Thursday, August 6, 2020

Breastfeeding in COVID-19

BREASTFEEDING IN COVID-19
Hello Friends!
     On the International Breastfeeding week, I would like to share information about “Breastfeeding in COVID-19”, whether it is safe or not to breastfeed the neonates & infants in this pandemic situation.
The COVID-19 Virus has not been detected in the breast milk of any mother either with confirm or suspected COVID-19. So, COVID-19 testing does not have any immediate implications for decisions on infant and young child feeding .The numerous benefits of breastfeeding substantially outweigh the potential risks of transmission and illness associated with COVID-19.Meanwhile researchers continue to test breast milk from infected mother.

Some information that you all need to know are-
1)WHO recommends that all mothers confirm or suspected COVID-19 continue to have skin to skin contact and to breastfeed. In all socio – economic conditions breastfeeding improves-
- Survival and provide lifelong health
- Development advantage to newborns &infants
- Reduce the risk of breast cancer & ovarian cancer in mother
- Skin to skin contact including kangaroo mother care reduce neonatal mortality especially in low birth weight newborns and it also improves thermal regulation of newborns and several other physiological outcomes. There are numerous benefits of skin to skin contact and breast feeding substantially outweigh the potential risks of transmission and illness associated with COVID-19.

2) While infants & neonates can contract COVID-19 they are at low risk of infection .A few confirm  cases of COVID-19 in young children have experience only mild or asymptomatic illness.

3)In all socio- economic settings Breastfeeding improves survival and provides lifelong health and development advantage to new born & infants.

4) If a mother is confirmed / suspected COVID- 19( for the time when she is likely to be infective ,i.e. while symptomatic or through the 14 days after the start of symptoms ,whichever is longer) then, 
(a) She should wash hands frequently with soap and water or use alcohol based sanitizer before touching the baby.
(b) She should wear a medical mask while feeding .It is important to-
* Replace mask as soon as they become damp 
* Dispose of mask immediately 
* Not reuse a mask 
* Not touch the front of mask but unite it from behind.
- Sneeze or cough into a tissue, immediately dispose of it and use alcohol based hand rub or wash hands again with soap and water.
- Regularly clean & disinfect surfaces.
(c) If medical mask not available to her, breastfeeding should be continued.
Other infection prevention measures such as washing hands , cleaning surface, sneezing or coughing into a tissue are also important .Non- Medical mask( homemade or cloth mask)have not been evaluated .At this time it is not possible to make a recommendation for or against their use. 
(d) If she had just coughed over her exposed chest or breast then she should gently wash the breast with soap and warm water for at least 20 seconds prior to feeding. It is not necessary to wash the breast before every breastfeed or prior to expressing milk.
(e) If she is not able to breastfeed then best alternatives are-
• Expressed breast milk
- Expression of breast milk is primarily done or taught through hand expression, with the use of a mechanical pump only when necessary. Hand expression and using a pump can be equally effective.
- The choice of how to express will depend on maternal preference, availability of equipment, hygiene condition and cost.
- The mother and anyone helping the mother, should was their hands before  expressing breast milk or touching any pump or bottle part and ensure pump, feeding utensils, milk storage container should be cleaned  after each use with liquid soap e.g. dishwashing liquid and warm water .Rinse after with hot water for 10- 15 seconds.
- Express breast milk should we feed to child preferably using a clean cup or spoon by a person who has no sign a symptom of illness and whom  the baby feel comfortable. The mother should was their hand before feeding the newborn / infant.
•Donor human milk
- Mother is unable to express milk and milk is available from human milk Bank, Donor human milk can be feed to the baby while the mother is recovering.
• If expressing breast milk or donor human milk and not feasible or available then consider-   
*Wet – nursing (another woman breastfeed the child).In settings where HIV is prevalent, prospective wet-nurses should undergo HIV counselling and rapid testing according to National guidelines where available. In the absence of testing if visible undertake HIV risk assessment. If HIV risk assessment/counselling is not possible, facilitate and support wet-nursing. Provide counselling on avoiding HIV infection during breastfeeding. Prioritise wet – nurses for the youngest infants.
* Infant formula Milk with measures to ensure that it is feasible, correctly prepared, safe and sustainable. There are always risk associated with giving infant formula Milk to newborns and infants in all setting. It is commonly of variable quality, of the wrong type, not accompanied by an essential package of care, distributed indiscriminately, not targeted to those who need it. That risk associated are increased whenever human  community conditions are compromised example reduce access to health service if baby become unwell / reduce access to clean water / access to supplies of infant formula milk difficult or not guaranteed not affordable and not sustainable.
 Donations of infant formula milk from confirm/ suspected mothers should not be accepted. If needed, supplies should be purchased based on assessed need. 
 Mother can start breastfeed when she feel well enough to do so. There is no fixed time interval to wait after confirmed or suspected COVID-19.There is no evidence that breastfeeding changes the clinical course of COVID-19 in a mother. Health workers or breastfeeding counsellors should support mothers to relactate.
(f) There is no need to provide a' top- up' with an infant formula milk. Giving a ‘top -up' will reduce the amount of milk produced by a mother. Mother who breastfeed should be counselled unsupported to optimise positioning and attachment to insure adequate milk production. Mother should be counselled about responsive feeding and perceived milk insufficiency and how to respond to their infant's hunger and feeding cues to increase the frequency of breastfeeding

5) Recommendations for adult and older children to maintain social distancing aim to reduce contact with asymptomatic person who have covid-19 and transmission of virus that may result. This strategy will reduce the overall prevalence of covid-19 and the number of adults who experience more serious disease.
The aim of recommendations on the care and young children whose mother have confirm or suspected covid-19 infection is to improve the immediate and lifelong survival, children health and development of newborns and infants. These recommendations consider likelihood and potential risks of COVID-19 in infants and also the risks of serious illness and death when infants are not breastfeed or when infant formula milk are used inappropriately as well as the protective side effects of breastfeeding and skin to skin contact.
Thus, It is safe to breastfeed the infants and neonates because no active COVID-19 Virus has not, to date been detected in breast milk of any confirm/suspected mother and it also provides remarkable benefits to the baby.

By- Neha Kumari
2nd year MBBS student
GMC BETTIAH

3 comments:

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