Vu Hoang Duong, Cashin Jennifer, Gribble Karleen, Marinelli Kathleen, Mathisen Roger
Alive & Thrvie Southeast Asia, FHI 360, Hanoi, Vietnam.
Alive & Thrive Southeast Asia, FHI 360, Yangon, Myanmar.
BMJ Nutr Prev Health. 2020 Dec 22;3(2):339-350. doi: 10.1136/bmjnph-2020-000184. eCollection 2020 Dec.
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.
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.
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.
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.
需要针对疑似或确诊感染新冠病毒的新妈妈及其婴儿的临床管理提出建议。指导方针必须权衡严重急性呼吸综合征冠状病毒2（SARS-CoV-2）传播带来的风险与母亲陪伴和母乳喂养为婴儿提供的保护。我们的目的是审查国际上关于孕产妇和新生儿护理的新冠病毒指导方针，评估其与世界卫生组织（WHO）建议的一致性，以及政策支持或不利于母乳喂养的程度。
评估了33个国家关于母亲疑似或确诊感染新冠病毒的婴儿护理的指导文件，以确定其与WHO关于以下方面建议的一致性：（1）皮肤接触；（2）尽早开始母乳喂养；（3）母婴同室；（4）直接母乳喂养；（5）提供挤出的母乳；（6）提供捐赠人乳；（7）雇佣奶妈；（8）提供母乳代用品；（9）为分离的母亲提供心理支持；（10）为分离的婴儿提供心理支持。
发现建议存在相当大的不一致性。即使在婴儿死亡率高的国家，反对支持母乳喂养做法的建议也很常见。所审查的指导文件中没有一份推荐WHO指导方针的所有方面。存在与WHO建议相冲突的有影响力的指导方针，以及对母亲陪伴和母乳喂养对婴儿健康重要性的低估，似乎导致了这种不一致。
在新冠疫情和其他传染病爆发期间制定指导方针的人员需要适当考虑皮肤接触、尽早开始母乳喂养、母婴同室和母乳喂养对母婴身心健康的重要性。在未来制定指导方针时权衡其他建议的价值时，各国应考虑过去对母乳喂养的可靠性和重视程度。在没有令人信服的证据表明有必要且比维持母婴关系完整危害更小的情况下，不应提出反对母亲陪伴和母乳喂养的建议。
