Breast feeding at the time of COVID-19: do not forget expressed mother's milk, please.

In the context of the coronavirus disease (COVID-19) prevention and cure, a remarkable issue, particularly in maternity hospitals, is represented by the risk of mother to child transmission by a breastfeeding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive woman.1

In a recent letter, Li states ‘all infants with suspected COVID-19 should be isolated and monitored regardless of whether or not they present with symptoms’,2 without giving further details on the management of newborn infant feeding. Moreover, Chinese colleagues who have recently coped with COVID-19 just do not consider the breast feeding option, nor the use of expressed breast milk for newborn infants.3 We can assume at least some of the reasons behind this choice: the routine separation between an infected mother and her baby, the need for an organisational simplification during a novel emergency.

Instead, from Switzerland, Favre et al suggest to avoid direct breast feeding,4 as sucking at the breast presumably might increase the risk of SARS-CoV-2 transmission via aerosol due to the intimate contact during feeds. Thus, the author seems to implicitly endorse the use of expressed mother’s milk, although in the flow chart contained in the online supplementary appendix, he contradictorily warns just against breast feeding for all SARS-CoV-2-positive mothers at delivery.

Actually before ignoring and/or discouraging breast feeding by default in a SARS-CoV-2-positive mother at delivery, we should carefully consider the following.

First, the primary concern is not whether the virus can be transmitted through breast milk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breast feeding. Washing mother’s hands before touching the infant and wearing a face mask, while feeding at the breast, remain effective basic preventive measures.

Second, we should be aware that the practice of routine separation of the newborn infant from her mother, also in case of asymptomatic or paucisymptomatic SARS-CoV-2 infection, for sure penalises the mother–baby relationship and the beginning of breast feeding.

Third, whenever direct breast feeding is not recommended on a case-by-case basis, use of expressed mother’s milk should be considered as a second choice, to rescue at least the benefits of the nutrition with mother’s milk, if not those related to direct breast feeding.

Fourth, in the light of limited scientific evidence breast milk cannot be considered per se a vehicle of SARS-CoV-2 infection, while on the contrary contains specific antibodies possibly modulating an eventual SARS-CoV-2 infection in the newborn infant.

In conclusion, protocols applied in maternity hospitals to prevent COVID-2 should consider, as far as possible, the promotion of breast feeding, without disregarding the feasible option of expressing mother’s milk.