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18-3 update Corona virus
ALLE ADVIEZEN VAN 14-3 BLIJVEN VAN KRACHT.
De KNOV heeft gisteren het onderstaande bericht met haar leden gedeeld:
Noodzaak lactatiekundige in het kraambed
Als blijkt dat een lactatiekundige nodig is in het kraambed, dan het liefste (beeld)bellen. Het kan echter zo zijn dat er praktische hulp aan bed nodig is. Weeg dit met de lactatiekundige af en wijs haar op de juiste voorzorgsmaatregelen.
Statement European Milk Bank Association (EMBA)
Regarding human milk donation:
Human milk is essential for premature infants, as it significantly reduces the risk of serious complications related to prematurity, in the short and long term.
Human milk donation is organized and supported by EMBA according to the common rules concerning the selection of donors based on a health questionnaire and on blood sampling as well as the handling and treatment of milk by pasteurisation, in accordance with the EMBA documents.
It is not yet known whether SARS CoV-2 can be found in human milk, and if found, it could be contagious.
Other coronaviruses are destroyed by thermal inactivation3. In particular, MERS-coronavirus is inactivated in camel, goat and cow’s milk at 63°C for 30 min4. However, it should be pointed out that the few available studies simulated pasteurisation in small aliquots, a procedure that does not follow human milk bank protocols. Based on the available data on other coronaviruses it is likely that, even if SARS CoV-2 is present in breastmilk, it could also be destroyed by pasteurisation, but solid data is needed.
De informatie die gebruikt worden in de protocollen (die we nu zien ontstaan) met betrekking tot zwangerschap en borstvoeding zijn terug te vinden via de volgende informatiebronnen:
De RCOG-richtlijn Coronavirus (NVOG, KNOV, NVK, RIVM) gedeeld via kenniscentrumgeboortezorg.nl
Omdat er nog niet veel data beschikbaar zijn over zwangere vrouwen en hun kinderen hebben de NVOG, KNOV, NVK en RIVM besloten de RCOG-richtlijn te volgen.
Informatie van de Royal College of Obstetricians & Gynaecologists
4.8 Postnatal management
4.8.1 Neonatal care
There are limited data to guide the postnatal management of babies of mothers who tested positive for COVID-19 in the third trimester of pregnancy. Reassuringly, there is no evidence at present of (antenatal) vertical transmission as of 17th March 2020. Media reports to the contrary are, to our current knowledge, based on incorrect information.
Literature from China has advised separate isolation of the infected mother and her baby for 14 days. However, routine precautionary separation of a mother and a healthy baby should not be undertaken lightly, given the potential detrimental effects on feeding and bonding. Given the current limited evidence we advise that women and healthy infants, not otherwise requiring neonatal care, are kept together in the immediate post-partum period.
A risks / benefits discussion with neonatologists and families to individualise care in babies that may be more susceptible is recommended. We emphasise that this guidance may change as knowledge evolves.
All babies born to COVID-19 positive mothers should be cared for as per RCPCH guidance.
4.8.2 Infant feeding
It is reassuring that in six Chinese cases tested, breastmilk was negative for COVID-19;2 however, given the small number of cases, this evidence should be interpreted with caution. The main risk for infants of breastfeeding is the close contact with the mother, who is likely to share infective airborne droplets. In the light of the current evidence, we advise that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk.The risks and benefits of breastfeeding, including the risk of holding the baby in close proximity to the mother, should be discussed with her.This guidance may change as knowledge evolves.
For women wishing to breastfeed, precautions should be taken to limit viral spread to the baby:
- Hand washing before touching the baby, breast pump or bottles;
- Try and avoid coughing or sneezing on your baby while feeding at the breast;
- Consider wearing a face mask while breastfeeding, if available;
- Follow recommendations for pump cleaning after each use;
- Consider asking someone who is well to feed expressed milk to the baby.
For women bottle feeding with formula or expressed milk, strict adherence to sterilisation guidelines is recommended.Where mothers are expressing breastmilk in hospital,a dedicated breast pump should be used.
Given the current limited evidence we advise that women and healthy infants, not otherwise requiring neonatal care, are kept together in the immediate post-partum period.
Informatie van de Center for Disease Control and Prevention
Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19
This interim guidance is intended for women who are confirmed to have COVID-19 or are persons-under-investigation (PUI) for COVID-19 and are currently breastfeeding. This interim guidance is based on what is currently known about COVID-19 and the transmission of other viral respiratory infections. CDC will update this interim guidance as needed as additional information becomes available. For breastfeeding guidance in the immediate postpartum setting, refer to Interim Considerations for Infection Prevention and Control of 2019 Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings.
Transmission of COVID-19 through breast milk
Much is unknown about how COVID-19 is spread. Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (flu) and other respiratory pathogens spread. In limited studies on women with COVID-19 and another coronavirus infection, Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been detected in breast milk; however we do not know whether mothers with COVID-19 can transmit the virus via breast milk.
CDC breastfeeding guidance for other infectious illnesses
Breast milk provides protection against many illnesses. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. CDC has no specific guidance for breastfeeding during infection with similar viruses like SARS-CoV or Middle Eastern Respiratory Syndrome (MERS-CoV).
Outside of the immediate postpartum setting, CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant.
Guidance on breastfeeding for mothers with confirmed COVID-19 or under investigation for COVID-19
Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers. A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.
INFORMATIE VAN DE ILCA (INTERNATIONAL LACTATION CONSULTANT ASSOCIATION)
RESOURCES FOR SKILLED LACTATION PROVIDERS ON COVID-19
WORLD HEALTH ORGANISATION (WHO) interim guidance on clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected:
“Infants born to mothers with suspected, probable, or confirmed COVID-19 should be fed according to standard infant feeding guidelines, while applying necessary precautions for IPC.”
“As with all confirmed or suspected COVID-19 cases, symptomatic mothers who are breastfeeding or practising skin-to-skin contact or kangaroo mother care should practise respiratory hygiene, including during feeding (for example, use of a medical mask when near a child if the mother has respiratory symptoms), perform hand hygiene before and after contact with the child, and routinely clean and disinfect surfaces with which the symptomatic mother has been in contact.”
“Breastfeeding counselling, basic psychosocial support, and practical feeding support should be provided to all pregnant women and mothers with infants and young children, whether they or their infants and young children have suspected or confirmed COVID-19.”
“In situations when severe illness in a mother with COVID-19 or other complications prevents her from caring for her infant or prevents her from continuing direct breastfeeding, mothers should be encouraged and supported to express milk, and safely provide breastmilk to the infant, while applying appropriate IPC measures.”
“Mothers and infants should be enabled to remain together and practise skin-to-skin contact, kangaroo mother care and to remain together and to practise rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”
“Parents and caregivers who may need to be separated from their children, and children who may need to be separated from their primary caregivers, should have access to appropriately trained health or non-health workers for mental health and psychosocial support.”
World health organization (WHO) guidance on breastfeeding with suspected Covic-19 with mild symptoms.
“Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can [sic] continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document.”
UNICEF GUIDANCE FOR PARENTS
Is it safe for a mother to breastfeed if she is infected with coronavirus?
All mothers in affected and at-risk areas who have symptoms of fever, cough or difficulty breathing, should seek medical care early, and follow instructions from a health care provider. Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions. For symptomatic mothers well enough to breastfeed, this includes wearing a mask when near a child (including during feeding), washing hands before and after contact with the child (including feeding), and cleaning/disinfecting contaminated surfaces – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children. If a mother is too ill, she should be encouraged to express milk and give it to the child via a clean cup and/or spoon – all while following the same infection prevention methods.”
ACADEMY FOR BREASTFEEDING MEDICINE (ABM) statement on Coronavirus 2019 (COVID-19)
“Breast milk provides protection against many illnesses. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. CDC has no specific guidance for breastfeeding during infection with similar viruses like SARS-CoV or Middle Eastern Respiratory Syndrome (MERS-CoV) also both Corona viruses. In a similar situation to COVID-19, the CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant. Given low rates of transmission of respiratory viruses through breast milk, the World Health Organization states that mothers with COVID-19 can breastfeed.”
The complete statement also includes guidance for both home and hospital.
The choice to breastfeed is the mother’s and families. If the mother is well and has only been exposed or is a PUI with mild symptoms, breastfeeding is a very reasonable choice and diminishing the risk of exposing the infant to maternal respiratory secretions with use of a mask, gown and careful handwashing is relatively easy. If the mother has COVD-19, there may be more worry, but it is still reasonable to choose to breastfeed and provide expressed milk for her infant. Limiting the infant’s exposure via respiratory secretions may require more careful adherence to the recommendations depending on the mother’s illness. …”
ACADEMY FOR BREASTFEEDING MEDICINE (ABM) news release: Coronavirus treatment and risk to breastfeeding women – Mary Ann Liebert Inc. Publishers.
Arthur I. Eidelman, MD, Editor-in-Chief of Breastfeeding Medicine, states: “Given the reality that mothers infected with coronavirus have probably already colonized their nursing infant, continued breastfeeding has the potential of transmitting protective maternal antibodies to the infant via the breast milk. Thus, breastfeeding should be continued with the mother carefully practicing handwashing and wearing a mask while nursing, to minimize additional viral exposure to the infant.”
Informatie van Lactation Education ResourcesFact_Sheet-Telehealth