Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, USA.
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Breastfeed Med. 2021 Mar;16(3):189-199. doi: 10.1089/bfm.2020.0353. Epub 2021 Feb 9.
Maternity care practices such as skin-to-skin care, rooming-in, and direct breastfeeding are recommended, but it is unclear if these practices increase the risk of clinically significant COVID-19 in newborns, and if disruption of these practices adversely affects breastfeeding. We performed a retrospective cohort study of 357 mothers and their infants <12 months who had confirmed or suspected COVID-19. Subjects came from an anonymous worldwide online survey between May 4 and September 30, 2020, who were recruited through social media, support groups, and health care providers. Using multivariable logistic regression, Fisher's exact test, and summary statistics, we assessed the association of skin-to-skin care, feeding, and rooming-in with SARS-CoV-2 outcomes, breastfeeding outcomes, and maternal distress. Responses came from 31 countries. Among SARS-CoV-2+ mothers whose infection was ≤3 days of birth, 7.4% of their infants tested positive. We found a nonsignificant decrease in risk of hospitalization among neonates who roomed-in, directly breastfed, or experienced uninterrupted skin-to-skin care ( > 0.2 for each). Infants who did not directly breastfeed, experience skin-to-skin care, or who did not room-in within arms' reach, were significantly less likely to be exclusively breastfed in the first 3 months, adjusting for maternal symptoms ( ≤ 0.02 for each). Nearly 60% of mothers who experienced separation reported feeling "very distressed," and 29% who tried to breastfeed were unable. Presence of maternal symptoms predicted infant transmission or symptoms (adjusted odds ratio = 4.50, 95% confidence interval = 1.52-13.26, = 0.006). Disruption of evidence-based quality standards of maternity care is associated with harm and may be unnecessary.
产妇护理实践，如皮肤接触、母婴同室和直接母乳喂养，被推荐使用，但目前尚不清楚这些实践是否会增加新生儿出现有临床意义的 COVID-19 风险，以及这些实践的中断是否会对母乳喂养产生不利影响。我们对 357 名患有确诊或疑似 COVID-19 的母亲及其 <12 个月大的婴儿进行了回顾性队列研究。研究对象来自于 2020 年 5 月 4 日至 9 月 30 日期间进行的一项匿名全球在线调查，通过社交媒体、支持团体和医疗保健提供者招募了这些参与者。我们使用多变量逻辑回归、Fisher 精确检验和汇总统计数据，评估了皮肤接触、喂养和母婴同室与 SARS-CoV-2 结局、母乳喂养结局和产妇焦虑之间的关联。调查结果来自 31 个国家。在感染发生在分娩后 ≤3 天的 SARS-CoV-2+母亲中，有 7.4%的婴儿检测结果呈阳性。我们发现，母婴同室、直接母乳喂养或持续进行皮肤接触的新生儿住院风险有一定程度的降低（每个因素风险降低幅度>0.2）。而没有直接母乳喂养、没有皮肤接触或没有母婴同室的婴儿，在调整了母亲症状后，在头 3 个月内更不可能完全母乳喂养（每个因素 P 值均≤0.02）。近 60%经历过母婴分离的母亲报告感到“非常痛苦”，而 29%试图母乳喂养的母亲则无法进行母乳喂养。母亲有症状预测了婴儿的传播或出现症状（调整后的优势比[OR] = 4.50，95%置信区间[CI] = 1.52-13.26，P=0.006）。破坏产妇护理的循证质量标准与危害有关，且可能是不必要的。
