Don't Separate Moms With COVID-19 From Newborns, Experts Say

By Anne Harding

April 22, 2020

NEW YORK (Reuters Health) - Separating mothers with COVID-19 from their newborns in the hospital to prevent viral spread interrupts breastfeeding, stresses mother and baby, and has other negative consequences that likely outweigh any benefit, experts on infant feeding warn.

"Mamas need babies and babies need mamas. Sometimes we have to separate mamas from babies, but there's no good science to say that this is one of those times," said Dr. Alison Stuebe, a distinguished scholar in infant and young child feeding and a professor in obstetrics and gynecology at the University of North Carolina Gillings School of Global Health in Chapel Hill.

In cases where a pregnant woman has suspected or confirmed COVID-19, the U.S. Centers for Disease Control and Prevention (CDC) initially advised hospitals to "consider temporarily separating the mother from her infant." On April 4, the CDC revised the guidance to emphasize the importance of skin-to-skin contact between mother and newborn and said the decision on separation should be made "on a case-by-case basis, using shared decision-making between the mother and the clinical team."

The World Health Organization (WHO) and other groups say mothers with confirmed or suspected COVID-19 should room with their babies and should breastfeed, with the mother wearing a mask, washing her hands frequently and disinfecting surfaces, Dr. Stuebe noted in a paper in Breastfeeding Medicine on the risks of mother-infant separation.

"If mom is unable to take care of her baby and is in the intensive care unit, that's a whole different ball of wax," Dr. Stuebe told Reuters Health in a telephone interview. In that case, she said, a mother can be assisted in expressing milk for her infant if she wishes.

But if a mother with COVID-19 is healthy enough to take care of her infant - and many have no symptoms, Dr. Stuebe noted - separation is not warranted.

While the goal of separation is to prevent the baby from contracting the virus in the hospital, she writes, babies can still be exposed after going home. "Especially in the context of social distancing and travel restrictions, few families have the resources to isolate the infant at home, and it is highly plausible that other household members may be infected," she adds. "Hospital isolation may therefore delay, but not prevent, infant infection."

Nursing strengthens the infant immune system in many ways, Dr. Stuebe notes. "Taking the baby away could hurt the baby. It could also hurt the mom," she said. "If you've got a mom with COVID and you take her baby away, you may make her worse."

Finally, as she points out in her article, separation doubles the demand for personal protective equipment (PPE) and other key supplies on an already stressed health care system.

The Fourth Trimester Project, a website run by Dr. Stuebe and other UNC colleagues, provides expert-vetted information on COVID-19 for new mothers (https://bit.ly/2KpFKFz).

"I definitely agree that there should be shared decision-making with the patients, and that's where I think this conversation has been lacking, that health care systems are making decisions for the patients and not really including them in the discussion," Dr. Judette Louis, president of The Society for Maternal-Fetal Medicine and chair of obstetrics and gynecology at the University of South Florida in Tampa, told Reuters Health in a telephone interview.

There's not enough data to say separation in the hospital prevents newborns from becoming infected, Dr. Louis noted, while there can be harms of separation, including interruption of breastfeeding.

Separation had been the default approach during the COVID-19 crisis in the U.S., she added, but after pushback from mothers, many centers have moved toward shared decision-making.

"The decision of whether you separate or not has to be made on a case-by-case basis because if the mom is severely ill, then that's different," Dr. Louis said.

In an email, Dr. Riccardo Davanzo, a pediatrician and neonatologist at the Institute for Maternal and Child Health--IRCCS "Burlo Garofolo," in Trieste, Italy, said he agreed with Dr. Stuebe. Dr. Davanzo helped write the Italian Society of Neonatology's guidelines on breastfeeding and COVID-19, which are similar to the WHO's recommendations.

"There are good reasons to protect breastfeeding and to keep mothers and neonates together," he told Reuters Health. "Nevertheless, I must observe that many health professionals do not make an adequate balance between reducing the risk of infection and promoting maternal-infant relationship at childbirth."

He noted that transmission of COVID-19 from mother to baby appears to be very rare, if it happens at all. "Fortunately, most babies of COVID-19 mothers are healthy, even in case of becoming SARS-CoV-2 positive a few days after childbirth. Rarely neonates are admitted to hospital after being infected at home from their parents, relatives, siblings, friends."

Hydroxychloroquine is safe for women to take while breastfeeding, Dr. Davanzo noted, while no data on the safety of remdesivir for nursing mothers are available. Nevertheless, he said, if the mother is generally healthy, she does not need to take these medications, which can have harmful side effects.

SOURCE: https://bit.ly/2Korq0k Breastfeeding Medicine, online April 9, 2020.

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