|All infants||Avoiding separation of mother-infant dyads, including infection control precautions.||Separation of a mother and her infant may have potential detrimental effects on feeding and bonding [18, 38, 40, 43,44,45].|
|Infant from healthy or non-symptomatic mother||Initiate and continue breastfeeding.||Breastfeeding is the optimal source of nutrition and protection for infants [46, 47].|
|Infant of mother with suspected COVID-19 (potentially exposed and/or symptomatic, but well enough to breastfeed)||Continue breastfeeding while applying infection control protocols with specific attention to droplet protection.||
Mechanisms of breastmilk protect the infant [40, 43,44,45].|
Respiratory viruses are not transmitted in breastmilk [1, 5, 38].
Direct transfer of antibodies into breastmilk .
Anti-infective factors transfer to breastmilk .
Immunological competence and memory in breastmilk .
|Continue breastfeeding.||The virus is not transmitted via breastmilk [1, 5, 15, 38, 43, 44].|
|All laboratory confirmed cases are isolated and cared for in a health care facility. Isolate mother-infant dyad together.||Avoid person-to-person transmission of the virus [35, 40].|
|Wear a mask during feeding.||To avoid coughing or sneezing on the baby while feeding at the breast [38, 43, 44, 47, 48].|
|Infant of mother who test positive for COVID-19 (mother well enough to breastfeed)||Continue breastfeeding.||
No virus detected in amniotic fluid [5, 15].|
No virus detected in cord blood [5, 15].
No virus detected in neonatal throat swabs [5, 15].
No virus detected in breastmilk after first breastfeeding [5, 15].
|Positive mother with mild symptoms||Isolate mother-infant dyad at home.||Avoid person-to-person transmission of the virus .|
|Wear a mask during feeding.||To avoid coughing or sneezing on the infant while feeding at the breast [38, 43, 44, 47, 48].|
|Positive mother with severe symptoms (can breastfeed)||Hospitalize mother-infant dyad.||All laboratory confirmed cases are isolated and cared for in a health care facility [35, 40].|
|Isolate mother-infant dyad together in hospital.||Avoid person-to-person transmission of the virus [35, 40].|
|Conduct a risk/benefits discussion between neonatologists and families to individualise infant care in the case of infants requiring neonatal care.||Admission to the neonatal unit may be required in infants that are born to COVID-19 positive mothers and/or have symptoms. This may require close observation and may lead to separation, however, not necessarily to discontinuation of breastfeeding .|
|Temporary separation may be needed in case of mothers who need medical care in hospital -continue to express milk [40, 47].|
|Infant of mother who test positive for COVID-19 (mother too ill to breastfeed)||Express milk and feed with clean cup or spoon.||Prevent accidental transmission of pathogens via surface areas [35, 44].|
|*Practical note: Mother can decant milk from her container into a clean container held by a healthy person to prevent transmission via the containers surface.|
|Wear a mask during expressing.||Prevent accidental transmission of pathogens via air [35, 44, 47].|
|Ask a healthy person to feed the baby expressed milk.||Prevent accidental transmission of pathogens via person-to-person contact or air [38, 47].|
|In case of separation, ensure appropriately trained mental health and psychosocial support for parents.||The prevalence of common mental disorders in the antenatal and postpartum period is high .|
|Expressing breastmilk:||Assumption: COVID-19 is not found in breastmilk, therefore general expressing guidelines apply.|
|Apply all general infection prevention measures.||Prevent accidental transmission of pathogens [35, 38, 47]|
|PUI and positive mothers should express in the area where they are isolated.||Prevent potential infection of non-infected areas and persons.|
|Do not share equipment for breastmilk expressing.||Milk particles can be left within any parts of the equipment and transferred to the next person. Any pathogens surviving on surfaces can be transferred via equipment [38, 49].|
|Rinse all expressing equipment in clean, cold running water before sterilising.||Prevent proteins in milk to coagulate due to heat, cold water removes milk residue .|
|Decant expressed milk into a clean container held by a healthy person wearing protective clothing.||Prevent transmission of the virus via container surface area potentially infected by positive mother via surfaces [42}.|
|Wipe down bottles with a viricidal agent of 1:10 diluted bleach.||Kill pathogens on surfaces, such as bottles handles by infected person .|
|Wash expressing equipment with hot soapy water with domestic detergent, rinse under running water and dry with a paper towel.||Kill pathogens [38, 47].|
|Sterilise equipment after each use .||Kill pathogens .|
|General infection control measures|
|Personal hygiene||Washing hands often for 20 s with soap and water or using alcohol-based hand rub (based on 80% ethanol or 75% 2-propanol).||Prevent accidental transmission of pathogens via person-to-person contact [4, 47, 50].|
|Personal hygiene||Cover mouth and nose with a disposable tissue or elbow when coughing and sneezing.||Prevent accidental transmission of pathogens via air [4, 14].|
|Personal hygiene||Wash hands before and after contact with the infant.||Prevent accidental transmission of pathogens via person-to-person contact [38, 43, 44, 47, 48].|
|Environment||Thoroughly cook meat and eggs.||Prevent accidental transmission of pathogens in food sources .|
|Environment||Clean/disinfect contaminated surfaces immediately.||Prevent accidental transmission of pathogens via surfaces [43, 44, 49].|
|Surface disinfection with 0.1% sodium hypochlorite or 71% ethanol reduces coronavirus infectivity on surfaces within 1-min exposure time.||Human coronaviruses can remain infectious on surfaces for up to 9 days .|
|Social distance||Keep mother and baby together and practice safe skin-to-skin contact and rooming-in.||Immediately after birth, during establishment of breastfeeding and whether mother or infant have suspected, probable, or confirmed COVID-19, 24 h/day [18, 43, 51].|
|Social distance||Avoid close contact with anyone who is coughing and/or sneezing.||Prevent accidental transmission of pathogens via air .|
|Social distance||Avoid crowds of people such as church gatherings, shopping malls and large events.||Prevent accidental transmission of pathogens via person-to-person contact or air .|
|Social distance||Do not allow anyone to kiss the infant and ask them to disinfect their hands when they come into the house or plan to touch the infant.||Prevent accidental transmission of pathogens via person-to-person contact .|
|Social distance||Do not allow anyone who is ill to visit the mother and infant.||Prevent accidental transmission of pathogens via person-to-person contact or air .|
|Mental health of mothers during COVID-19 pandemic||No need for alarm.||Children (aged 1–16 years) accounted for roughly 5% of total patients with COVID-19 in China, but frequently do not have a notable disease and no transfer via breastmilk has been confirmed [1, 5, 7, 13, 52].|
|Use self-isolation time to bond with infant at home.||Bonding improves relationships and mental health and overall wellbeing .|