Newborn Did Not Contract Virus From COVID-Positive Breast Milk

By Carolyn Crist

November 18, 2020

NEW YORK (Reuters Health) - An infant in Italy, born to a mother who tested positive for COVID-19 after delivery, didn't contract the coronavirus when fed breast milk before the mother knew she was positive, according to a new case report from Italian doctors.

Public-health officials and hospital administrators continue to debate their approaches to breastfeeding during the pandemic, and new reports could help doctors to make better decisions in labor and delivery units, the authors write in Pediatrics.

"Information on the perinatal aspects of COVID-19 is still scarce," said lead author Dr. Licia Lugli of the University Hospital of Modena and Reggio Emilia in Italy.

Medical societies across the world have suggested various guidelines to handle breastfeeding and contact between babies and mothers who tested positive for COVID-19. Some recommend separation in hospitals and caution around breastfeeding, but some recommend breastfeeding due to the protective nature of breast milk.

"The management of an infant born to a SARS-CoV-2-positive mother who is asymptomatic or has mild symptoms is controversial," Dr. Lugli told Reuters Health by email.

She and her colleagues describe the case of a healthy preterm newborn who was inadvertently fed virus-positive breast milk before they knew the mother had contracted the virus. Although the hospital had protocols for COVID-19 deliveries, the mother's medical history didn't indicate any suspected infection, so the care team didn't put those protocols into action at first.

During the postpartum period, the mother tested positive, which was "unexpected," the authors write.

The baby, who was delivered by emergency cesarean section after the mother had a placental abruption, was placed on ventilation for three days.

The mother visited the neonatal intensive-care unit (NICU) and always wore a face mask and gown while there. She was discharged from the hospital after the third day and developed a sore throat and fatigue at home. While she rested at home, a family member delivered breast milk to the hospital for the third through sixth days since delivery.

After nine days, the mother went back to the hospital for a follow-up visit and brought breast milk with her, which the doctors gave to the baby. During her follow-up exam, the mother had a fever and tested positive for COVID-19. She returned home to isolate, and two samples of the breast milk were tested, which both came back positive.

The hospital team stopped giving the breast milk to the newborn, who didn't develop COVID-19 symptoms and had normal chest imaging. They tested the baby several times over a 10-day period, and all of the tests came back negative.

The baby received donor breast milk until hospital discharge. The mother tested negative for COVID-19 twice at that point, so they restarted breastfeeding at home.

"The infant remained healthy and had no evidence of SARS-CoV-2 infection, perhaps because of the protection conferred by fresh breast milk," Dr. Lugli said. "Indeed, in most maternal viral infections, the continuation of breastfeeding is in the best interest of the infant and the mother because infection transmission through breast milk is rare."

Still, questions remain about breastfeeding during the pandemic, particularly whether higher viral loads could lead to infection in newborns, the authors write.

Other case reports have documented COVID-19 in breast milk in China and Germany, for instance, and the researchers in Germany found that the newborn tested positive and developed symptoms. However, they couldn't determine whether the baby contracted the virus from the breast milk or through respiratory droplets from the mother.

"The infection-control measures in the NICU should address the droplets and contact transmission of SARS-CoV-2 from a positive mother, rather than a focus on the mother's milk," said Dr. Riccardo Davanzo of the Institute for Maternal and Child Health in Trieste, Italy.

Dr. Davanzo, who wasn't involved with the new case report, wrote breastfeeding guidelines at the beginning of the pandemic on behalf of the Italian Society of Neonatology, which recommended that breastfeeding practices continue.

"Obviously, it is important to share information about SARS-CoV-2 and human milk, which helps to reassure the public," he said. "But recent studies show breastfeeding is no longer an issue, as compared to concerns earlier in the pandemic."

SOURCE: Pediatrics, online November 10, 2020.