Literature review for - Flourish Paediatrics

eview by (Bulteel and Henderson 2007) concluded that the majority of evidence suggests
that mixed feeding is associated with a significantly increased risk of MTCT.
In addition to not breastfeeding, other options besides commercial formulas include heat
treatment of expressed breast milk, wet-nursing, or use of human breastmilk from donor milk
banks. The WHO recent guidelines note that heat treatment of expressed breastmilk from
HIV-infected mothers, if correctly done, can inactivate HIV. As the methods of heat
treatment do not appear to reduce the nutritional or immunological properties of breastmilk
the practice of heat treatment on expressed breastmilk could be considered as a potential
approach to safely providing breastmilk to their exposed infants (WHO 2010).
In developed countries if a newborn infant whose mother’s HIV serostatus is unknown, the
health care professional should perform rapid HIV antibody testing on the mother or on the
newborn infant, with results reported to the health care professional no later than 12 hours
after the infant’s birth. If the rapid HIV antibody test result is positive, antiretroviral
prophylaxis should be instituted as soon as possible after birth but certainly by 12 hours after
delivery, pending completion of confirmatory HIV testing. Assistance with immediate
initiation of hand and pump expression to stimulate milk production should be offered to the
mother, given the possibility that the confirmatory test result may be negative. If the
confirmatory test result is negative, then prophylaxis should be stopped and breastfeeding
may be initiated. (Havens, Chakraborty et al. 2008) .
The current guidelines in Australia are for HIV infected women to avoid breastfeeding
following the long-held notion that avoidance of breastfeeding by HIV-1-infected women
remains the only means by which prevention of breastfeeding transmission of HIV-1 can be
absolutely ensured. The WHO state that counselling and support to mothers known to be
HIV-infected, and health messaging to the general population, should be carefully delivered
so as not to undermine optimal breastfeeding practices among the general population.
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