PMC:7727601 / 10605-17359 JSONTXT

{"project":"LitCovid-PubTator","denotations":[{"id":"102","span":{"begin":141,"end":151},"obj":"Species"},{"id":"103","span":{"begin":574,"end":579},"obj":"Species"},{"id":"104","span":{"begin":259,"end":267},"obj":"Disease"},{"id":"105","span":{"begin":598,"end":606},"obj":"Disease"},{"id":"117","span":{"begin":686,"end":691},"obj":"Species"},{"id":"118","span":{"begin":1639,"end":1649},"obj":"Species"},{"id":"119","span":{"begin":1746,"end":1756},"obj":"Species"},{"id":"120","span":{"begin":1783,"end":1788},"obj":"Species"},{"id":"121","span":{"begin":1217,"end":1220},"obj":"Chemical"},{"id":"122","span":{"begin":1382,"end":1385},"obj":"Chemical"},{"id":"123","span":{"begin":647,"end":655},"obj":"Disease"},{"id":"124","span":{"begin":802,"end":810},"obj":"Disease"},{"id":"125","span":{"begin":1307,"end":1315},"obj":"Disease"},{"id":"126","span":{"begin":1794,"end":1802},"obj":"Disease"},{"id":"127","span":{"begin":1895,"end":1903},"obj":"Disease"},{"id":"131","span":{"begin":2010,"end":2018},"obj":"Disease"},{"id":"132","span":{"begin":2164,"end":2172},"obj":"Disease"},{"id":"133","span":{"begin":2587,"end":2595},"obj":"Disease"},{"id":"136","span":{"begin":2926,"end":2931},"obj":"Gene"},{"id":"137","span":{"begin":3344,"end":3352},"obj":"Disease"},{"id":"141","span":{"begin":4668,"end":4675},"obj":"Species"},{"id":"142","span":{"begin":4472,"end":4475},"obj":"Chemical"},{"id":"143","span":{"begin":4682,"end":4685},"obj":"Chemical"},{"id":"147","span":{"begin":5104,"end":5109},"obj":"Gene"},{"id":"148","span":{"begin":5213,"end":5218},"obj":"Gene"},{"id":"149","span":{"begin":5300,"end":5308},"obj":"Disease"},{"id":"154","span":{"begin":5510,"end":5515},"obj":"Species"},{"id":"155","span":{"begin":5739,"end":5746},"obj":"Species"},{"id":"156","span":{"begin":5722,"end":5725},"obj":"Chemical"},{"id":"157","span":{"begin":5544,"end":5552},"obj":"Disease"},{"id":"160","span":{"begin":6012,"end":6020},"obj":"Disease"},{"id":"161","span":{"begin":6021,"end":6030},"obj":"Disease"},{"id":"163","span":{"begin":6215,"end":6224},"obj":"Disease"},{"id":"165","span":{"begin":6580,"end":6588},"obj":"Disease"}],"attributes":[{"id":"A102","pred":"tao:has_database_id","subj":"102","obj":"Tax:2697049"},{"id":"A103","pred":"tao:has_database_id","subj":"103","obj":"Tax:9606"},{"id":"A104","pred":"tao:has_database_id","subj":"104","obj":"MESH:C000657245"},{"id":"A105","pred":"tao:has_database_id","subj":"105","obj":"MESH:C000657245"},{"id":"A117","pred":"tao:has_database_id","subj":"117","obj":"Tax:9606"},{"id":"A118","pred":"tao:has_database_id","subj":"118","obj":"Tax:2697049"},{"id":"A119","pred":"tao:has_database_id","subj":"119","obj":"Tax:2697049"},{"id":"A120","pred":"tao:has_database_id","subj":"120","obj":"Tax:9606"},{"id":"A123","pred":"tao:has_database_id","subj":"123","obj":"MESH:C000657245"},{"id":"A124","pred":"tao:has_database_id","subj":"124","obj":"MESH:C000657245"},{"id":"A125","pred":"tao:has_database_id","subj":"125","obj":"MESH:C000657245"},{"id":"A126","pred":"tao:has_database_id","subj":"126","obj":"MESH:C000657245"},{"id":"A127","pred":"tao:has_database_id","subj":"127","obj":"MESH:C000657245"},{"id":"A131","pred":"tao:has_database_id","subj":"131","obj":"MESH:C000657245"},{"id":"A132","pred":"tao:has_database_id","subj":"132","obj":"MESH:C000657245"},{"id":"A133","pred":"tao:has_database_id","subj":"133","obj":"MESH:C000657245"},{"id":"A136","pred":"tao:has_database_id","subj":"136","obj":"Gene:723792"},{"id":"A137","pred":"tao:has_database_id","subj":"137","obj":"MESH:C000657245"},{"id":"A141","pred":"tao:has_database_id","subj":"141","obj":"Tax:9606"},{"id":"A147","pred":"tao:has_database_id","subj":"147","obj":"Gene:723792"},{"id":"A148","pred":"tao:has_database_id","subj":"148","obj":"Gene:723792"},{"id":"A149","pred":"tao:has_database_id","subj":"149","obj":"MESH:C000657245"},{"id":"A154","pred":"tao:has_database_id","subj":"154","obj":"Tax:9606"},{"id":"A155","pred":"tao:has_database_id","subj":"155","obj":"Tax:9606"},{"id":"A157","pred":"tao:has_database_id","subj":"157","obj":"MESH:C000657245"},{"id":"A160","pred":"tao:has_database_id","subj":"160","obj":"MESH:C000657245"},{"id":"A161","pred":"tao:has_database_id","subj":"161","obj":"MESH:D007239"},{"id":"A163","pred":"tao:has_database_id","subj":"163","obj":"MESH:D007239"},{"id":"A165","pred":"tao:has_database_id","subj":"165","obj":"MESH:C000657245"}],"namespaces":[{"prefix":"Tax","uri":"https://www.ncbi.nlm.nih.gov/taxonomy/"},{"prefix":"MESH","uri":"https://id.nlm.nih.gov/mesh/"},{"prefix":"Gene","uri":"https://www.ncbi.nlm.nih.gov/gene/"},{"prefix":"CVCL","uri":"https://web.expasy.org/cellosaurus/CVCL_"}],"text":"Discussion\nDuring 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. 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.\nVarious organizations have promulgated COVID-19 guidance on care for pregnant women and newborns, which at times has been conflicting. 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. 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). During data collection for this survey, CDC (August 3¶¶) and AAP (July 22***) updated their guidance, supporting maternal autonomy in decision-making. Changes in guidance reflect evolving knowledge about the virus and its potential impact on newborns. To date, there has been no definitive evidence of transmission of SARS-CoV-2 through breast milk. 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).\nOne 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. 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). 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.\nNearly one in five hospitals in this study reported that in-person lactation support had decreased during the pandemic. 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). 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. Notably, these changes in lactation support affect newborns broadly, not just those born to mothers with COVID-19.\nApproximately equal numbers of hospitals reported that their exclusive breastfeeding rates had increased and decreased; the majority reported the rate had stayed approximately the same. The reasons for these changes are unknown. However, the pandemic could contribute to reduced breastfeeding as a result of maternal/newborn separation and reductions in lactation support. 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.\nApproximately three fourths of hospitals reported discharging mothers and their newborns \u003c48 hours after birth because of the pandemic. 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 \u003c48 hours for a vaginal delivery or \u003c96 hours for a cesarean section.¶¶¶ AAP describes discharge \u003c48 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). AAP also recommends that all newborns discharged \u003c48 hours after birth be evaluated by a pediatric health care provider within 48 hours of discharge (10). 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.\nThe findings in this report are subject to at least three limitations. First, although mPINC is a census of all birth hospitals, this survey was only sent to the hospitals that completed the 2018 mPINC survey. Second, hospitals used their own definitions for suspected and confirmed COVID-19, and those definitions might have been different. Finally, data captured in this survey represent a single point in time. Policies and practices likely will continue to change as the pandemic evolves.\nWomen 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 \u003c48 hours after delivery receive prompt follow-up with a pediatric health care provider to ensure optimal feeding.\nSummary\n\nWhat is already known about this topic?\nEvidence-based hospital practices supporting breastfeeding have sometimes conflicted with COVID-19 infection prevention and control measures.\n\nWhat is added by this report?\nDuring summer 2020, hospitals implemented a variety of practices intended to balance evidence-based maternity care with infection prevention and control. 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 \u003c48 hours after birth.\n\nWhat are the implications for public health practice?\nAdditional postdischarge breastfeeding support and newborn follow-up might be needed during the COVID-19 pandemic. Longer-term monitoring of exclusive breastfeeding rates at hospital discharge will be important for assessing this aspect of the pandemic on infant health."}

{"project":"LitCovid-sentences","denotations":[{"id":"T100","span":{"begin":0,"end":10},"obj":"Sentence"},{"id":"T101","span":{"begin":11,"end":280},"obj":"Sentence"},{"id":"T102","span":{"begin":281,"end":607},"obj":"Sentence"},{"id":"T103","span":{"begin":608,"end":742},"obj":"Sentence"},{"id":"T104","span":{"begin":743,"end":1158},"obj":"Sentence"},{"id":"T105","span":{"begin":1159,"end":1320},"obj":"Sentence"},{"id":"T106","span":{"begin":1321,"end":1471},"obj":"Sentence"},{"id":"T107","span":{"begin":1472,"end":1572},"obj":"Sentence"},{"id":"T108","span":{"begin":1573,"end":1670},"obj":"Sentence"},{"id":"T109","span":{"begin":1671,"end":1908},"obj":"Sentence"},{"id":"T110","span":{"begin":1909,"end":2137},"obj":"Sentence"},{"id":"T111","span":{"begin":2138,"end":2365},"obj":"Sentence"},{"id":"T112","span":{"begin":2366,"end":2622},"obj":"Sentence"},{"id":"T113","span":{"begin":2623,"end":2742},"obj":"Sentence"},{"id":"T114","span":{"begin":2743,"end":2969},"obj":"Sentence"},{"id":"T115","span":{"begin":2970,"end":3238},"obj":"Sentence"},{"id":"T116","span":{"begin":3239,"end":3353},"obj":"Sentence"},{"id":"T117","span":{"begin":3354,"end":3539},"obj":"Sentence"},{"id":"T118","span":{"begin":3540,"end":3582},"obj":"Sentence"},{"id":"T119","span":{"begin":3583,"end":3726},"obj":"Sentence"},{"id":"T120","span":{"begin":3727,"end":4097},"obj":"Sentence"},{"id":"T121","span":{"begin":4098,"end":4233},"obj":"Sentence"},{"id":"T122","span":{"begin":4234,"end":4681},"obj":"Sentence"},{"id":"T132","span":{"begin":5882,"end":5921},"obj":"Sentence"},{"id":"T133","span":{"begin":5922,"end":6063},"obj":"Sentence"},{"id":"T134","span":{"begin":6065,"end":6094},"obj":"Sentence"},{"id":"T123","span":{"begin":4682,"end":4836},"obj":"Sentence"},{"id":"T124","span":{"begin":4837,"end":5016},"obj":"Sentence"},{"id":"T125","span":{"begin":5017,"end":5087},"obj":"Sentence"},{"id":"T126","span":{"begin":5088,"end":5226},"obj":"Sentence"},{"id":"T127","span":{"begin":5227,"end":5358},"obj":"Sentence"},{"id":"T128","span":{"begin":5359,"end":5430},"obj":"Sentence"},{"id":"T129","span":{"begin":5431,"end":5509},"obj":"Sentence"},{"id":"T130","span":{"begin":5510,"end":5872},"obj":"Sentence"},{"id":"T131","span":{"begin":5873,"end":5880},"obj":"Sentence"},{"id":"T135","span":{"begin":6095,"end":6248},"obj":"Sentence"},{"id":"T136","span":{"begin":6249,"end":6428},"obj":"Sentence"},{"id":"T137","span":{"begin":6430,"end":6483},"obj":"Sentence"},{"id":"T138","span":{"begin":6484,"end":6598},"obj":"Sentence"},{"id":"T139","span":{"begin":6599,"end":6754},"obj":"Sentence"}],"namespaces":[{"prefix":"_base","uri":"http://pubannotation.org/ontology/tao.owl#"}],"text":"Discussion\nDuring 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. 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.\nVarious organizations have promulgated COVID-19 guidance on care for pregnant women and newborns, which at times has been conflicting. 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. 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). During data collection for this survey, CDC (August 3¶¶) and AAP (July 22***) updated their guidance, supporting maternal autonomy in decision-making. Changes in guidance reflect evolving knowledge about the virus and its potential impact on newborns. To date, there has been no definitive evidence of transmission of SARS-CoV-2 through breast milk. 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).\nOne 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. 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). 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.\nNearly one in five hospitals in this study reported that in-person lactation support had decreased during the pandemic. 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). 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. Notably, these changes in lactation support affect newborns broadly, not just those born to mothers with COVID-19.\nApproximately equal numbers of hospitals reported that their exclusive breastfeeding rates had increased and decreased; the majority reported the rate had stayed approximately the same. The reasons for these changes are unknown. However, the pandemic could contribute to reduced breastfeeding as a result of maternal/newborn separation and reductions in lactation support. 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.\nApproximately three fourths of hospitals reported discharging mothers and their newborns \u003c48 hours after birth because of the pandemic. 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 \u003c48 hours for a vaginal delivery or \u003c96 hours for a cesarean section.¶¶¶ AAP describes discharge \u003c48 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). AAP also recommends that all newborns discharged \u003c48 hours after birth be evaluated by a pediatric health care provider within 48 hours of discharge (10). 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.\nThe findings in this report are subject to at least three limitations. First, although mPINC is a census of all birth hospitals, this survey was only sent to the hospitals that completed the 2018 mPINC survey. Second, hospitals used their own definitions for suspected and confirmed COVID-19, and those definitions might have been different. Finally, data captured in this survey represent a single point in time. Policies and practices likely will continue to change as the pandemic evolves.\nWomen 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 \u003c48 hours after delivery receive prompt follow-up with a pediatric health care provider to ensure optimal feeding.\nSummary\n\nWhat is already known about this topic?\nEvidence-based hospital practices supporting breastfeeding have sometimes conflicted with COVID-19 infection prevention and control measures.\n\nWhat is added by this report?\nDuring summer 2020, hospitals implemented a variety of practices intended to balance evidence-based maternity care with infection prevention and control. 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 \u003c48 hours after birth.\n\nWhat are the implications for public health practice?\nAdditional postdischarge breastfeeding support and newborn follow-up might be needed during the COVID-19 pandemic. Longer-term monitoring of exclusive breastfeeding rates at hospital discharge will be important for assessing this aspect of the pandemic on infant health."}