Hi, All:

It's been a while since my last post. As you may know that SARS has become
a more serious problem in Taiwan in these two weeks. In the medical center
where I work, we have been planning all the procedures once there is
outbreak in our area. We have meeting twice a week and every health worker
has to receive the training for caring of SARS patients. The knowledge is
being update frequently for it is such a brand new virus. We are learning
from the painful experience of our colleagues in Taipei city.

Fortunately, from the experience in Hong Kong, we know that the pediatric
population will have the mildest symptoms of all age group and no mortality
was reported in this age group. However, as an advocator of breastfeeding,
we are challenged by many of the hospitals about the BFHI practice during
the SARS epidemic. They withdraw the practice of room-in and early contact
for fear of SARS.

As this is a new virus, no official recommendation is available though I
have tried to contact UNICEF. (Please remember that WHO has ignored the
people in Taiwan for about 30 years though I had some personal contact with
individual person.) From the knowledge what I have, I have made some
suggestions to our health workers:

1.For healthy mother
She should keep on breastfeeding, because breast milk provides the perfect
nutrition and immunological protection for the baby, especially under the
threatening of SARS.

2.For mother who is quarantined due to close contact with suspected or
probable cases of SARS, and she has no symptom and sign of SARS
She should stay with her baby and keep on breastfeeding as usual. If the
baby is cared by nanny (working mothers) and separated from her, the mother
can express her milk and give the baby.

3.For the mother who is a suspected or probable case (with fever, cough,
and even pneumonia)
That¡¦s the most difficult case. Our infection doctors are worried about
the virus in the milk and the probable quick deterioration of the clinical
condition of the mother. At the present, when the mother has symptoms, her
baby may be separated from her already. We may suggest artificial feeding
but encourage continuous breast expression. No one knows whether exclusive
breastfeeding will carry the same risk as artificial feeding like the case
of HIV.

4.Is it safe to keep on early contact and room-in?
The baby will expose to more health staffs with increased risk for virus
exposure when he/she stays in the nursery. Early contact and room-in should
be the routine as usually. Health staffs should wear masks and wash hands
before they visit mother and baby.

5.Is it safe to keep on early contact and room-in for a mother who is been
quarantined and without symptoms or signs?
Mother and baby should keep together from the beginning with close
supervision from the health staffs. Health staffs should practice good
infection control and hygiene.

That¡¦s my own opinion. I am open for any suggestion and information, which
is really needed here.

Chao-Huei
Neonatologist, Taichung Veterans General Hospital

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