Speech therapy, breastfeeding and COVID-19: information to speech therapist

Vanessa Souza Gigoski de Miranda Rafaela Soares Rech Márcia Angélica Peter Maahs Monalise Costa Batista Berbert Sheila Tamanini de Almeida About the authors

During the first months of 2020, a new virus spread rapidly to countries around the world, SARS-CoV 2. The World Health Organization (WHO) called the disease caused by this virus Coronavirus Disease 19 (COVID-19)11 WHO: World Health Organization. Coronavirus disease (COVID-19) outbreak situation [Internet]. Geneva: WHO; 2019 [citado em 2020 Apr 20]. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/emergencies/diseases...
. The most common manifestations of COVID-19 are fever, cough and fatigue or myalgia, sputum production and headache22 Ma K, Chen T, Han MF, Guo W, Ning Q. Management and clinical thinking of Coronavirus Disease 2019. Zhonghua Gan Zang Bing Za Zhi. 2020;28:E002. PMid:32125126.

3 Zhu ZB, Zhong CK, Zhang KX, Dong C, Peng H, Xu T, et al. Epidemic trend of corona virus disease 2019 (COVID-19) in mainland China. Zhonghua Yu Fang Yi Xue Za Zhi. 2020;54(0):E022. PMid:32125133.
-44 Yang HY, Duan GC. Analysis on the epidemic factors for the Corona Virus Disease. Zhonghua Yu Fang Yi Xue Za Zhi. 2020;54(0):E021. PMid:32125129..

Previous coronavirus data (SARS-CoV and MERS-CoV) showed that pregnant women could be in risk groups with a higher chance of morbidity and mortality than the general population55 Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. (2020). Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol. 1-5. https://doi.org/10.1080/15513815.2020.1747120.
https://doi.org/10.1080/15513815.2020.17...
. However, little is known about COVID-19 in this population5. In a study conducted in Wuhan6 - the city's first epicenter of the disease, researchers reported nine live births to mothers positive for COVID-19, and all samples were negative for the virus in neonates. Their findings supported that there is currently no evidence of vertical transmission in infected mothers in late pregnancy66 Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-15. http://dx.doi.org/10.1016/S0140-6736(20)30360-3. PMid:32151335.
http://dx.doi.org/10.1016/S0140-6736(20)...
.

Although COVID-19 can affect individuals of all age groups, the disease is generally milder in children than in adults, especially in neonates77 Lu Q, Shi Y. Coronavirus disease (COVID‐19) and neonate: what neonatologist need to know. J Med Virol. 2020;92(6):564-7. http://dx.doi.org/10.1002/jmv.25740. PMid:32115733.
http://dx.doi.org/10.1002/jmv.25740...
. The most common clinical symptoms in the pediatric population include fever, fatigue and dry cough. Some patients have upper respiratory manifestations, such as nasal obstruction, nasal discharge and sore throat, and others have gastrointestinal symptoms, such as abdominal discomfort, vomiting, abdominal pain and diarrhea66 Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-15. http://dx.doi.org/10.1016/S0140-6736(20)30360-3. PMid:32151335.
http://dx.doi.org/10.1016/S0140-6736(20)...
.

Currently, there is no evidence that the Corona Virus can be transmitted through breast milk, but it is known that an infected mother can transmit the virus through respiratory droplets during breastfeeding8. In a study carried out with six newborns of infected mothers, who were breastfeeding their babies, all samples were negative for the virus6.

The speech therapist who needs to evaluate babies of confirmed and / or suspected mothers of COVID-19 should follow the recommendations for the use of protective tools like other health professionals: hats, goggles, protective clothing, gloves, N95 masks. Neonatologists advise that no visits should be allowed for newborns with a diagnosis, or with mothers with suspected or diagnosed COVID - 1977 Lu Q, Shi Y. Coronavirus disease (COVID‐19) and neonate: what neonatologist need to know. J Med Virol. 2020;92(6):564-7. http://dx.doi.org/10.1002/jmv.25740. PMid:32115733.
http://dx.doi.org/10.1002/jmv.25740...
. The breastfeeding guidelines of the Italian Society of Neonatology (SIN), endorsed by the European Union of Neonatology and Perinatal Societies (UENPS) are: if a mother previously identified as COVID - 19 positive or under suspicion for COVID - 19 is asymptomatic at the time of delivery, direct breastfeeding is advisable, under strict infection control measures; and when a mother with COVID-19 is too sick to care for the newborn, the newborn will be treated separately and fed fresh expressed breast milk, without the need to pasteurize it, as there is no evidence that human milk COVID-1988 Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020;pii: S0002-9378(20):30197-6. transmitter is possible.

According to the Disease Prevention Control Center (2020), measures must be taken to reduce the chance of viral transmission during breastfeeding, such as: avoid kissing the newborn, protect him from adult cough, wear a mask while breastfeeding, clean hold hands before feeding and suspend visits. In addition, when the baby is in joint accommodation with the sick mother, the baby must remain at a distance of at least 2 meters from the mother, with the presence of a physical barrier between them, such as a curtain99 Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. Breastfeeding and Coronavirus Disease-2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr. 2020;e13010. PMid:32243068.,1010 CDC: Centers of Disease Control and Prevention. Coronavirus disease 2019 [Internet]. Atlanta: CDC; 2019 [citado em 2020 Apr 7]. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html
https://www.cdc.gov/coronavirus/2019-nco...
. The WHO also advises that surfaces that the contaminated mother has contact be cleaned and disinfected regularly11 WHO: World Health Organization. Coronavirus disease (COVID-19) outbreak situation [Internet]. Geneva: WHO; 2019 [citado em 2020 Apr 20]. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/emergencies/diseases...
.

As for the storage of human milk, the WHO recommends that mothers with suspected or confirmed COVID -19 use the same precautions indicated at the time of breastfeeding: hand hygiene, wearing a mask, disinfecting contact surfaces. They indicate that the container that received the human milk must have the external part disinfected after its extraction, with adequate sanitary solutions, before storage in milk banks, wards or in the postpartum's own residence1111 WHO: World Health Organization. Infection prevention and control during health care when COVID-19 is suspected: interim guidance. Geneva: WHO; 2020 [citado em 2020 Apr 7]. Disponível em: https://apps.who.int/iris/handle/10665/331495
https://apps.who.int/iris/handle/10665/3...
. With the spread of the disease, and the growing number of pregnant women and mothers who may have symptoms - but in testing for the virus - the WHO recommendation is that all mothers who donate and receive milk from human milk banks follow these recommendations. hygiene pre, peri and during receipt of the bottle. Still, for mothers infected with COVID-19 who need to express milk in a hospital using pumps, these devices must be for the individual use of this puerperal woman1111 WHO: World Health Organization. Infection prevention and control during health care when COVID-19 is suspected: interim guidance. Geneva: WHO; 2020 [citado em 2020 Apr 7]. Disponível em: https://apps.who.int/iris/handle/10665/331495
https://apps.who.int/iris/handle/10665/3...
,1212 Marinelli KA, Lawrence RM. Safe handling of containers of expressed human milk in all settings during the SARS-CoV-2 (COVID-19) Pandemic. J Hum Lact. In press 2020;890334420919083. PMid:32242762..

There is little and fragile evidence regarding COVID-19 and breastfeeding so far, as well as in other areas. Science is taking shape and institutions are drawing up their recommendations according to the course of the disease's evolution. It has been identified that breastfeeding is, so far, indicated in cases of suspected and confirmed COVID-19, with infection control99 Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. Breastfeeding and Coronavirus Disease-2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr. 2020;e13010. PMid:32243068.

10 CDC: Centers of Disease Control and Prevention. Coronavirus disease 2019 [Internet]. Atlanta: CDC; 2019 [citado em 2020 Apr 7]. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html
https://www.cdc.gov/coronavirus/2019-nco...
-1111 WHO: World Health Organization. Infection prevention and control during health care when COVID-19 is suspected: interim guidance. Geneva: WHO; 2020 [citado em 2020 Apr 7]. Disponível em: https://apps.who.int/iris/handle/10665/331495
https://apps.who.int/iris/handle/10665/3...
and hygiene. In addition, all mothers who donate and receive milk from human milk banks must disinfect the bottles before handling, even if they do not show symptoms of the virus.

The Brazilian Society of Pediatrics said in a note, to be favorable to the maintenance of breastfeeding in mothers with COVID-19, given the current evidence1313 Sociedade Brasileira de Pediatria. O aleitamento materno nos tempos de COVID-19! No. 9. São Paulo: Departamento Científico de Aleitamento Materno; 2020. Nota de Alerta.. The speech therapist as an active member in Health Education, has a positive role and intervention in the guidance of breastfeeding1414 Medeiros AMC, Santos JCJ, Santos DAR, Barreto IDC, Alves YVT. Acompanhamento fonoaudiológico do aleitamento materno em recém-nascidos nas primeiras horas de vida. Audiol Commun Res. 2017;22:e1856. http://dx.doi.org/10.1590/2317-6431-2017-1856.
http://dx.doi.org/10.1590/2317-6431-2017...
, must be updated and following the new recommendations of major international organizations, as well as the dentist and other health professionals, as adequate breastfeeding stimulates growth and harmonious craniofacial development1515 Leite ICG, Pinheiro AM, Brum LRG, Souza AS, Marinho SBA. Relação da amamentação com o desenvolvimento do sistema estomatognático. J Bras Fonoaudiol. 2002;3:237-42..

  • Study conducted at Departamento de Fonoaudiologia, Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA - Porto Alegre (RS), Brasil.
  • Financial support: nothing to declare.

References

  • 1
    WHO: World Health Organization. Coronavirus disease (COVID-19) outbreak situation [Internet]. Geneva: WHO; 2019 [citado em 2020 Apr 20]. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
    » https://www.who.int/emergencies/diseases/novel-coronavirus-2019
  • 2
    Ma K, Chen T, Han MF, Guo W, Ning Q. Management and clinical thinking of Coronavirus Disease 2019. Zhonghua Gan Zang Bing Za Zhi. 2020;28:E002. PMid:32125126.
  • 3
    Zhu ZB, Zhong CK, Zhang KX, Dong C, Peng H, Xu T, et al. Epidemic trend of corona virus disease 2019 (COVID-19) in mainland China. Zhonghua Yu Fang Yi Xue Za Zhi. 2020;54(0):E022. PMid:32125133.
  • 4
    Yang HY, Duan GC. Analysis on the epidemic factors for the Corona Virus Disease. Zhonghua Yu Fang Yi Xue Za Zhi. 2020;54(0):E021. PMid:32125129.
  • 5
    Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. (2020). Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol. 1-5. https://doi.org/10.1080/15513815.2020.1747120
    » https://doi.org/10.1080/15513815.2020.1747120
  • 6
    Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-15. http://dx.doi.org/10.1016/S0140-6736(20)30360-3 PMid:32151335.
    » http://dx.doi.org/10.1016/S0140-6736(20)30360-3
  • 7
    Lu Q, Shi Y. Coronavirus disease (COVID‐19) and neonate: what neonatologist need to know. J Med Virol. 2020;92(6):564-7. http://dx.doi.org/10.1002/jmv.25740 PMid:32115733.
    » http://dx.doi.org/10.1002/jmv.25740
  • 8
    Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020;pii: S0002-9378(20):30197-6.
  • 9
    Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. Breastfeeding and Coronavirus Disease-2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr. 2020;e13010. PMid:32243068.
  • 10
    CDC: Centers of Disease Control and Prevention. Coronavirus disease 2019 [Internet]. Atlanta: CDC; 2019 [citado em 2020 Apr 7]. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html
    » https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html
  • 11
    WHO: World Health Organization. Infection prevention and control during health care when COVID-19 is suspected: interim guidance. Geneva: WHO; 2020 [citado em 2020 Apr 7]. Disponível em: https://apps.who.int/iris/handle/10665/331495
    » https://apps.who.int/iris/handle/10665/331495
  • 12
    Marinelli KA, Lawrence RM. Safe handling of containers of expressed human milk in all settings during the SARS-CoV-2 (COVID-19) Pandemic. J Hum Lact. In press 2020;890334420919083. PMid:32242762.
  • 13
    Sociedade Brasileira de Pediatria. O aleitamento materno nos tempos de COVID-19! No. 9. São Paulo: Departamento Científico de Aleitamento Materno; 2020. Nota de Alerta.
  • 14
    Medeiros AMC, Santos JCJ, Santos DAR, Barreto IDC, Alves YVT. Acompanhamento fonoaudiológico do aleitamento materno em recém-nascidos nas primeiras horas de vida. Audiol Commun Res. 2017;22:e1856. http://dx.doi.org/10.1590/2317-6431-2017-1856
    » http://dx.doi.org/10.1590/2317-6431-2017-1856
  • 15
    Leite ICG, Pinheiro AM, Brum LRG, Souza AS, Marinho SBA. Relação da amamentação com o desenvolvimento do sistema estomatognático. J Bras Fonoaudiol. 2002;3:237-42.

Publication Dates

  • Publication in this collection
    15 May 2020
  • Date of issue
    2020

History

  • Received
    24 Apr 2020
  • Accepted
    24 Apr 2020
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