COVID-19 ve Anne Sütü ile Beslenme

Aralık 2019’da Çin’den başlayarak tüm dünyaya yayılan COVID-19 enfeksiyonu doğumdan itibaren yaşamın her evresini etkileyen bir enfeksiyondur. Küçük çocukların çoğunda asemptomatik ya da hafif şiddette seyrettiği bildirilen COVID-19 enfeksiyonuna yakalanan gebe ve çocuk sayısı giderek artmaktadır. Olağanüstü koşullarda sağlığın korunması ve sürdürülmesinde anne sütü ile beslenme çok önemlidir. Anne sütünün hem anne hem de bebek için kısa ve uzun vadede pek çok olumlu etkisi olduğu bilinmektedir. Yenidoğan gereksinimlerine göre düzenlenebilen eşsiz besleyici özelliği yanı sıra anne sütü içinde bulunan biyoaktif maddeler, büyüme ve gelişmeyi etkileyen hormon ve büyüme faktörleri, immün sistemi düzenleyen faktörler ve antienflamatuvar maddeler bebeği enfeksiyonlardan korumaktadır. Ayrıca maternal enfeksiyonda 7 gün içinde anne sütünde saptanan antikorlar da bebekte enfeksiyon riskini azaltmaktadır. Bu sayede anne sütü ile beslenen bebeklerde otitis media, alt solunum yolu enfeksiyonları, gastroenterit ve prematüre bebeklerde nekrotizan enterokolit nadir görülmektedir. Bu zamana kadar yapılan çalışmalarda anne sütünden bebeğe COVID-19 enfeksiyonu bulaştığı bildirilmemiştir. DSÖ anne sütünün yararlarını, formül sütle beslenmenin zararlarını da hesaba katarak COVID-19 enfekte annelerin maske ve el hijyenine dikkat ederek ten temasını ve anne sütüyle beslenmeyi önermektedir. Sağlık personelleri bu önerilerin rehberliğinde emzirmeyi başlatma ve sürdürme konusunda anne-bebek çiftine destek olmalıdır.

COVID-19 Pandemic and Breastfeeding

COVID-19, which spread around the world starting from China in December 2019, is an infection that affects every stage of life from birth. The number of pregnant women and children infected with COVID-19, which is reported to be asymptomatic or to show mild symptoms in most young children, is increasing. Breastfeeding is paramount in terms of sustaining good health during these exceptional conditions. Breast milk is known to have many positive effects for both the mother and the baby in the short and long term. Breast milk has unique nutritious properties that can be regulated according to neonatal requirements, bioactive substances in breast milk, hormone, and growth factors that affect growth and development factors that regulate the immune system and anti-inflammatory substances which protect the baby from various infections. In addition, antibodies detected in breast milk within 7 days of maternal infection reduce the risk of infection in the baby. In this way, otitis media, lower respiratory tract infections, gastroenteritis, and necrotizing enterocolitis are rare in infants who are breastfed. It has not been reported that COVID-19 infection can be transmitted through breast milk from the mother to the baby. Taking into account the benefits of breast milk and skin to skin contact in contrast with the harms of feeding with formula milk, the WHO advices mothers with COVID-19 to use masks and to pay close attention to hand hygiene. Health care personnels should support the mother in starting and maintaining breastfeeding under the guidance of these recommendations.

___

  • 1. Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr 2020 Apr 22. doi: 10.1001/jamapediatrics.2020.1467 Epub ahead of print. PMID: 32320004.
  • 2. Gokcay G, Keskindermirci G. Breastmilk and Covid-19. J Ist Faculty Med Published online March 23, 2020. doi: 10.26650/ IUITFD.2020.0025
  • 3. Karabayir N, Yaşa B, Gökçay G. Chickenpox infection during lactation. Breastfeed Med 2015;10(1):71-2.
  • 4. Sendelbach DM, Sanchez PJ. Varicella, influenza: not necessary to separate mother and infant. Pediatrics 2012 Aug;130(2):e464; author reply 465-6.
  • 5. Halperin BA, Morris A, Mackinnon-Cameron D, J Mutch, J M Langley, S A McNeil, et al. Kinetics of the antibody response to tetanusdiphtheriaacellular pertussis vaccine in women of childbearing age and postpartum women. Clin Infect Dis 2011;53:885-92.
  • 6. Bachrach VR, Schwarz E, Bachrach LR. Breastfeeding and the risk of hospitalization for respiratory disease in infancy: a meta-analysis. Arch Pediatr Adolesc Med 2003;157:237-43.
  • 7. Lau Y, Tha PH, Ho-Lim SST, Wong LY, Lim PI, Citra Nurfarah BZM, et al. Analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation. Matern Child Nutr 2018;14(1). doi: 10.1111/mcn.12492
  • 8. Stuebe A. Breastfeed Med 2020; Apr 7. doi: 10.1089/bfm.2020. 29153.ams
  • 9. Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. J Affect Disord 2015 Jan;171:142-54.
  • 10. World Health Organization, Guiding principles for feding infants and young children during emergencies. 2004, Geneva WHO/ NHD/99.10
  • 11. Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol 2020 Jul;223(1):36-41. doi: 10.1016/j. ajog.2020.04.013. Epub 2020 Apr 18. PMID: 32311350; PMCID: PMC7165087.
  • 12. Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L, et al. Sixth batch of Anhui medical team aiding Wuhan for COVID-19. Coronavirus disease 2019 in pregnancy. Int J Infect Dis 2020 Jun;95:376-83. doi: 10.1016/j.ijid.2020.04.065. Epub 2020 Apr 27. PMID: 32353549; PMCID: PMC7185021.
  • 13. Elshafeey F, Magdi R, Hindi N, Elshebiny M, Farrag N, Mahdy S, et al. A systematic scoping review of COVID-19 during pregnancy and childbirth. Int J Gynaecol Obstet 2020 Jul;150(1):47-52. doi: 10.1002/ijgo.13182. Epub 2020 May 17. PMID: 32330287.
  • 14. Wu Y, Liu C, Dong L, Zhang C, Chen Y, Liu J, et al. Coronavirus disease 2019 among pregnant Chinese women: Case series data on the safety of vaginal birth and breastfeeding. BJOG 2020 May 5;127(9):1109-15. doi: 10.1111/1471-0528.16276. Epub ahead of print. PMID: 32369656; PMCID: PMC7383704.
  • 15. De Rose DU, Piersigilli F, Ronchetti MP, Santisi A, Bersani I, Dotta et al. Study Group of Neonatal Infectious Diseases of The Italian Society of Neonatology (SIN). Novel Coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr 2020 Apr 29;46(1):56. doi: 10.1186/s13052-020-0820-x. PMID: 32349772; PMCID: PMC7190200.
  • 16. Royal College of Paediatrics and Child Health. COVID-19-guidance for paediatric services. RCPCH. London. Erişim: https://www.rcpch. ac.uk/sites/default/files/generated-pdf/ document/COVID-19--- guidance-for-paediatric-services.pdf. Erişim Mayıs 2020, https:// abm.memberclicks.net/abm-statement-coronavirus erişim Mayıs 2020.
  • 17. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020 Feb 10;12(2). pii: E194.
  • 18. Robertson CA, Lowther S, Birch T, Tan C, Sorhage F, Stockman L, et al. SARS and Pregnancy: A Case Report. Emerg Infec Dis 2004;Feb;10(2):345-8. doi: 10.3201/eid1002.030736. PMID: 15030710; PMCID: PMC3322896.
  • 19. Unicef. Nutrition. Advocacy Brief. Breastfeeding and HIV. Global breastfeeding collective. Erişim: https://www.unicef.org/ nutrition/files/Global_Breastfeeding_Collective_Advocacy_Brief_ Breastfeeding_and_HIV.pdf Son erişim tarihi: 30 Nisan 2020
  • 20. Dünya Sağlık Örgütü. https://www.who.int/docs/defaultsource/ maternal- health/faqs-breastfeeding-and-covid-19. pdf?sfvrsn=d839e6c0_1 Erişim : 30 Nisan 2020