Human milk banks in the response to COVID-19: a statement of the regional human milk bank network for Southeast Asia and beyond

Estrella Olonan-Jusi,Sopapan Ngerncham,Paul G Zambrano,Zaw Win Moe,Vu H Duong,Nguyen T T Anh,Nguyen T T Phuong,Hikmah Kurniasari,Janice Datu-Sanguyo,Mei Chien Chua,Nant S S Aye

doi:10.1186/s13006-021-00376-2

Abstract

BackgroundThe World Health Organization (WHO) recommendations on infant feeding in the context of COVID-19 uphold standing recommendations for breastfeeding, non-separation, and skin-to-skin contact, including the use of donor human milk when mother’s own milk is not available.Insufficient guidance on the use of donor human milk and the role of human milk banks in the pandemic responseCOVID-19 clinical management guidelines in seven countries in Southeast Asia are not aligned with WHO recommendations despite the lack of evidence of transmission through either breastmilk or breastfeeding. The use of safe donor human milk accessed through human milk banks is also insufficiently recommended, even in countries with an existing human milk bank, leading to a gap in evidence-based management of COVID-19. This highlights long-standing challenges as well as opportunities in the safe, equitable, and resilient implementation of human milk banks in the region.ConclusionsThis statement reflects the expert opinion of the Regional Human Milk Bank Network for Southeast Asia and Beyond on the need to revisit national guidelines based on the best evidence for breastfeeding during the COVID-19 pandemic, to incorporate human milk bank services in national obstetric and newborn care guidelines for COVID-19 where possible, and to ensure that operations of human milk banks are adapted to meet the needs of the current pandemic and to sustain donor human milk supply in the long-term. The Network also recommends sustained engagement with the global human milk bank community.

Highlights

The World Health Organization (WHO) recommendations on infant feeding in the context of COVID19 uphold standing recommendations for breastfeeding, non-separation, and skin-to-skin contact, including the use of donor human milk when mother’s own milk is not available.Insufficient guidance on the use of donor human milk and the role of human milk banks in the pandemic response: COVID-19 clinical management guidelines in seven countries in Southeast Asia are not aligned with WHO recommendations despite the lack of evidence of transmission through either breastmilk or breastfeeding
While a number of case studies reported the detection of SARS-CoV-2 RNA in breastmilk samples of women who tested positive for COVID-19 [3,4,5], more robust research suggests that breastmilk is not a route of vertical transmission [6]
Antibodies for SARS-CoV-2 have even been detected in breastmilk, suggesting a potential protective benefit [7, 8]

Summary

Conclusions

The aim of this paper is to highlight the need for alignment with WHO guidance on infant feeding in the context of COVID-19, including the need to ensure that human milk bank services are included in the evidencebased package of services for vulnerable infants during the pandemic and beyond. We recommend the following to ministries of health, professional associations, and fellow human milk bank practitioners in the region: 1. Revisit and update guidelines that recommend the separation of mothers and infants if the mother has suspected or confirmed COVID-19. Ensure that the WHO recommended hierarchy of feeding options is followed, with breastfeeding and feeding with mother’s expressed milk prioritized. This can be followed by safe donor human milk from a human milk bank should separation be required or unavoidable (e.g. if the mother is severely ill). C. Ensure that breastfeeding is protected, promoted, and supported, especially for mothers with suspected or confirmed COVID-19.

Background