284 - Feeding strategies to prevent neonatal SARS-CoV-2 infection in term or late preterm babies born to mothers with confirmed COVID-19

Poster Number: 284
Publication Number: 284.226

Kikelomo Babata, UTSOUTHWEstern Medical center, allen, TX, United States; Kee Thai Yeo, KK Women's & Children's Hospital, Singapore, N/A, Singapore; Rehena Sultana, Duke-NUS Medical School, Singapore, N/A, Singapore; Christina S. Chan, University of Texas Southwestern Medical School, Dallas, TX, United States; Kelly M. Mazzarella, University of Texas Southwestern Medical School, Frisco, TX, United States; Juin Yee Kong, Kk women’s and children’s hospital, Singapore, N/A, Singapore; Tanaz Muhamed, Plano East Senior High School, Richardson, TX, United States; Jean-Michel Jean-Michel HASCOËT, Lorraine University, NANCY, Lorraine, France; Luc P. Brion, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Through the SARS-CoV-2 pandemic, there have been various newborn feeding guidelines to reduce the risk of SARS-CoV-2 transmission. Questions have arisen about whether breastmilk/breastfeeding increases the risk of SARS-CoV-2 Infection or confers protection.
 

Objective: To systematically review available evidence to evaluate SARS-Cov-2 infection risk among neonates born ≥34 weeks gestation by feeding and precaution practices

Design/Methods: We executed a systematic review to evaluate neonatal feeding practices and the risk of SARS-CoV-2 infection in exposed neonates. We performed a search using PubMed, Medline and Google Scholar from 1st of January 2020 through 22nd of July 2020. Neonates born ≥34 weeks gestational age were included if (1) they were born to mothers who tested positive for SARS-CoV-2 within 10 days prior to birth or during maternal birth hospitalization; (2) neonatal SARS-CoV-2 testing was done during their birth hospitalization and (3) feeding practices were described. We also included neonates < /= 28 days of age who tested positive for SARS-CoV-2 after birth hospitalization. Primary outcomes were SARS-CoV-2 infection and neonatal death while the secondary outcome was infection severity. We classified reports based on feeding categories shown in Table 1. Two reviewers screened and discussed studies eligibility.
 

Results: A total of 2668 publications were identified, 474 were eligible for full-text review, and 38 met the criteria for inclusion. Of these, 35 were case series/case reports and 3 cohort studies. 271 infants were included (some infants were exposed to more than 1 feeding type) (Table 1). Clinical characteristics are shown in Table 2. Based on our analysis of available data(Table 3), there was no statistically significant difference in SARS-CoV-2 positive rates or presence of COVID-19 symptoms when comparing infants with and without exposure to breastfeeding and/or infection control precautions. No deaths were reported.Conclusion(s): We did not detect association of breastfeeding with the transmission or severity of SARS-CoV-2 infection among infants born ≥34 weeks. Our study is limited by lack of randomization, evaluation of publications during the early pandemic period, publication bias, incomplete data for analysis, infants with more than one feeding type, the low numbers, and other possible sources of neonatal exposure to infection (e.g. vertical infection, nosocomial, etc). There is very low certainty of the evidence for all outcomes of this review, Data analysis is ongoing to extend the period of review to July 2021.
 
Table 1. Distribution of infants analysed, stratified by feeding strategy*Indicates number of infants with specific characteristics/total infants with available data. Groups are not mutually exclusive.
ΦPooled event rate with 95% confidence interval (95%CI)
Most reports had incomplete data and some infants were exposed to more than one feeding type; therefore,
totals do not add up.
Table 2. Clinical characteristics of infants included in review* Indicates number of infants with specific characteristics/total infants with available data. Some groups are not mutually exclusive.
Φ pooled event rate with 95% confidence interval (95%CI)