Ask an answerable question (PICO)：
Since the first COVID-19 case confirmed at the end of 2019, COVID-19 has become one of the major epidemics in the world. A pregnant woman with confirmed COVID-19 not only risks the health of her newborns, but also raises a concern to the safety of breastfeeding. Therefore, it forms a clinical question: does breastfeeding (intervention) of a mother who’s diagnosed with COVID-19 (patient) increase the confirmed rate of COVID-19 to her newborns (outcome)?
The Method and Analysis of Literature Review：
This study uses the 5A steps of empirical nursing to establish PICO question (P: confirmed COVID-19 puerpera; I: breastfeeding; C: no breastfeeding; D: newborn diagnosed with COVID-19). And uses MeSH terms (with the strategy of “OR” and “AND”) to search UpToDate, Cochrane Library, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Chinese Electronic Periodical Services (CEPS) within the range from 2019 to 2022 and the research types in Randomized Controlled Trial (Randomized Controlled Trial, RCT), Systematic Review (Systematic Review, SR). The preliminary result is 80 complete English/Chinese articles. excluding articles without full text and non-Chinese and English articles, with a total of 80 chapters. After a final review, the study identified three SR literatures.
Critical Appraisal：
The study used 2011 OCEBM Levels of Evidence to evaluate the three SR literatures. All the three articles were evaluated level 2 because most are observational studies and case reports. Additionally, the three literatures score 4-6 points in the Oxford Systematic Literature Review. The three literatures were all published in 2021. Though, in the three literatures, 15 articles and 83 cases were found repetitive, the three literatures are still included in the review because the repetitive articles and cases did not cover the entire article. The research results of the three literatures all support that breastfeeding of mothers with confirmed COVID-19 does not affect the COVID-19 confirmed rate in newborns.
Clinical Application of Evidence：
Combining empirical evidence to support that mothers continue to breastfeed after diagnosis will not increase the chance of neonatal diagnosis, and in accordance with the recommendations of the Society of Obstetrics and Gynecology, the risk of breast milk transmission in confirmed cases is low. It is not advisable to room in with children and breastfeed after delivery, but maternal care needs to be taken into consideration. Infant contact and infection control issues during breast milk acquisition, transportation and feeding. The Society of Neonatology's guidelines recommend that those diagnosed can still express breast milk, but they should wear a mask, wash hands thoroughly and properly clean the breast area when expressing breast milk. Breast milk must be fed by caregivers. The gynecology and pediatrics team jointly developed a breastfeeding care process for hospital medical staff to care for mothers diagnosed with COVID-19. If the mother is diagnosed when she is admitted to the hospital and expects to give birth, we will provide shared medical and medical decision-making via telephone instructions, discuss with the parents based on empirical evidence, and provide a reference to the QR code for hand expression. Encourage hand expression to maintain lactation until the isolation is released or the rapid screening test is negative. , you can collect breast milk and give it to others to feed.If it is during the independent health management period after the diagnosis is confirmed and the patient is released from quarantine, the milk can be collected and given to medical staff for feeding. Before the diagnosis, the newborn was cared for all the time. There is no need to separate the baby after the diagnosis. The baby can continue to breastfeed. According to the principles of health education and infection control, when the baby does not need to breastfeed, the distance between the baby and the baby should be more than 2 meters in the same space.
Evaluation of Effectiveness：
Pregnant women diagnosed with COVID-19 include those whose laboratory data showed PCR test positive in hospital, and who managed their own health within 14 days after diagnosis. A total of 7 newborns were at risk of infection during hospitalization before the intervention. The breastfeeding rates during the hospitalization period, two weeks after delivery, and two months after delivery were 14%, 28%, and 28%, and the rate of newborns diagnosed with COVID-19 was 0%. After intervention, a total of 10 newborns who are at risk of infection during hospitalization. The breastfeeding rates during hospitalization, two weeks after delivery, and two months after delivery are 90%, 90%, and 80%, and the rate of newborns diagnosed with COVID-19 is still 0%.
Conclusions and Recommendations：
The results support that maternal continued breastfeeding after diagnosis will not increase the chance of neonatal diagnosis. Breastfeeding should continue after delivery to benefit the newborn. It is recommended that it can be continuously applied to clinical cases in the future, and larger samples and more rigorous research designs be used to verify the effectiveness of different outcome measures to increase more objective and accurate results.
