Feeding Practices of Stable Term and Late Preterm Neonates Born at a Tertiary Hospital in the Philippines during the COVID-19 Pandemic.

Objective: We aimed to evaluate the impact of maternal COVID-19 infection and separation of the mother-baby dyad on feeding practices by determining modes of feeding upon discharge and following up at 2-3 days, 14 days, and 1 month post-discharge.

Methods: This was a prospective observational cohort study conducted at the Philippine General Hospital, a tertiary government COVID-19 referral center in Manila. Mothers who delivered between the months of July and August 2021, and whose COVID-19 status was known were followed up on their baby's mode of feeding at 2-3 days, 14 days, and 1 month post-discharge via phone call. For babies of COVID-19 positive mothers, presence of any symptoms (up to the 14-day time point only) as well as adherence to infection prevention and control practices were also identified.

Results: For all time points post-discharge, breastfeeding rates were higher in babies born to COVID-19-negative mothers and in those who were roomed in. However, the differences were not statistically significant. Of the 108 infants, 72.90% remained exclusively breastfed by 1 month of age, with 4.67% formula-fed and 22.43% on mixed feeding. Perception of insufficient milk supply was the most common reason for shifting to formula or mixed feeding. We found a significantly higher direct breastfeeding rate upon discharge in the roomed-in population compared to those admitted to the NICU. Risk factors affecting breastfeeding at 1 month of age was the presence of COVID-19 infection in the mother and mother-baby separation due to NICU admissionCOVID-19-positive mothers were 66.02% less likely (p=0.016, 95% CI 0.1411 to 0.8183) to still be breastfeeding at 1 month, and separation was not found to be a significant risk factor.

Conclusions: Feeding practices can be affected not only by COVID-19 infection in the mother and its attendant difficulties such as prolonged hospital stay and physical and social isolation, but also by limitations in the hospital environment that can have an impact on breastfeeding education, support, and opportunities for mother-child bonding.