Table 1.
Studies included in the review of breastfeeding (BF) and SARS-CoV-2 infection (N=28).
| Authors | Year | Country | Study Type | No of infected mothers | Mother’s age (years) | Infant’s Age (months) | Mother’s Symptoms | Infant’s Symptoms/test | Feeding mode | Maternal Separation (Y, yes/N, no) | SARS-CoV-2 in breastmilk | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A. Infected mother–non-infected infant | ||||||||||||
| Lowe and Bopp (13) | 2020 | Australia | Case report | 1 | 31 | <1 | Fever & respiratory symptoms | (−) | BF | N | N/A | BF & room-in with precautions |
| Pereira et al. (14) | 2020 | Spain | Retrospective case series | 22 | 34 (19–43) | <1 | 50% symptomatic (6 mild symptoms, 5 pneumonia) | (−) | 20/22 BF | 9/11 symptomatic mothers isolated | N/A | BF with precautions, Upon maternal isolation: feeding with pasteurized DHM or IF until BF is resumed |
| 2/22 IF | ||||||||||||
| Lang and Zhao (15) | 2020 | China | Case report | 1 | 30 | <1 | Dry cough | (−) | BF after isolation | Y | (−) | BF after isolation and negative test, PBM during isolation |
| Bastug et al. (16) | 2020 | Turkey | Case report | 1 | 20 | <1 | Asymptomatic | (−) | PBF, When SARS-CoV-2 detected in BM-BF discontinued | Y | (+) | Decision about BF by parent & doctor |
| Gabriel et al. (17) | 2020 | Spain | Observational prospective study | 7 | 33.4 (31–37) | <1 | 6/7 asymptomatic 1/7 fever, myalgia, malaise, headache | (−) | BF | N/A | (−) | Direct BF safe or hand: expressed BM with precautions |
| Chu et al. (18) | 2020 | China | Case report | 1 | 30 | <1 | Gastrointestinal symptoms, fever | (−) | PBM | Y | (−) | SARS-CoV-2 rarely transmitted through BM- possible induction of passive immunity via lgG |
| Liu et al. (19) | 2020 | China | Case report | 1 | 37 | 6 | Fever, cough, sore throat, fatigue | (−) | BF discontinued after mother’s positive test | Y | N/A | PBM and feeding to infant by a healthy caretaker/family member |
| Feng et al. (20) | 2020 | China | Case report | 1 | 33 | 2 | Fever | (−) | Suspended BF after diagnosis | Y | N/A | BF temporal suspension |
| Perrone et al. (21) | 2020 | Italy | Case report | 1 | N/A | <1 | fever, anosmia, & malaise | (−) | BF + expressed maternal milk | N | (−) | BF with precautions when virus is not traced in milk |
| Liu et al. (22) | 2020 | China | Prospective study | 19 | 31 (27–34) | <1 | fever (11/19), 5/19 cough or dyspnea, 2/19 diarrhea or another gastrointestinal symptom | (−) | Term Formula | Y | (−) | Not vertical transmission with BF |
| Dong et al. (23) | 2020 | China | Case report | 1 | 33 | <1 | Cough & chest tightness | (−) | BF | Y | (−) | lgG & lgA of BM might provide immune protection |
| Zhu et al. (24) | 2020 | China | Case report | 5 | 32 (27–34) | <1 | Main symptoms: fever, chest distress or dyspnea, cough, nasal congestion, rhinorrhea, poor appetite, or diarrhea | (−) | N/A | N/A | 1/5 (+) | Generally BF encouragement but when SARS-CoV-2 BM increased risk of transmission |
| Dong et al. (25) | 2020 | China | Case report | 1 | 29 | <1 | Fever, nasal congestion, respiratory difficulties | (−) | N/A | Y | (−) | When increased lgG & lgM levels-infection at delivery cannot ruled out |
| Li et al. (26) | 2020 | China | Case Report | 1 | 30 | <1 | Dry cough, fever | (−) | N/A | Y | (−) | mother-to-child transmission is unlike. |
| B. Infected mother–Infected infant | ||||||||||||
| Yu et al. (27) | 2020 | China | Case report | 1 | 32 | 13 | Nasal congestion | (+) | Directly BF & complementary after 6 months | N | (−) | BF safe |
| Fever, dry cough, nasal congestion | ||||||||||||
| Groß et al. (28) | 2020 | Germany | Case series | 2 | N/A | <1 | Mild symptoms | (+) | BF | N | Mother’s 1 (−) | BF with precautions/further investigation on virus transmission potential during BF |
| Respiratory, breathing symptoms icterus | Mother’s 2 | |||||||||||
| (+) | ||||||||||||
| Tam et al. (29) | 2020 | Australia | Case series | 1 | 40 | 8 | Sore throat, myalgia, productive cough, fever | (+) | BF discontinued and PBM when infant was confirmed with COVID-19 | N | (+) | In infected infants BF should be continued/nil adverse effects/SARS-CoV-2 RNA in breast milk sample did not indicate viable virus |
| Mild coryzal symptoms, non-productive cough | ||||||||||||
| Salvatori et al. (30) | 2020 | Italy | Case report | 2 | 31 (26–36) | <1 | 50% anosmia & dysgeusia, 50% back & thoracic pain | (+) | BF | N | (−) | BF supported, transmission more possibly through respiratory droplets |
| 50% asymptomatic | ||||||||||||
| 50% diarrhea, cough, poor feeding | ||||||||||||
| Phadke et al. (31) | 2020 | India | Case report | 1 | 33 | <1 | Asymptomatic | (+) | IF | Y | N/A | BF & room-in with precautions |
| asymptomatic | After positive test for infant: direct BF | |||||||||||
| Kirtsman et al. (32) | 2020 | Canada | Case report | 1 | 40 | <1 | myalgia, decreased appetite, fatigue, dry cough & fever | (+) | BF | N | (+) | Further studies to neonates are needed to identify transmission routes |
| Neutropenic, mild hypothermia, feeding difficulties & hypoglycemic episodes | ||||||||||||
| Hinojosa-Velasco et al. (33) | 2020 | Mexico | Case report | 1 | 21 | <1 | Cough, odynophagia, headache, diarrhea, rhinorrhea, sore throat, fever | (+) newborn jaundice, tachypnea, hypernatremia, central cyanosis, dyspnea, and oxygen saturation of less than 92%, (NICU) | Synthetic milk formula | Y | (+) | BF might be protective |
| Wang et al. (34) | 2020 | China | Case report | 1 | 34 | <1 | Fever, vaginal bleeding, lower abdominal pain | (+) | Infant Formula | Y | (−) | No BF |
| Fan et al. (35) | 2020 | China | Case series | 2 | 31.5 (29–34) | <1 | 1: Nasal congestion, fever | (+) | IF | 1/2 Y | (−) | Low risk of vertical transmission via BF, potential protective role of passive antibodies |
| 2: fever, nasal congestion, sore throat | 1: fever and abdominal distension with lymphopenia | |||||||||||
| 2: mild neonatal pneumonia and lymphopenia | ||||||||||||
| C. Infected mother- both infected and non-infected infants | ||||||||||||
| ElHalik et al. (36) | 2020 | United Arab Emirates | Retrospective observational study | 35 | 32 (24–42) | <1 | Negative | 34/36 (−) | 32/36 direct BF or PBM | 27/36 roomed-in | N/A | Direct BF or PBM encouraged with precautions |
| 2/36 (+) | ||||||||||||
| 1 asymptomatic | ||||||||||||
| 1 admitted to NICU with respiratory distress | ||||||||||||
| Ronchi et al. (37) | 2020 | Italy | Prospective multicenter study | 61 | 32 (28–36) | <1 | Symptoms at diagnosis: 34/61 asymptomatic | 0/62 on birth | 45/62 Exclusive BF | 51/52 roomed-in exclusive BF | N/A | BF and room-in encouraged to infected mothers with good clinical condition with precautions |
| 27/61 at least 1 symptom | 2/62 positive for SARS-CoV-2 at 7 and 20d of life respectively | 13/62 BF + IF 3/62 exclusive IF 1/62 BF + PBM | ||||||||||
| Patil et al. (38) | 2020 | United States of America | Retrospective cross-sectional study | 45 | 30 (27.5–35.5) | <1 | 27/45 asymptomatic | 42/45 (+) SARS-CoV-2 | 31/33 | 33/45 roomed-in | No tested sample | BF and room-in under proper precautions |
| 16/45 mild symptoms | 3/45 -(+)/admitted to NICU-asymptomatic | 5/45 separated, | ||||||||||
| 2/45 ICU | 7/45 preterm admitted to NICU | |||||||||||
| Bertino et al. (39) | 2020 | Italy | Prospective Collaborative Observational Study | 12 | 30.5 (24–38) | <1 | 10/12 symptomatic: fever, myalgia, rhinitis, cough, dyspnea, sore throat, conjunctivitis, diarrhea, chest pain, anosmia, ageusia | 4/12 (+) SARS-CoV-2 asymptomatic | 11/12 exclusively BF | No | 11/12 (−) | BF or PBM (in isolation) encouraged irrespective swab test results with proper precautions |
| 1/12 (+) | ||||||||||||
| D. Non-infected mother-infected infant | ||||||||||||
| Le et al. (40) | 2020 | Vietnam | Case report | 1 (non-infected) | N/A | 3 | None (−) | (+) Rhinorrhea, nasal congestion & fever | Exclusively BF | No | No tested sample | Need to further investigate SARS-CoV-2 transmission routes to pediatric population |
BF, breastfeeding; IF, infant formula; Y, yes; n, no; N/A, not available; DHA, donor human milk; PBM, pumped breast milk; PBF, pumped breastfeeding; BM, breast milk; (−), negative; (+), positive; NICU, neonatal intensive care unit.