Id |
Subject |
Object |
Predicate |
Lexical cue |
T100 |
0-10 |
Sentence |
denotes |
Discussion |
T101 |
11-280 |
Sentence |
denotes |
During a 5-week period (July 15–August 20) when many areas of the country were experiencing substantial community transmission of SARS-CoV-2, hospitals were implementing a variety of practices intended to balance evidence-based maternity care with COVID-19-related IPC. |
T102 |
281-607 |
Sentence |
denotes |
Hospital practices are likely evolving along with the pandemic (7), potentially driven by multiple factors, including level of community transmission, guidance from public health and medical professional organizations, and a hospital’s own experience in preparation for or caring for pregnant women and newborns with COVID-19. |
T103 |
608-742 |
Sentence |
denotes |
Various organizations have promulgated COVID-19 guidance on care for pregnant women and newborns, which at times has been conflicting. |
T104 |
743-1158 |
Sentence |
denotes |
The World Health Organization recommends that mothers with COVID-19 be able to practice skin-to-skin care, rooming-in, and direct breastfeeding while wearing a mask, unless they are too ill to do so**; similar guidance is supported by the American Academy of Family Physicians,†† and the American College of Obstetricians and Gynecologists§§ promotes shared decision-making with the mother and the health care team. |
T105 |
1159-1320 |
Sentence |
denotes |
On the other hand, when this survey was launched, CDC and AAP recommended temporary separation of newborns from mothers with suspected or confirmed COVID-19 (8). |
T106 |
1321-1471 |
Sentence |
denotes |
During data collection for this survey, CDC (August 3¶¶) and AAP (July 22***) updated their guidance, supporting maternal autonomy in decision-making. |
T107 |
1472-1572 |
Sentence |
denotes |
Changes in guidance reflect evolving knowledge about the virus and its potential impact on newborns. |
T108 |
1573-1670 |
Sentence |
denotes |
To date, there has been no definitive evidence of transmission of SARS-CoV-2 through breast milk. |
T109 |
1671-1908 |
Sentence |
denotes |
In addition, there have been reports of secretory immunoglobulin A against SARS-CoV-2 in breast milk samples of women with COVID-19, suggesting that breastfeeding might be particularly important for newborns of mothers with COVID-19 (9). |
T110 |
1909-2137 |
Sentence |
denotes |
One third of hospitals in this study reported not having cared for any neonates born to mothers with COVID-19; however, others had extensive experience, including 17 hospitals reporting caring for at least 100 of these newborns. |
T111 |
2138-2365 |
Sentence |
denotes |
Follow-up of mothers with COVID-19 delivering at three large New York birth hospitals found reduced breastfeeding rates both in the hospital and after returning home among mothers who had been separated from their newborns (7). |
T112 |
2366-2622 |
Sentence |
denotes |
After identification of this finding, and the observed stress among mothers and newborns as a result of separation, the hospital system revised its policy and began to allow asymptomatic mothers with laboratory-confirmed COVID-19 to room-in and breastfeed. |
T113 |
2623-2742 |
Sentence |
denotes |
Nearly one in five hospitals in this study reported that in-person lactation support had decreased during the pandemic. |
T114 |
2743-2969 |
Sentence |
denotes |
Approximately 60% of hospitals in this study reported offering in-person breastfeeding consultations postdischarge, compared with 69% of hospitals reporting offering this in the 2018 mPINC survey (CDC, unpublished data, 2020). |
T115 |
2970-3238 |
Sentence |
denotes |
Lactation specialists working in health care settings should follow recommended IPC measures for those settings.††† Nearly one half of hospitals reported offering virtual breastfeeding consultations; however, no data are available on this practice before the pandemic. |
T116 |
3239-3353 |
Sentence |
denotes |
Notably, these changes in lactation support affect newborns broadly, not just those born to mothers with COVID-19. |
T117 |
3354-3539 |
Sentence |
denotes |
Approximately equal numbers of hospitals reported that their exclusive breastfeeding rates had increased and decreased; the majority reported the rate had stayed approximately the same. |
T118 |
3540-3582 |
Sentence |
denotes |
The reasons for these changes are unknown. |
T119 |
3583-3726 |
Sentence |
denotes |
However, the pandemic could contribute to reduced breastfeeding as a result of maternal/newborn separation and reductions in lactation support. |
T120 |
3727-4097 |
Sentence |
denotes |
On the other hand, the visitor restriction policies implemented by many hospitals could potentially provide more opportunities for breastfeeding and for a mother to learn her newborn’s feeding cues.§§§ Longer-term monitoring of exclusive breastfeeding rates at hospital discharge will be important to assess as one measure of the impact of the pandemic on infant health. |
T121 |
4098-4233 |
Sentence |
denotes |
Approximately three fourths of hospitals reported discharging mothers and their newborns <48 hours after birth because of the pandemic. |
T122 |
4234-4681 |
Sentence |
denotes |
No standard length of stay for the birth hospitalization exists, but the Newborn Mothers’ Health and Protection Act of 1996 prohibits the restriction of benefits to <48 hours for a vaginal delivery or <96 hours for a cesarean section.¶¶¶ AAP describes discharge <48 hours after delivery as a “shortened hospital stay” and notes that although it can be accommodated for healthy term newborns, it is not appropriate for all mothers and infants (10). |
T132 |
5882-5921 |
Sentence |
denotes |
What is already known about this topic? |
T133 |
5922-6063 |
Sentence |
denotes |
Evidence-based hospital practices supporting breastfeeding have sometimes conflicted with COVID-19 infection prevention and control measures. |
T134 |
6065-6094 |
Sentence |
denotes |
What is added by this report? |
T123 |
4682-4836 |
Sentence |
denotes |
AAP also recommends that all newborns discharged <48 hours after birth be evaluated by a pediatric health care provider within 48 hours of discharge (10). |
T124 |
4837-5016 |
Sentence |
denotes |
This visit, in part, assesses effective feeding, which might be more critical during the pandemic when breastfeeding mothers might be receiving reduced hospital lactation support. |
T125 |
5017-5087 |
Sentence |
denotes |
The findings in this report are subject to at least three limitations. |
T126 |
5088-5226 |
Sentence |
denotes |
First, although mPINC is a census of all birth hospitals, this survey was only sent to the hospitals that completed the 2018 mPINC survey. |
T127 |
5227-5358 |
Sentence |
denotes |
Second, hospitals used their own definitions for suspected and confirmed COVID-19, and those definitions might have been different. |
T128 |
5359-5430 |
Sentence |
denotes |
Finally, data captured in this survey represent a single point in time. |
T129 |
5431-5509 |
Sentence |
denotes |
Policies and practices likely will continue to change as the pandemic evolves. |
T130 |
5510-5872 |
Sentence |
denotes |
Women with suspected or confirmed COVID-19 who are separated from their newborns and whose newborns are not feeding directly at the breast might need timely, professional, breastfeeding support.**** In addition, AAP advises that infants discharged <48 hours after delivery receive prompt follow-up with a pediatric health care provider to ensure optimal feeding. |
T131 |
5873-5880 |
Sentence |
denotes |
Summary |
T135 |
6095-6248 |
Sentence |
denotes |
During summer 2020, hospitals implemented a variety of practices intended to balance evidence-based maternity care with infection prevention and control. |
T136 |
6249-6428 |
Sentence |
denotes |
Because of the pandemic, 17.9% of hospitals reported that in-person lactation support had decreased, and 72.9% reported discharging mothers and their babies <48 hours after birth. |
T137 |
6430-6483 |
Sentence |
denotes |
What are the implications for public health practice? |
T138 |
6484-6598 |
Sentence |
denotes |
Additional postdischarge breastfeeding support and newborn follow-up might be needed during the COVID-19 pandemic. |
T139 |
6599-6754 |
Sentence |
denotes |
Longer-term monitoring of exclusive breastfeeding rates at hospital discharge will be important for assessing this aspect of the pandemic on infant health. |