Breastfeeding During the COVID-19 Pandemic

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Background: Recommendations and practices regarding breastfeeding infants born to COVID-19 positive mothers have evolved throughout the pandemic, from concern with mother-baby contact to education on the encouragement of breastfeeding and rooming-in.

Objective: We examined the rates of breastfeeding for infants born to COVID-19 positive mothers during the newborn hospitalization compared to historical trends at Long Island Jewish Hospital and Cohen Children's Medical Center, Northwell Health. We hypothesized that the rates of breastfeeding for 2020 COVID-19 positive mothers are less than those of healthy postpartum mothers in 2019.

Methods: This is a retrospective medical record review of birth hospitalization feeding patterns of newborns whose mothers tested positive on admission screening by PCR for SARS-CoV-2. Mothers delivering in March, April, and May 2020 and their singleton infants admitted to the newborn nursery were enrolled. The data included maternal gravidity, parity, ethnicity, newborn feeding intent, and maternal report of symptoms. Infant data included birth and discharge weight, length of stay, diet, SARS-CoV-2 PCR test result at 24 hours, and subsequent feeding and testing data during outpatient follow up.

Results: Mothers (n=129) were gravida 2 (median), para 1 (median), and 33% white, 32% black, 9% Hispanic, and 12% Asian. Although 78% mothers planned to breastfeed, only 61% achieved that goal, and 21% breastfed exclusively. The rates of any and of exclusive breastfeeding in the study population increased over time from March to May 2020 (Figure). By May, the rate of breastfeeding for COVID-positive mothers approached that of the 2019 data (Figure). Of note, rates of any breastfeeding in this cohort displayed racial disparity: 70% of white mothers, 46% of black mothers, and 80% of Asian mothers had any breastfeeding in 2020. At 24 hours, infant PCR screening for SARS-CoV-2 was negative. Outpatient retesting results were available for 44 of the infants. Upon retest at 13 +/- 8.2 days, none of the infants who breastfed during the newborn hospitalization had seroconverted.

Conclusions: Although there was a difference in the number of COVID-positive mothers who breastfed compared with those who indicated their intent to breastfeed exclusively, the number of infants who received breastmilk during the newborn hospitalization period increased during our observation period from March to May 2020 and approached the typical rates previously seen in our institution. Based on PCR results in follow-up we found no vertical transmission in breastfeeding dyads. These data suggest that pediatricians continue strong support for breastfeeding during the newborn hospitalization.

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Northwell Health - Cohen Children's Medical Center
Baystate Children's Hospital
Cohen Children's Medical Center

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