WHO greenlights breastfeeding throughout COVID-19

24 Jun 2020 --- COVID-19 in infants and children represents a much lower threat to survival and health than other infections that breastfeeding protects against, according to a scientific brief from the World Health Organization (WHO). It recommends that parents should be encouraged to breastfeed, even if they have suspected or confirmed COVID-19. However, the organization flags that there is insufficient data to ascertain whether vertical transmission of COVID-19 is possible through breastfeeding.

“Mothers should be counseled that the benefits of breastfeeding substantially outweigh the potential risks for transmission. Mother and infant should be enabled to remain together while rooming-in throughout the day and night and to practice skin-to-skin contact, including kangaroo mother care, especially immediately after birth and during establishment of breastfeeding, whether they or their infants have suspected or confirmed COVID-19,” recommends WHO.

The living systematic review used evidence up to May 15 to identify studies including mothers with suspected or confirmed COVID-19 and their infants or young children. A total of 12,198 records were retrieved and 6,945 were screened after removing duplicates. In the end, 153 records with mother-infant dyads in which the mother had COVID-19 were included in the full-text review.

Ultimately, a total of 46 mother-infant dyads had breast milk samples tested for COVID-19. All mothers had COVID-19, while 13 infants tested COVID-19 positive. Breast milk samples from 43 mothers were negative for the COVID-19 virus, while samples from three mothers tested positive for viral particles by reverse transcription-polymerase chain reaction (RT-PCR). 

One of the infants whose mother’s breast milk had tested positive also tested positive. However, infant feeding practices were not reported. Additionally, it is unclear through which route or source the infant became infected. For example, it could be through breast milk or from a droplet due to close contact with the infected mother. The two other infants tested negative for COVID-19. One was breastfed, and the other newborn was fed expressed breast milk after viral RNA particles were no longer detected.  

WHO also points to a preprint article, which reported that secretory immunoglobulin A (sIgA) immune response against the COVID-19 virus was found in 12 of 15 breast milk samples from mothers with COVID-19. However, the implications of this finding on the effect, duration and protection against COVID-19 for the child were not addressed.

Non-breastfed infants have a 14-fold higher risk of mortality than exclusively breastfed babies.Weighing up the risks
WHO details that the detection of COVID-19 viral RNA in breast milk is not the same as finding a viable and infective virus. Transmission of COVID-19 would need replicative and infectious viruses to be able to reach target sites in the infant and also to overcome infant defense systems. If, in the future, COVID-19 virus from breast milk were shown to be replicative in cell culture, it would need to reach target sites in the infant and overcome infant defense systems for transmission of COVID-19 to occur.

Additionally, children seem to be at low risk of COVID-19, with most children who test positive experiencing only mild or asymptomatic illness. Meanwhile, WHO stresses that non-breastfed infants have a 14-fold higher risk of mortality than exclusively breastfed babies. In terms of maternal care, breastfeeding also protects against breast cancer and may protect against ovarian cancer and Type 2 diabetes. Therefore, WHO recommendations on the initiation and continued breastfeeding of infants and young children also apply to mothers with suspected or confirmed COVID-19.

“The benefits of breastfeeding and nurturing mother-infant interaction to prevent infection and promote health and development are especially important when health and other community services are themselves disrupted or limited. Adherence to infection prevention and control measures is essential to prevent contact transmission between COVID-19 suspected or confirmed mothers and their newborns and young infants,” details the organization. 

WHO is not the only organization investigating this space. In March, an investigation into the safety and protective functions of breast milk as it relates to the COVID-19 pandemic was initiated by the University of California San Diego and the Family Larsson-Rosenquist Foundation.

However, a WHO report from last month called for legal measures to prohibit the promotion of breast milk substitutes to health workers and in health facilities. In collaboration with the UN’s Children’s Fund (UNICEF) and the International Baby Food Action Network (IBFAN), WHO noted that COVID-19 leaves an opening for the breast milk substitute industry to “capitalize on the crisis.”

Edited by Katherine Durrell