Following emerging evidence that transmission of COVID-19 from mother to baby is very rare, most COVID-19 hospitals that were initially separating newborns from the infected mothers are now practising “rooming-in”.
Paediatricians, who assert that benefits of breastfeeding substantially outweigh the potential risks of transmission, are of the view that COVID-19 antibodies in breast milk protect the babies. Hence, infected mothers are being advised to continue breastfeeding with adequate precautions.
WHO recommendation
While the World Health Organisation (WHO) also recommends that mothers with suspected or confirmed SARS-CoV-2 should be encouraged to initiate or continue breastfeeding, a recent research published in JAMA Paediatrics has found that mothers with COVID-19, who take basic precautions, rarely pass on the virus to their newborns. The study examined outcomes in the first 101 newborns born to infected mothers at the NewYork-Presbyterian Hospital in the U.S. from March 13 to April 24, 2020. Of these, only two newborns tested positive, the study said.
Doctors in COVID-19 hospitals said very few babies have been infected although they have started following “rooming-in” (keeping the baby at a distance of six feet from the mother) concept. Venkat Reddy, nodal officer of COVID-19 ward at the State-run Hajee Sir Ismail Sait Gosha Hospital, that is now a dedicated COVID-19 maternity facility, said of the 182 babies born there, 10 have been infected so far.
Similarly, not more than four babies that were born to infected mothers in Trauma and Emergency Care Centre on Victoria Hospital campus have been infected. A team of doctors from the adjacent Vani Vilas Maternity Hospital conducted over 230 deliveries there till Gosha Hospital was identified as a dedicated COVID-19 maternity facility. “Although earlier, the babies were separated from the mothers and kept under isolation at Vani Vilas, breastfeeding was being allowed with adequate precautions. Hardly 3 to 4 babies got the infection,” said Geeta Shivamurthy, Vani Vilas Medical Superintendent.
Asha Benekappa, former director of Indira Gandhi Institute of Child Health, said breastfed infants have an advantage of receiving additional protection against SARS-CoV-2.
Antibodies against virus
“An infected mother produces antibodies against the virus, which is transmitted to the baby through breastfeeding. The immature immune system of the baby is protected by colostrum (the first milk), an immunological elixir, which the baby gets, if fed immediately after birth. Hence, breastfeeding should be encouraged, mothers and their babies should be cared for together, and skin-to-skin contact ensured,” she said.
“If mothers are too ill to breastfeed, they should still be supported to express their milk, and the infant should be fed by a healthy individual. ,” said Dr. Benkappa, who is now heads the Department of Paediatrics at Chandramma Dayananda Sagar Institute of Medical Education and Research.
N. Karthik Nagesh, chairman and HOD of Neonatology and NICUs at Manipal Hospitals Group, said it is important that the mother wears a mask, washes her hands, wipes the chest and the surface baby is going to come in contact with sanitiser or soap and water.
“We recommend zero separation in case if both mother and baby are healthy, partial separation in case mother is sick or if other relatives are available to look after the baby, and complete separation only if mother is very sick and requires ICU care or if the baby is sick and needs to be in the newborn ICU,” said Dr. Nagesh.
