key: cord-0686535-c04xxo8d
authors: Stuebe, Alison
title: Should Infants Be Separated from Mothers with COVID-19? First, Do No Harm
date: 2020-05-01
journal: Breastfeed Med
DOI: 10.1089/bfm.2020.29153.ams
sha: 98a08ebf6d640f75f2ae255dc3342255025d9372
doc_id: 686535
cord_uid: c04xxo8d

nan

(1) Separation may not prevent infection. A study published in late March reported that 3 of 33 infants born in Wuhan, China, to mothers with COVID-19 tested positive for SARS-CoV-2; the infants were born by cesarean and managed with strict isolation precautions. 3 Even if separation prevents infection during the maternity stay, it does not address exposure after the infant is discharged. 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. Hospital isolation may therefore delay, but not prevent, infant infection. (2) Interruption of skin-to-skin care disrupts newborn physiology. Infants who are separated from their mothers have higher heart rates and respiratory rates and lower glucose levels than infants who are skin-toskin. 4 This holds true even for infants who are placed in incubators. In a randomized controlled trial for 1200-to 2199-gram newborns, among infants who were skin-to-skin, 17% of infants experienced instability, based on objective parameters, compared to 92% of the infants in conventional incubators. 5 In a subsequent study among term infants placed skin-toskin versus alone in a crib, separation increased stress activity by 176%. 6 As noted by the Royal College of Obstetricians and Gynecologists, ''routine precautionary separation of a mother and a healthy baby should not be undertaken lightly, given the potential detrimental effects on feeding and bonding.'' 7 Isolation is a significant stressor for newborn infants; for those infants already infected with SARS-CoV-2, isolation could worsen the disease course. (3) Separation stresses mothers. When mothers held their preterm infants skin-to-skin in the neonatal intensive care unit, their heart rate, salivary cortisol level, and stress scores decreased. 8 Separating mothers from their infants, especially in the context of being diagnosed with a pandemic disease, has the potential to cause significant suffering, and the associated physiologic stress could worsen the mother's disease course. of the infant microbiome. Antibodies specific to maternal antigen exposure begin to appear in milk within 7 days, 9 protecting the infant from infection. Furthermore, human milk contains multiple oligosaccharides and innate immune factors that mitigate the impact of viral infections. (5) Early separation disrupts breastfeeding, and not breastfeeding increases the risk of infant hospitalization for pneumonia. Early separation decreases breastfeeding duration compared to keeping mothers and infants together. And when infants are not breastfed, they have 3.6 times the risk of being hospitalized for pneumonia compared to infants who are exclusively breastfed for ‡4 months. 10 Separating mother and baby immediately after birth may make the infant more vulnerable to severe respiratory infections, including COVID-19, in the first year of life. (6) Separate isolation doubles the burden on the health system. Separately isolating mother and infant requires twice the resources: two hospital rooms, two provider teams, and two sets of personal protective equipment (PPE) each time a provider enters or leaves the room.

In the context of hospital overcrowding and dangerous shortages of PPE, this is deeply problematic.

In the United States, technology and clinical science have long been ''normal,'' whereas skin-to-skin contact and rooming in defy the reductionism of Western medicine. In contrast, officials at the WHO remember the lessons of the human immunodeficiency virus epidemic, where recommendations to substitute formula for breastfeeding had devastating consequences in low-income countries. 11 At the time of writing, we have no evidence to show that early separation improves outcomes. As we navigate the COVID-19 pandemic, I am hopeful that we can center mothers and babies and remember to first do no harm.

Clinical Management of Severe Acute Respiratory Infection (SARI) when COVID-19 Disease is Suspected. Geneva: World Health Organization

Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings

Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China

Early skin-toskin contact for mothers and their healthy newborn infants

Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200-to 2199-gram newborns

Should neonates sleep alone?

Royal College of Paediatrics and Child Health, et al. Coronavirus (COVID-19) Infection in Pregnancy: Information for Health Care Professionals

Salivary cortisol and mood and pain profiles during skin-to-skin care for an unselected group of mothers and infants in neonatal intensive care

Kinetics of the antibody response to tetanus-diphtheriaacellular pertussis vaccine in women of childbearing age and postpartum women

Breastfeeding and the risk of hospitalization for respiratory disease in infancy: a meta-analysis

Current knowledge and future research on infant feeding in the context of HIV: basic, clinical, behavioral, and programmatic perspectives