Search

Purpose: To synthesize the current evidence for the presence of SARS-CoV-2 RNA in the human milk of mothers with confirmed COVID-19 and its potential role in neonatal SARS-CoV-2 infection. Materials and methods: Using terms related to novel coronavirus 2019 and human milk, a systematic search was performed in three electronic databases (PubMed, EMBASE, and Web of Science) for studies published between December 2019 and 15 October 2020. Published peer-reviewed studies reporting the results of RT-PCR for SARS-CoV-2 RNA in human milk in mothers with confirmed COVID-19 were included. Proportion meta-analysis of case series and prospective cohort studies was performed using STATA version 14.2 (StataCorp, College Station, TX) and pooled estimate (with 95% confidence interval) of overall incidence of SARS-CoV-2 transmission was calculated. Results: We identified 936 records, of which 34 studies (24 case-reports, 10 cohort studies) were eligible for this systematic review. A total of 116 confirmed COVID-19 lactating women (88 in cohort and 28 in case-reports) underwent RT-PCR testing in human milk, and 10 (six in case reports) were detected to have SARS-CoV-2 RNA. The overall pooled proportion (from cohort studies) for SARS-CoV-2 RNA detection in human milk was 2.16% (95% CI: 0.0–8.81%, I²: 0%). Four studies (six patients) also reported the presence of SARS-CoV-2 specific antibodies (along with RT-PCR) in human milk. Conclusions: The limited low-quality evidence suggests that SARS-CoV-2 RNA is detected in human milk in an extremely low proportion, however, based on current evidence no conclusion can be drawn about its infectivity and impact on the infants. In concordance with World Health Organization recommendations, exclusive breastfeeding should be considered in all cases unless any other contraindication exists. [ABSTRACT FROM AUTHOR]

To the Editor, Perinatal management during COVID-19 requires expertise and coordination among various teams (obstetrics, neonatology, anesthesia, infectious disease) therefore, explicit guidance during pregnancy and delivery is deemed necessary. As COVID-19 is a never seen before emergency, an explicit, nationwide guidance policy will help the clinicians in routine clinical practice, avoiding law-suit problems, and ethical dilemmas. The daily ANS dose (360 mg hydrocortisone equivalent) is even more than the therapeutic dose used in ongoing trials (125-250 mg hydrocortisone equivalent) in COVID-19, suggesting potential harm. [Extracted from the article]

Dear Editor, We read the recent systematic review by Gu et al. [[1]] on the efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia. The forest plot for meta-analysis of exchange transfusion shows that in the Saeidi et al. study [[5]] there was one event in the fluid supplementation group and six events in the control group. Moreover, when there is no difference in the duration of phototherapy and the need for exchange transfusion, this therapy cannot be recommended. [Extracted from the article]

Dear Sir, The trial by Balachander et al. [[1]] showed that ibuprofen and paracetamol (PCM) are equally efficacious for ductal closure in preterm infants. In the current era, there is a lot of controversy over the treatment of patent ductus arteriosus (PDA) and many of the centers prefer "not to treat" patent ductus arteriosus (PDA) in babies' > 32 weeks/1500 g [[3]]. Low platelet count is an independent predictor of delayed closure and treatment failure in PDA [[8]]. [Extracted from the article]

To the Editor, The trial by Cavallin et al. [[1]] showed that along with others, home delivery is an independent risk factor for the need of exchange transfusion in neonates. The authors mentioned various causes of death like kernicterus (28 cases), encephalopathy (eight cases), hyperbilirubinemia (seven cases), etc. Similarly, encephalopathy stands for bilirubin encephalopathy or its encephalopathy of another etiology, is not clear. [Extracted from the article]

The article by Bhasin et al. [[1]] compared various clinical, biochemical and echocardiographic markers of myocardial dysfunction in neonates with and without perinatal asphyxia. Despite the title (Myocardial dysfunction as a predictor of the severity and mortality of hypoxic-ischaemic encephalopathy in severe perinatal asphyxia: a case-control study), the results do not fully support it. The optimal way to present such conclusions in a case-control study is by calculating odds ratios and risk ratios. [Extracted from the article]

We read the article by Khuwuthyakorn et al. [[1]] which compared the efficacy of oral ibuprofen and oral indomethacin in very low-birthweight (VLBW) infants. Recent evidence shows that paracetamol is as effective as other therapies and remains a good alternative therapeutic agent when ibuprofen and indomethacin are contraindicated. Association of placebo, indomethacin, ibuprofen, and acetaminophen with closure of hemodynamically significant patent ductus arteriosus in preterm infants: a systematic review and meta-analysis. [Extracted from the article]

We read with interest the article by Prashantha et al. regarding the safety of low-cost devices for therapeutic hypothermia (TH) in low- and middle-income countries (LMIC) such as India [[1]] and wish to make certain points. For it to be standard care in India, its long-term efficacy needs to be proved in large multi-centre randomised controlled trials (RCT) following standard study protocols. [Extracted from the article]