52 Revista Médica Vozandes
Volumen 32, Número 2, 2021
Pace et al, conducted a study to determine whether RNA of the
virus can be detected in breast milk and breast skin of infected
women, the risk of transmission during suckling from a mother
with mastitis, and measured the concentrations of antibodies
to SARS-CoV2 transmitted in breast milk. Milk samples were
collected under all asepsis and antisepsis standards, with
protective measures: face mask, gloves, hand washing of the
mothers, breast skin swabs were taken before and after washing
the breasts, sodium/potassium was quantied as an indirect
marker of mastitis (a Na/K index greater than 0.6 was interpreted
as subclinical mastitis). 18 women entered the study, 50% had
subclinical mastitis, no breast milk sample identied virus RNA
despite the previous nding of subclinical mastitis in half of the
women in the study. Virus RNA was isolated from a swab taken
prior to breast cleansing, but when an attempt was made to
identify it in the post-cleansing swab, the result was negative.
This study concludes that breast milk is not a transmitter of the
SARS-CoV2 virus, breast washing led to the non-detection of the
virus, which supports that proper hygiene prevents transmission
breast milk samples. Also identied antibodies to SARS-CoV2
that were more IgA than IgG, supporting previous studies that
breast milk provides a signicant degree of immunity to the
newborn to combat the virus 22.
In some studies where neonates were separated from their
mothers at birth, they were infected later, demonstrating that
the separation of newborns is not a protective factor, since
the neonate has contact with multiple health professionals,
increasing the risk of infection, poor oral tolerance to formula
feeding, alteration in thermal control, among others23.
The current evidence on breast milk from mothers with Covid-19,
so far, has shown to be safe for newborns, once again conrming
the importance of the immunological contribution by transferring
antibodies against the virus protecting the newborn, the risk
remains the transmission of the newborn through drops of the
infected mother. For this reason, the American Academy of
Pediatrics supports breastfeeding in patients without severe
symptoms; in case of severe symptoms, it is recommended to
pump breast milk under adequate hygiene measures and to
feed the newborn with unpasteurized breast milk (since there is
no evidence of probable transmission of the virus and because it
reduces the immunological value) given by a healthy person24,25.
To prevent transmission, the mother should adopt adequate
hand hygiene measures before and after contact with the
newborn, washing the breast before and after
breastfeeding, strict use of masks, keeping the
newborn at 2 meters distance in the room, use of
a physical barrier, and periodic disinfection of the
room. Isolation of the newborn from the mother
has not proven to be benecial so far25-26.
About early attachment, the WHO and the Italian
Society of Neonatology recommend maintaining
skin-to-skin contact in the delivery room and the
likelihood of breastfeeding in the same room. The
use of breast milk expressed from mothers with
unpasteurized Covid-19 can be used to feed
newborns who have been separated from their
mothers due to health conditions27,28.
CONCLUSION
The current evidence shows that breastfeeding
provides protection to the newborn through
the transmission of antibodies to the child,
mainly immunoglobulin A, which provides
immunologically active cells that support the
immature immune system. Although there are two
studies that have shown the presence of the virus
in breast milk, there are no records proving the
infection of the newborn through breastfeeding,
so it is recommended to continue breastfeeding,
in case the mother is able to do it directly, or to
feed the newborn with breast milk expressed
without pasteurization by a healthy caregiver in
case the mother is not able to do it.
Always keep protective measures such as frequent
hand washing, breast washing before and after
breastfeeding, the use of masks and cleanliness of
the entire place where the mother stays.
Regular check-ups in newborn are necessary,
whether remote or face-to-face. When in
doubt about the management of the newborn,
specialized medical personnel should always be
contacted.
Arévalo Zabala C, et al.
BREASTFEEDING IN CHILDREN WITH MOTHERS
SUFFERING FROM COVID-19 (...)
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