Recommendations must balance risks v/s benefit of mother-infant contact and breastfeeding
It is of course common sense that breast feeding is an integral part of post-partum care of a new-born. Since ancient times, exclusive breastfeeding for the new-born for a minimum of six months has been emphasized as it is an optimum source of nutrients as well as antibodies that can improve the immunity of the baby, sometimes lasting lifelong. It also lays the foundation for somatic and psychological bonding between mother and child.
The first breast milk colostrum is also known as golden fluid and is a combination of immune, growth and tissue repair factors. Respiratory infections are a leading cause of morbidity in children. During the first year of life breast feeding provide protection from these infections mainly lower respiratory infections.
The immaturity of infants’ immune system at birth increases the risk of infection, which is related to unpreparedness respiratory and gastrointestinal tract to resist infection. The anti-inflammatory protection conveyed by breast milk is affected by both chemical components cellular interaction.
The COVID pandemic has created a dilemma of the essential part of post-partum care like, early skin to skin contact, Kangaroo mother care (baby lying on the lap of the mother) and breast feeding can still be thought of, as the risk of transmission of SARS COV-2 VIRUS to infant may be there. Also, COVID positive mothers have COVID antibodies which are also transmitted through Breast milk to the baby and helps providing protection for new Born against COVID infection.
Recommendations must balance risks v/s benefit of mother infant contact and breastfeeding, based on a full consideration of not only the potential risks of covid-19 infection of infant, but also the risks of morbidity and mortality associated with not breastfeeding, the inappropriate use of infant formula milk and protective benefits of skin to skin contact.
As per the WHO recommendations, the mothers with suspected or confirmed covid-19 should be encouraged to continue breastfeeding, but observing all appropriate safety measures, for the mother and close contacts. With the vaccination scheduling process pregnant mothers to be prioritized for vaccination.
UNICEF and US centres for disease control and prevention have highlighted the well-established overall short and long term immunological and psychosomatic benefits of breastfeeding, for this reason, strict measure for mother infant separation and discontinuation of breast feeding how to be avoided, unless the severity is of such level that mother cannot take care of the infant.
In such cases fresh expressed unpasteurized breast milk should be provided for the baby. Every hospital should have their protocols laid down to make it convenient for the COVID positive mother to feed their baby. In cases where feeding becomes controversial, parents should be allowed to decide whether to breastfeed or not, due to insecurity caused by the perceived risk of transmission to the infant.
When both mother and infant are SARS COV-2 positive, breast feeding is strongly encouraged as the role of IgG antibodies in the immunity of infants as well established. Before breastfeeding mothers must ensure they have an N-95 mask and they should clean the breast surface either with an alcohol based sanitizer or with simple soap and water.
When during the night, wearing a mask is difficult, baby can be shifted to another room and brought only during breastfeeding time. The regular routine of hand washing, cleaning and disinfection of surfaces touched, thorough cleaning and sterilization of infant feeding equipment before and after use and avoidance of falling asleep with a baby should be followed.