Literature review for - Flourish Paediatrics

antiretroviral intervention to reduce transmission or avoidance of all breastfeeding, will be
primarily promoted and supported by Maternal and Child Health services. National or subnational
health authorities should decide which strategy that will most likely give infants the
greatest chance of HIV-free survival. The decisions should be based on international
recommendations and consideration of the:
- socio-economic and cultural contexts of the populations served by maternal, newborn and
child health services,
- availability and quality of health services;
- local epidemiology including HIV prevalence among pregnant women;
- main causes of maternal and child undernutrition
- main causes of infant and child mortality.
The revised guidelines state that pregnant women and mothers known to be HIV-infected
should be informed of the infant feeding practice recommended by the national or subnational
authority to improve HIV-free survival of HIV-exposed infants and the health of
HIV-infected mothers, and informed that there are alternatives that mothers might wish to
adopt. If a mother does choose to breastfeed, the WHO advises exclusive breastfeeding and
ART interventions.
There is a reduction in HIV transmission with exclusive, compared to mixed, breastfeeding in
the first 6 months of life (Stein and Kuhn 2009). Depending on when supplements are
introduced and on the components of the infant’s diet the odds ratio quantifying the
disadvantage of mixed feeding compared to exclusive breastfeeding is estimated to be
between 2.5-10 (Stein and Kuhn 2009). Further research is required to determine the
physiological mechanism that explains the adverse effects of mixed feeding in young infants
of HIV infected mothers. To prevent postnatal MTCT transmission of HIV breastfeeding
mothers should receive advice about optimal breastfeeding techniques to avoid cracked
nipples, milk stasis and mastitis.
A randomised trial in Zambia aimed to determine whether mixing complementary food and
fluid with breastmilk at the age of four months would have unfavourable effects. The results
demonstrated that abrupt weaning is contraindicated indicating that infants that are breastfed
should be weaned gradually (Kuhn, Aldrovandi et al. 2008). In line with these results the
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