Hello wise ones,

Before many of you disappear for the ILCA conference, I'd like to pick some brains. I've been studying maternal infectious diseases over the last days and went over the info about chickenpox (varicella zoster) again in Lawrence and Riordan. In both texts breastfeeding directly out the breast (as oposed to feeding expressed milk) is contraindicated if a mother contracts varicella in the last 5 days before delivery and in the first 2 days post partum (reason being that mother has not had enough time to mount an immune response and pass on Ig to infant). 
But, Australian and UK guidelines do not advise isolation of infant from mother, and breastfeeding can continue (avoiding contact with lesions), no matter when the mother developed chickenpox:
http://www.prodigy.nhs.uk/guidance.asp?gt=Chickenpox#MI_Breastfeeding
http://www.mja.com.au/public/issues/174_06_190301/heuchan/heuchan.html

I have also spoken with a Dutch ped. who stated also that infants do not need to be separated, no matter when the mother contracted or developed varicella. Her argument being that cross-infection can occur before the mother knows she has chickenpox (ie.in the 48 hours or so before the rash develops). A new born would most likely have been already exposed in utero, during the birth and with the kissing and cudling after birth. The protocol would be to give immunoglobulin to the infant, but no separation of mother and infant.

Interested to hear what anyone else thinks about this? Or have USA guidelines change recently to mirror UK, Australian, Dutch guidelines?

Thanks in advance,
Sara Bernard
(18 days to the exam!)

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