Research Corner: Featured Articles

Research Corner by Nancy E. Wight MD, IBCLC, FABM, FAAP

Neonatologist, Lactation Consultant

Previously, the American Academy of Pediatrics (AAP) recommended that infected mothers pump breastmilk until they were no longer contagious, rather than directly feeding the baby. This study helped to change the AAP guidelines to ones more in line with the WHO.

Research Corner by Seth M Pransky, MD

Pediatric Otolaryngology, Head and Neck Surgery

Intervention for breastfeeding difficulties with frenulotomy continues to be recommended and performed with increasing frequency. However, there is still significant controversy regarding the appropriateness and need for intervention and greater recognition of complications from the procedure. More recent literature has clarified the true anatomy of the frenulum, the difficulties in appropriate definition of "tongue tie" and the challenges in diagnosis of ankyloglossia as the cause for the breastfeeding problem as well as the benefits of multidisciplinary assessment prior to referral for frenulotomy. The article "Primum non nocere: lingual frenotomy for breastfeeding problems, not as innocent as generally accepted" provides an excellent summary of the controversies and concerns regarding referral for frenotomy.

Research Corner by Nancy E. Wight MD, IBCLC, FABM, FAAP

Neonatologist, Lactation Consultant

In a brief letter to the editor in The Lancet published online May 21, 2020, Rüdiger Groß et al. from Ulm University Medical Center in Germany report two mother-infant pairs with COVID-19 symptoms and 1 mother with SARS-CoV-2 RNA in her breastmilk. Her infant was positive for both RSV and SARS-CoV-2 and was symptomatic by day 10 of life despite the mother wearing a mask, good hand hygiene and careful cleaning of her pumping equipment. Although SARS-CoV-2 RNA was discovered in the breastmilk, that does not necessarily mean the infant acquired the illness THROUGH the milk, since close contact was also present.

A prominent pediatric infectious disease specialist, Dr. John Bradley, of Rady Children’s Hospital San Diego and UCSD, also noted that the authors used an antibacterial (not viricidal) preparation to clean the breasts, such that the breastmilk may still have been contaminated from mother’s other PCR-positive secretions.

As human milk contains many immunologic factors to fight both bacterial and viral infections, the authors also spiked "clean" human breastmilk with serial dilutions of SARs-CoV-2 and found up to 89.2% reduced recovery rate in whole milk, and 51.1% in skimmed milk (fat removed)! Clearly human milk has some effect on reducing the infectivity of the virus, much like its effect on other viruses.

Article and appendix materials can be accessed at:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31181-8/fulltext