“…Their ability to successfully breastfeed may never recover, an obvious harm with longterm effects, manifesting initially by decreased initiation, exclusivity, and duration. 49 The absence of recommendations for psychological support for separated mothers and infants in the vast majority of guidance is alarming and cannot be justified on the basis of infection control risk. 50 Physical distance between mothers and infants and lack of breastfeeding undermine maternal caregiving capacity and place infants at increased risk of poor developmental and psychological outcomes, abuse and neglect.…”

Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study

“…One study estimated the negative effects of separation on breastfeeding both in-hospital and after discharge. 22 The American Academy of Pediatrics (AAP) perinatal COVID-19 registry published online data about the safety of rooming-in and direct breastfeeding in July and October, with >3,500 mother/infant dyads, but did not include specifics about infant distance from the mother. 23 In July and August 2020, data were published by 2 metropolitan New York hospitals that practiced rooming-in, skin-toskin care, and direct breastfeeding, each with very different transmission rates (0% and 6.7%).…”