Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations
Introduction Recommendations for the clinical management of new mothers with suspected or confirmed COVID-19 and their infants are required. Guidance must weigh the risk posed by transmission of SARS-CoV-2 against the protection that maternal proximity and breastfeeding provide infants. Our aim was...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
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| Series: | BMJ Nutrition, Prevention & Health |
| Online Access: | https://nutrition.bmj.com/content/early/2020/12/21/bmjnph-2020-000184.full |
| _version_ | 1818589970994036736 |
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| author | Roger Mathisen Duong Vu Hoang Jennifer Cashin Karleen Gribble Kathleen Marinelli |
| author_facet | Roger Mathisen Duong Vu Hoang Jennifer Cashin Karleen Gribble Kathleen Marinelli |
| author_sort | Roger Mathisen |
| collection | DOAJ |
| description | Introduction Recommendations for the clinical management of new mothers with suspected or confirmed COVID-19 and their infants are required. Guidance must weigh the risk posed by transmission of SARS-CoV-2 against the protection that maternal proximity and breastfeeding provide infants. Our aim was to review international COVID-19 guidance for maternal and newborn care, assessing alignment with WHO recommendations and the extent to which policy supported or undermined breastfeeding.Methods Guidance documents from 33 countries on the care of infants whose mothers were suspected or confirmed as having COVID-19 were assessed for alignment with WHO recommendations regarding: (1) skin-to-skin contact; (2) early initiation of breastfeeding; (3); rooming-in; (4) direct breastfeeding; (5) provision of expressed breastmilk; (6) provision of donor human milk; (7) wet nursing; (8) provision of breastmilk substitutes; (9) psychological support for separated mothers; and (10) psychological support for separated infants.Results Considerable inconsistency in recommendations were found. Recommendations against practices supportive of breastfeeding were common, even in countries with high infant mortality rates. None of the guidance documents reviewed recommended all aspects of WHO guidance. The presence of influential guidance conflicting with WHO recommendations and an undervaluing of the importance of maternal proximity and breastfeeding to infant health appeared to contribute to this poor alignment.Conclusion Those developing guidance in the COVID-19 pandemic and other infectious disease outbreaks need to appropriately consider the importance of skin-to-skin contact, early initiation of breastfeeding, rooming-in and breastfeeding to maternal and infant physical and psychological health. In weighing the value of recommendations of others in future guidance development, countries should consider past reliability and value placed on breastfeeding. Recommendations against maternal proximity and breastfeeding should not be made without compelling evidence that they are necessary, and less harmful than maintaining dyad integrity. |
| first_indexed | 2024-12-16T09:49:07Z |
| format | Article |
| id | doaj.art-ff40e7d3356541d39fb8e1bd6c698208 |
| institution | Directory Open Access Journal |
| issn | 2516-5542 |
| language | English |
| last_indexed | 2024-12-16T09:49:07Z |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Nutrition, Prevention & Health |
| spelling | doaj.art-ff40e7d3356541d39fb8e1bd6c6982082022-12-21T22:36:07ZengBMJ Publishing GroupBMJ Nutrition, Prevention & Health2516-554210.1136/bmjnph-2020-000184Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendationsRoger Mathisen0Duong Vu Hoang1Jennifer Cashin2Karleen Gribble3Kathleen Marinelli4registered clinical nutritionist and dietitianAlive & Thrvie Southeast Asia, FHI 360, Hanoi, VietnamAlive & Thrive Southeast Asia, FHI 360, Yangon, MyanmarWestern Sydney University School of Nursing and Midwifery, Penrith South DC, New South Wales, AustraliaPediatrics, University of Connecticut School of Medicine, Hartford, Connecticut, USAIntroduction Recommendations for the clinical management of new mothers with suspected or confirmed COVID-19 and their infants are required. Guidance must weigh the risk posed by transmission of SARS-CoV-2 against the protection that maternal proximity and breastfeeding provide infants. Our aim was to review international COVID-19 guidance for maternal and newborn care, assessing alignment with WHO recommendations and the extent to which policy supported or undermined breastfeeding.Methods Guidance documents from 33 countries on the care of infants whose mothers were suspected or confirmed as having COVID-19 were assessed for alignment with WHO recommendations regarding: (1) skin-to-skin contact; (2) early initiation of breastfeeding; (3); rooming-in; (4) direct breastfeeding; (5) provision of expressed breastmilk; (6) provision of donor human milk; (7) wet nursing; (8) provision of breastmilk substitutes; (9) psychological support for separated mothers; and (10) psychological support for separated infants.Results Considerable inconsistency in recommendations were found. Recommendations against practices supportive of breastfeeding were common, even in countries with high infant mortality rates. None of the guidance documents reviewed recommended all aspects of WHO guidance. The presence of influential guidance conflicting with WHO recommendations and an undervaluing of the importance of maternal proximity and breastfeeding to infant health appeared to contribute to this poor alignment.Conclusion Those developing guidance in the COVID-19 pandemic and other infectious disease outbreaks need to appropriately consider the importance of skin-to-skin contact, early initiation of breastfeeding, rooming-in and breastfeeding to maternal and infant physical and psychological health. In weighing the value of recommendations of others in future guidance development, countries should consider past reliability and value placed on breastfeeding. Recommendations against maternal proximity and breastfeeding should not be made without compelling evidence that they are necessary, and less harmful than maintaining dyad integrity.https://nutrition.bmj.com/content/early/2020/12/21/bmjnph-2020-000184.full |
| spellingShingle | Roger Mathisen Duong Vu Hoang Jennifer Cashin Karleen Gribble Kathleen Marinelli Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations BMJ Nutrition, Prevention & Health |
| title | Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations |
| title_full | Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations |
| title_fullStr | Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations |
| title_full_unstemmed | Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations |
| title_short | Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations |
| title_sort | misalignment of global covid 19 breastfeeding and newborn care guidelines with world health organization recommendations |
| url | https://nutrition.bmj.com/content/early/2020/12/21/bmjnph-2020-000184.full |
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