The Evidence of Separating Breastfeeding Dyads at Birth When Mothers are Positive for SARS-CoV-2
by Anne Eglash MD, IBCLC, FABM
Since the COVID-19 pandemic hit, there has been a great deal of variation between birthing centers in the USA and in other countries regarding the practice of separation vs room-sharing among newborns and their mothers who test positive for SARS-CoV-2. In April and May 2020, the US Centers for Disease Control and the American Academy of Pediatrics (AAP) advised that separation of newborns from COVID+ mothers should be strongly considered to protect newborns, although they still recommended that mothers express breastmilk for their infants. These guidelines have been interpreted differently between institutions, creating stress and anxiety among hospital personnel with varying priorities.
On July 22nd, 2020, the AAP updated their guidelines, stating that 2-5% of newborns of COVID+ mothers test positive within 24-96 hours after birth. There has not been a published report of a newborn death due to SARS-CoV-2 infection. There is no evidence that newborns who are separated from COVID+ mothers are less likely to test positive for SARS-CoV-2 as compared to infants who room share with their mothers, when infection prevention measures are in place. Therefore, the AAP now states that mothers who are COVID-19+ may room-in with their newborns according to usual center practice.
- Delayed cord clamping should be discontinued to decrease the time the newborn is skin to skin with their COVID+ mother.
- COVID+ mothers should wash their breasts before breastfeeding, in addition to using masks and hand washing.
- COVID+ mothers of NICU infants can provide expressed breastmilk because there is no evidence that SARS-CoV-2 infection is spread via breastmilk.
- Infants born to COVID+ mothers should not have their baths delayed.
- There is no evidence that early discharge from the birthing center is beneficial for a COVID+ mother or newborn.
See the Answer
There is no abstract.
The updated AAP guidelines are welcome recommendations for the protection and establishment of breastfeeding. Breastfeeding mothers who are COVID+ are advised to wear a mask and wash their hands before breastfeeding, but washing the breasts has not been demonstrated to be a strategy that decreases viral transmission to newborns. Mothers should continue to keep a 6-foot (2 meters) distance away from their newborns and have a healthy caregiver present to provide care for the newborn.
Delaying the bath has become standard in many birthing centers because it reduces the risk of hypothermia in the first 24 hours, and improves breastfeeding rates. However, early newborn bathing is recommended by the AAP to wash off viral particles. Delayed cord clamping is still recommended when mom is COVID-19+, and the baby should be placed skin to skin with mom, who would wear a mask. Although SARS-CoV-2 RNA has been found in breastmilk of COVID+ mothers, there is no evidence that the presence of the RNA signifies the presence of active viral particles that can transmit infection.