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3.
Am J Perinatol ; 37(13): 1377-1384, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32898920

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in changes to perinatal and neonatal care, concentrating on minimizing risks of transmission to the newborn and health care staff while ensuring medical care is not compromised for both mother and infant. Current recommendations on infant care and feeding when mother has COVID-19 ranges from mother-infant separation and avoidance of human milk feeding, to initiation of early skin-to-skin contact and direct breastfeeding. Health care providers fearing risks of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) maternal-infant transmission may veer toward restricted breastfeeding practices. We reviewed guidelines and published literature and propose three options for infant feeding depending on various scenarios. Option A involves direct breastfeeding with the infant being cared for by the mother or caregiver. In option B, the infant is cared for by another caregiver and receives mother's expressed milk. In the third option, the infant is not breastfed directly and does not receive mother's expressed milk. We recommend joint decision making by parents and the health care team. This decision is also flexible as situation changes. We also provide a framework for counseling mothers on these options using a visual aid and a corresponding structured training program for health care providers. Future research questions are also proposed. We conclude that evidence and knowledge about COVID-19 and breastfeeding are still evolving. Our options can provide a quick and flexible reference guide that can be adapted to local needs. KEY POINTS: · SARS-CoV-2 is unlikely transmitted via human milk.. · A shared decision making on infant feeding is the preferred approach.. · Mothers can safely breastfeed with appropriate infection control measures..


Assuntos
Aleitamento Materno/métodos , Infecções por Coronavirus , Controle de Infecções/métodos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Leite Humano/virologia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Aconselhamento/métodos , Tomada de Decisões , Feminino , Humanos , Recém-Nascido , Comportamento Materno , Mães/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Risco Ajustado/métodos
4.
Int Breastfeed J ; 15(1): 69, 2020 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-32770999

RESUMO

BACKGROUND: The first reports of the Chinese experience in the management of newborns of mothers with SARS-CoV 2 infection did not recommend mother-baby contact or breastfeeding. At present, the most important International Societies, such as WHO and UNICEF, promote breastfeeding and mother-baby contact as long as adequate measures to control COVID-19 infection are followed. In cases where maternal general health conditions impede direct breastfeeding or in cases of separation between mother and baby, health organizations encourage and support expressing milk and safely providing it to the infants. METHODS: A series of 22 case studies of newborns to mothers with COVID-19 infection from March 14th to April 14th, 2020 was conducted. Mothers and newborns were followed for a median period of 1.8 consecutive months. RESULTS: Out of 22 mothers, 20 (90.9%) chose to breastfeed their babies during hospital admission. Timely initiation and skin to skin contact at delivery room was performed in 54.5 and 59.1%, respectively. Eighty two percent of newborns to mothers with COVID-19 were fed with breast milk after 1 month, decreasing to 77% at 1.8 months. Six of 22 (37.5%) mothers with COVID-19 required transitory complementary feeding until exclusive breastfeeding was achieved. During follow-up period, there were no major complications, and no neonates were infected during breastfeeding. CONCLUSIONS: Our experience shows that breastfeeding in newborns of mothers with COVID-19 is safe with the adequate infection control measures to avoid mother-baby contagion. Supplementing feeding with pasteurized donor human milk or infant formula may be effective, until exclusive breastfeeding is achieved.


Assuntos
Betacoronavirus , Aleitamento Materno/métodos , Infecções por Coronavirus/complicações , Leite Humano , Pneumonia Viral/complicações , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Mães/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
6.
PLoS One ; 15(8): e0237067, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817664

RESUMO

BACKGROUND: Little consensus exists for growth performance of different feeding patterns in infancy. The objective of this study is to assess the growth performance of exclusively breastfed, partially breastfed and formula fed infants in China. METHODS: Data from a total of 109,052 infants aged 1-<12 months were collected from the 4th and 5th China National Surveys in 2005 and 2015. Feeding patterns were classified into three types for infants under 6 months of age: exclusive breastfeeding, partial breastfeeding and formula feeding. Exclusive breastfeeding refers to feeding exclusively from the mother's own milk (bottle-feeding included). RESULTS: 34.0% and 43.9% of infants were exclusively breastfed and 41.5% and 36.3% were partially breastfed at 4-<6 months in 2005 and 2015 respectively. Exclusively breastfed infants were generally a little heavier than partially breastfed and formula fed infants aged 1-<6 months; however, there was not a significant statistical difference between continued breastfeeding and formula feeding infants aged 6-<12 months. No significant statistical difference for length was observed among the three groups for ages 1-<6 months; however, infants who were continued to be breastfed were a little shorter compared to those who were formula fed (ages 6-<12 months). For infants aged 1-<2 months there was not a substantial difference from the 2006 WHO growth standards; however, for infants aged 2-<12 months the average weight and length of different feeding infants in China were a little heavier and longer than the 2006 WHO growth standards. CONCLUSIONS: Partial breastfed and formula fed infants were a little lighter than exclusively breastfed infants in the first half of the first year. Formula fed infants were a little longer than continued breastfed infants in the second half.


Assuntos
Alimentação Artificial/métodos , Aleitamento Materno/métodos , Desenvolvimento Infantil/fisiologia , Peso Corporal/fisiologia , China , Comportamento Alimentar/fisiologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Leite Humano/metabolismo
7.
Breastfeed Med ; 15(8): 488-491, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32614251

RESUMO

Background: Limited data are available on the perinatal and postnatal transmission of novel coronavirus disease 2019 (COVID-19). The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) recommended breastfeeding with necessary precautions to mothers with COVID-19. Case Presentation: A 20-year-old pregnant woman with no symptoms of COVID-19 presented to the hospital for delivery at 39 weeks of gestation. She was tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR) because her father had been diagnosed with COVID-19. A nasopharyngeal swab RT-PCR test was positive for SARS-CoV-2. Therefore, the baby and the mother were cared for separately after delivery. Breast milk obtained after first lactation was tested by real-time RT-PCR and was positive for SARS-CoV-2. Conclusions: In this article, we aimed to report the presence of SARS-CoV-2 in breast milk. Although further studies are needed, this situation may have an impact on breastfeeding recommendations.


Assuntos
Betacoronavirus/isolamento & purificação , Aleitamento Materno , Infecções por Coronavirus , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Leite Humano/virologia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Adulto , Doenças Assintomáticas/terapia , Aleitamento Materno/efeitos adversos , Aleitamento Materno/métodos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia
8.
Breastfeed Med ; 15(8): 492-494, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32644841

RESUMO

Aim: The objective of our study was to determine whether the SARS-CoV-2-positive mothers transmit the virus to their hand-expressed colostrum. Methods: This is an observational prospective study that included pregnant women who tested positive for SARS-CoV-2 by PCR test on a nasopharyngeal swab at the moment of childbirth and who wanted to breastfeed their newborns. A colostrum sample was obtained from the mothers by manual self-extraction. To collect the samples, the mothers wore surgical masks, washed their hands with an 85% alcohol-based gel, and washed their breast with gauze that was saturated with soap and water. Results: We obtained seven colostrum samples from different mothers in the first hours postdelivery. SARS-CoV-2 was not detected in any of the colostrum samples obtained in our study. Conclusion: In our study, breast milk was not a source of SARS-CoV-2 transmission. Hand expression (assuring that a mask is used and that appropriate hygienic measures are used for the hands and the breast), when direct breastfeeding is not possible, appears to be a safe way of feeding newborns of mothers with COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Aleitamento Materno/métodos , Extração de Leite/métodos , Colostro/virologia , Infecções por Coronavirus , Leite Humano/virologia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Adulto , Técnicas de Laboratório Clínico/métodos , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Triagem Neonatal/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Espanha/epidemiologia
11.
PLoS Genet ; 16(6): e1008790, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32525877

RESUMO

Recent discoveries from large-scale genome-wide association studies (GWASs) explain a larger proportion of the genetic variability to BMI and obesity. The genetic risk associated with BMI and obesity can be assessed by an obesity-specific genetic risk score (GRS) constructed from genome-wide significant genetic variants. The aim of our study is to examine whether the duration and exclusivity of breastfeeding can attenuate BMI increase during childhood and adolescence due to genetic risks. A total sample of 5,266 children (2,690 boys and 2,576 girls) from the Avon Longitudinal Study of Parents and Children (ALSPAC) was used for the analysis. We evaluated the role of breastfeeding (exclusivity and duration) in modulating BMI increase attributed to the GRS from birth to 18 years of age. The GRS was composed of 69 variants associated with adult BMI and 25 non-overlapping SNPs associated with pediatric BMI. In the high genetic susceptible group (upper GRS quartile), exclusive breastfeeding (EBF) to 5 months reduces BMI by 1.14 kg/m2 (95% CI, 0.37 to 1.91, p = 0.0037) in 18-year-old boys, which compensates a 3.9-decile GRS increase. In 18-year-old girls, EBF to 5 months decreases BMI by 1.53 kg/m2 (95% CI, 0.76 to 2.29, p<0.0001), which compensates a 7.0-decile GRS increase. EBF acts early in life by delaying the age at adiposity peak and at adiposity rebound. EBF to 3 months or non-exclusive breastfeeding was associated with a significantly diminished impact on reducing BMI growth during childhood. EBF influences early life growth and development and thus may play a critical role in preventing overweight and obesity among children at high-risk due to genetic factors.


Assuntos
Índice de Massa Corporal , Aleitamento Materno/estatística & dados numéricos , Obesidade/genética , Adiposidade/genética , Adolescente , Aleitamento Materno/métodos , Feminino , Predisposição Genética para Doença , Humanos , Lactente , Masculino , Obesidade/epidemiologia , Obesidade/prevenção & controle , Polimorfismo de Nucleotídeo Único , Adulto Jovem
14.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32424077

RESUMO

BACKGROUND: The American Academy of Pediatrics (AAP) revised its infant vitamin D intake guidelines in 2008. We aimed to examine previously unexplored trends in meeting vitamin D intake guidelines among US infants since 2009 and whether there were differences across demographic subgroups. METHODS: We analyzed dietary recall data for infants 0 to 11 months in the 2009-2016 NHANES. We estimated the percentage meeting 2008 AAP vitamin D guidelines, defined as consuming ≥1 L of infant formula and/or receiving a vitamin D supplement of ≥400 IU. We used Poisson regressions to assess trends over time and differences across demographic subgroups. RESULTS: Overall, 27.1% (95% confidence interval [CI]: 24.3%-29.8%) of US infants in 2009-2016 met vitamin D intake guidelines, with nonbreastfeeding infants (31.1% [95% CI: 27.6%-34.5%]) more likely to meet guidelines than breastfeeding infants (20.5% [95% CI: 15.4%-25.5%]; P < .01). From 2009-2010 to 2015-2016, overall and for both breastfeeding and nonbreastfeeding infants, there were no significant changes over time in the percentage of infants who met the guidelines (P > .05). Among breastfeeding infants, those with a family income ≥400% of the federal poverty level, with a college graduate head of household, and with private insurance were more likely to meet guidelines. CONCLUSIONS: Among US infants, we observed no increase in meeting AAP vitamin D intake guidelines since 2009. Less than 40% of infants met guidelines in nearly all demographic subgroups. These findings suggest renewed consideration of how to best meet vitamin D intake guidelines.


Assuntos
Suplementos Nutricionais , Fenômenos Fisiológicos da Nutrição do Lactente/efeitos dos fármacos , Adesão à Medicação , Política Nutricional/tendências , Vitamina D/administração & dosagem , Aleitamento Materno/métodos , Aleitamento Materno/tendências , Estudos Transversais , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido , Masculino , Inquéritos Nutricionais/métodos , Inquéritos Nutricionais/tendências , Estados Unidos/epidemiologia , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/prevenção & controle
15.
Ann Allergy Asthma Immunol ; 125(3): 280-286.e5, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32387533

RESUMO

BACKGROUND: Cesarean delivery (C-section) may influence the infant microbiome and affect immune system development and subsequent risk for allergic rhinitis (AR). OBJECTIVE: To investigate the association between C-section and AR at ages 6, 8, and 10 years. METHODS: Data were collected prospectively through Kaiser Permanente Northern Californias (KPNC) integrated healthcare system. Children were eligible if they were born in a KPNC hospital and remained in the KPNC system for minimum 6 years (n = 117,768 age 6; n = 75,115 age 8; n = 40,332 age 10). Risk ratios (RR) for C-section and AR were estimated at each follow-up age and adjusted for important covariates, including intrapartum antibiotics, pre-pregnancy body mass index, maternal allergic morbidities, and breastfeeding. Subanalyses considered information on C-section indication, labor, and membrane rupture. RESULTS: After adjusting for confounders, we did not observe an association between C-section and AR at follow-up ages 6, 8, or 10 years (RR [CI]: 6 years, 0.98 [0.91, 1.04]; 8 years, 1.00 [0.95, 1.07]; 10 years, 1.03 [0.96, 1.10]). In stratified analyses, there was limited evidence that C-section increases the risk of AR in certain subgroups (eg, children of non-atopic mothers, second or higher birth order children), but most estimated risk ratios were consistent with no association. Estimated associations were unaffected by participant attrition, missing data, or intrapartum antibiotics. CONCLUSION: C-section delivery was not associated with AR at follow-up ages of 6, 8, or 10 years in a large contemporary US cohort.


Assuntos
Cesárea/efeitos adversos , Rinite Alérgica/etiologia , Adulto , Peso ao Nascer/imunologia , Peso ao Nascer/fisiologia , Aleitamento Materno/métodos , Criança , Feminino , Humanos , Masculino , Mães , Gravidez , Rinite Alérgica/imunologia , Risco , Adulto Jovem
17.
J Gynecol Obstet Hum Reprod ; 49(7): 101805, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32407898

RESUMO

Introduction: In the context of the stage 3 SARS-Cov-2 epidemic situation, it is necessary to put forward a method of rapid response for an HAS position statement in order to answer to the requests from the French Ministry of Solidarity and Health, healthcare professionals and/or health system users' associations, concerning post-natal follow-up for women and neonates during the COVID-19 pandemic. Methods: A simplified 7-step process that favours HAS collaboration with experts (healthcare professionals, health system users' associations, scientific societies etc.), the restrictive selection of available evidence and the use of digital means of communication. A short and specific dissemination format, which can be quickly updated in view of the changes in available data has been chosen.


Assuntos
Betacoronavirus , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Cuidado Pós-Natal/normas , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/normas , Betacoronavirus/isolamento & purificação , Aleitamento Materno/métodos , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , França/epidemiologia , Humanos , Recém-Nascido , Disseminação de Informação/métodos , Triagem Neonatal/normas , Pandemias/prevenção & controle , Alta do Paciente/normas , Isolamento de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Cuidado Pós-Natal/organização & administração , Gravidez , Terceiro Trimestre da Gravidez , Gestantes
18.
J Neonatal Perinatal Med ; 13(3): 307-311, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32444569

RESUMO

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six "COVID-19 maternity centres" were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards.


Assuntos
Infecções por Coronavirus , Controle de Infecções , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias , Assistência Perinatal , Pneumonia Viral , Padrões de Prática Médica/tendências , Complicações Infecciosas na Gravidez , Betacoronavirus/isolamento & purificação , Aleitamento Materno/métodos , Defesa Civil/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Salas de Parto/normas , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Feminino , Humanos , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Inovação Organizacional , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle
20.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32161111

RESUMO

The nutritional and immunologic properties of human milk, along with clear evidence of dose-dependent optimal health outcomes for both mothers and infants, provide a compelling rationale to support exclusive breastfeeding. US women increasingly intend to breastfeed exclusively for 6 months. Because establishing lactation can be challenging, exclusivity is often compromised in hopes of preventing feeding-related neonatal complications, potentially affecting the continuation and duration of breastfeeding. Risk factors for impaired lactogenesis are identifiable and common. Clinicians must be able to recognize normative patterns of exclusive breastfeeding in the first week while proactively identifying potential challenges. In this review, we provide new evidence from the past 10 years on the following topics relevant to exclusive breastfeeding: milk production and transfer, neonatal weight and output assessment, management of glucose and bilirubin, immune development and the microbiome, supplementation, and health system factors. We focus on the early days of exclusive breastfeeding in healthy newborns ≥35 weeks' gestation managed in the routine postpartum unit. With this evidence-based clinical review, we provide detailed guidance in identifying medical indications for early supplementation and can inform best practices for both birthing facilities and providers.


Assuntos
Aleitamento Materno/métodos , Prática Clínica Baseada em Evidências , Lactação/fisiologia , Leite Humano/fisiologia , Algoritmos , Peso ao Nascer , Glicemia/metabolismo , Peso Corporal/fisiologia , Extração de Leite/métodos , Colostro/fisiologia , Suplementos Nutricionais , Feminino , Glicogênio/metabolismo , Humanos , Hiperbilirrubinemia/terapia , Recém-Nascido , Método Canguru , Transtornos da Lactação/etiologia , Microbiota/fisiologia , Leite Humano/química , Leite Humano/imunologia , Mães , Fototerapia , Fatores de Risco , Fatores de Tempo
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