David W Kimberlin, Karen M Puopolo, Breast Milk and COVID-19: What Do We Know?, Clinical Infectious Diseases, Volume 72, Issue 1, 1 January 2021, Pages 131–132, https://doi.org/10.1093/cid/ciaa800
If the last 6 months have taught us anything, it is how rapidly things can change. Entire ways of life have been disrupted. The health of millions of people has been jeopardized and many have been prematurely lost. Systems put in place over decades have been stretched and sometimes have broken. During these dizzying times, one of the challenges that we face is to know when to let go of previously held understandings, and when to hold tight to that which has long proven to be true. The management of babies born to women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19) at the time of delivery—including whether to advocate that they breastfeed—provides an important example of the challenges we face in providing guidance in the absence of adequate evidence to inform risk.
Data from across the world relatively quickly revealed that children are not suffering the same quantity and quality of morbidity and mortality as are adults [1, 2]. Reports of neonatal infection suggest that the same holds true for newborns, although international approaches focused on maternal/newborn separation at the time of birth have complicated this assessment [3–8]. Faced with the important question of how to handle babies born to infected mothers, the American Academy of Pediatrics (AAP) provided initial guidance that took the conservative stance of recommending that infected mothers be temporarily separated from their newborns immediately after delivery, and that the babies be fed expressed breast milk rather than directly breastfeeding during the period of high maternal infectivity . The rationale for making recommendations diametrically opposed to those normally made by AAP is that we do not fully know what the risk of infection with SARS-CoV-2 is in the immediate newborn period. At the same time, we do know that neonates have an immature immune system and can suffer severe morbidity and even mortality from viral and bacterial infections. What is missing from this calculus, though, is actual data. That is why reports such as the one in this issue of Clinical Infectious Diseases by Tam et al are an important step for obtaining the data we need to fully inform our risk/benefit assessments.
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