"I've had another question about whether it is safe for an adoptive mother to breastfeed a baby who is known to be HIV+, or at risk for it but still too young for a definitive test to be made.  In 1990, at a European are conference of LLLI, a physician spoke about a report of mothers in eastern Europe having been infected by their nursing infants, who had contracted it from transfusions.  I've heard some other things, over the years, but can't remember anything definitive.  It's confusing that they say it can't be transferred by kissing, even thought people often have small cracks in their lips or small wounds inside their mouths.  I seems reasonable that, if kissing is safe, breastfeeding would be too, but I certainly don't want to encourage it without knowing for sure.

Does anyone have any kind of recent evidence that I could pass on to these mothers?  It is quite a common question."

Darilyn,

You are describing my worst nightmare - both as an adoptive physician and as a lactation consultant.

The risk of baby-to-mother infectious disease transmission is a well known fact and such transmission was reported in several diseases, including two well known clusters of HIV infection in Southern Russia in early 80s and Libya in 1990's.
In Russia epidemic did start with the index case of the first documented HIV infection in the Soviet Union (traveling abroad father infected mother and, subsequently - the baby). Baby was sick since birth and was admitted first to the local (Elista) hospital, from which the index case was transferred to the regional center (Rostov?). The use of multi-dose vials of heparin was implicated in transmission of HIV through the NICU patients, who in turn did infect their mothers.
In Lybia the same situation was restricted to one referral hospital.

Without knowing all the details of this particular baby it is almost impossible to give a definite recommendation.

But at the same time, understanding the devastating implications of the HIV infection to both mother and child, I would highly advise to consult your infection disease specialist to make sure that baby is evaluated properly and the HIV status is expeditiously determined to the highest degree possible.
Appropriate treatment needs to be initiated as soon as possible.

Until clarification of baby's HIV status direct breastfeeding is not really advisable. Mom can pump and feed the baby with other means - finger feeding while wearing a glove, cup feeding, even bottle feeding.
Definitely mother can continue skin-to-skin contact.

Can you give us more information of the case (on- list or off-list)?

Hope that helps
Alla

Alla Gordina, MD, IBCLC, FAAP
Clinical Assistant Professor of Pediatrics

Drexel University College of Medicine and

UMDNJ - Robert Wood Johnson Medical School


Global Pediatrics
International Adoptions Medical Support Services
7 Auer Court, East Brunswick, NJ 08816, USA
732-432-7777 (voice)
732-432-9030 (fax)

www.globalpfm.com
drgordina @globalpediatrics.net






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