Abstract Ref Number = APCP93
SICK MOTHERS AND LACTATION
Breastfeeding Task Force Indonesian Pediatrics Society
There are many benefits associated with breastfeeding, including nutritional, immunological, psychological, developmental, environmental, social, economic and health (eg, decrease in infectious diseases).Although human milk contains antibodies, mononuclear cells and other protective factors, it may be a possible source of infection for the infant in some maternal diseases.
Health care practices should have a knowledge about maternal infectious diseases in which continuing breastfeeding is recommended to promote, protect and support breastfeeding.
Maternal infectionand breastfeeding
Maternal bacterial infections are rarely complicated by transmission to the infant through breastfeeding. Mothers with mastitis or breast abscesses should be encouraged to continue breastfeeding. Maternal tuberculosis (TB) is compatible with breastfeeding, provided the mother is not contagious or she has received two weeks of appropriate TB treatment. Continuing breastfeeding while on TB therapy is not a problem, as these drugs appear to be safe for use with breastfeeding.Respirologi Working Group of Indonesian Pediatric Society based on National Guidelines Tuberculosis Children still suggest breastfeeding in infants with mothers who suspect / proven tuberculosis. If possible, the baby is kept breastfeeding, but the mother should wear a mask to prevent TB transmission to her baby. In a very infectious mother (smear positive), the infant is separated until sputum smear or infectious mother is no longer infected, but breastfeeding is still given. BTA (Acid-resistant bacilli) reexamination of breastfeeding mothers is performed 2 weeks after treatment. Anti-tuberculosis drugs are very little excreted in breast milk, so they are safe for consumption during breastfeeding.In several maternal viral diseases, such as hepatitis, herpes, measles, mumps and rubella, among others, the virus may be excreted into human milk. However, except for infections caused by retroviruses, human immunodeficiency virus (HIV-1), human T-lymphotropic virus type I (HTLV I) and human T-lymphotropic virus type II (HTLV II), transmission via human milk has little epidemiological relevance.Nevertheless, WHO and UNICEF recommend, in poor countries, when diseases such as diarrhea, pneumonia and malnutrition still have high morbidity and mortality rates, breastfeeding benefits still need to be taken into consideration than the risk of HIV transmission. In all infants born to HIV+ mothers, both breast-fed and formula-fed, zidovudine prophylactic with 4 mg/kg/times, two times daily for 6 weeks. In breast-fed infants, zidovudine is continued for up to 2 week after breastmilk is discontinued. Mothers still have to take antiretroviral treatment or antiretroviral prophylaxis.Hepatitis A, B and C viruses can be transmitted to the infant during pregnancy, delivery or postnatal period. Viruses transmitted by the oral-fecal route, as in hepatitis A, have a higher chance of being transmitted to the infant at delivery. Although hepatitis C virus has been detected in the milk of HCV-positive mothers, its transmission via breastmilk has not been confirmed. Therefore, breastfeeding is not contraindicated in HCV-positive mothers. In mothers with latent cytomegalovirus (CMV) infection, the virus reactivates in breast milk during the postpartum period and can be transmitted to the infant with breastfeeding. This does not pose a risk to the term infant because serious disease is prevented by placen- tally transferred maternal antibody. For premature infants, especially those less than 32 weeks gestation, breastfeeding from a CMV-positive mother is controversial. However, recent studies suggest that that the relative incidence and severity of CMV disease in such premature infants are low, and that the rate of CMV acquisition is not much different from the rate of acquisition in premature infants fed CMV-negative breast milk, providing further support for fresh breast milk feeding even if the mother is CMV positive.
The mother who is exposed to infectious diseases may transmit pathogenic agents through the human milk. The healthcare provider must take his/her decision upon suspending or still continue breastfeeding. This information is important not only to protect nursing infants from untoward effects of maternal infection and medication as well.