Pregnancy and being under 2 years of age are risk factors for severe disease complications from H1N1. Consequently early vaccinations have been aimed at these groups. When a pregnant woman does contract H1N1 recommendations for the feeding of her infant vary. Things to be considered include the dangers of not breastfeeding, the safety of the milk itself for the infant, the safety of mother/infant direct contact and the safety of the medications used to treat the H1N1 being ingested by the infant via the mother’s milk

Consulting the major pundits that I am aware of I find the opinion that breast milk is best especially is true across the board. All three also feel the typical influenza antivirals are safe for an infant in the small volumes ingested via breast milk. There is some variance in recommendations on temporary separation of mother and baby with WHO not addressing the issue, CDC recommending a minimum of 48 hours (while mom is on anti virals) separation while feeding the baby expressed breast milk and AAP recommending direct breastfeeding with common sense precautions to prevent droplet contamination of the infant. If you know other nation's clinical recommendations sites that deal with this topic /msg me and I'll be glad to add them.

Relevant quotes from each organization are pasted below.

The World Health Organization:
Mothers who are breast feeding may continue breastfeeding while ill and receiving oseltamivir or zanamivir.

For pregnant women or mothers who are breast feeding, ensure that antimicrobials for treating any secondary infection are safe for use during pregnancy and lactation, e.g. avoid tetracyclines, chloramphenicol, and quinolones.

The US Center for Disease Control and Prevention:
Step 1: Providers should consider temporarily separating the infected mother from the newborn within her room (in an isolette) or in separate rooms until the risk of infectious transmission is reduced, defined as having met ALL of the following criteria:

• The mother has received antiviral medications for at least 48 hours and; • The mother is without fever for 24 hours without antipyretics and; • The mother can control cough and respiratory secretions. Once these criteria are met, the mother and infant can initiate close contact throughout the postpartum period with droplet precautions and the mother can begin infant feedings.

Step 2: Once the mother and infant are able to initiate close contact, the following guidance is offered for mothers immediately prior to feeding and handling the infant in order to protect the newborn from droplet exposure:

• The mother should wash her hands with soap and water; • The mother should put on a face mask; The mother should observe all respiratory hygiene/ cough etiquette guidelines.

• These precautions should be followed for 7 days after symptom onset or 24 hours after resolution of symptoms, whichever is longer.

Healthy term newborns of infected mothers with suspected or confirmed 2009 H1N1 should be considered exposed, rather than infected, if they are born in the hospital setting following infection control guidelines. These infants should be observed for signs of infection. Unless clinically indicated, these newborns should be cared for with standard precautions whether they are cared for in the mother’s room or in the term newborn nursery setting.

The American Academy of Pediatrics:
While the benefits of breastfeeding are well-known, this close interaction of mother and newborn also can facilitate transmission of influenza virus. The benefits and the risks of close contact must be considered carefully.

To protect the infant from possible serious infection while allowing essential and encouraged mother-infant bonding to occur, a compromise is required until more data are available. The following precautions are suggested to minimize the risk of infection to the infant, particularly while still in the hospital and while the mother is symptomatic with fever and coryza:

• Pay careful attention to hand washing prior to any contact. • Prior to breastfeeding, wash the breast with mild soap and water; rinse well • The mother should wear a surgical mask to prevent nasal secretions and the spontaneous cough or sneeze from inoculating the infant. • Use clean blankets and burp cloths for each contact. Monitor the maternal-infant interaction on perinatal floors for compliance with the above precautions.

• These precautions are designed to minimize the risk of transmission until mother’s immune response to H1N1 influenza is established, and increased, specific immune protection may be provided by breast milk. Note that influenza virus does not pass through breast milk.

Although the most effective way to prevent influenza transmission is complete separation from her infant when a mother is receiving antiviral treatment, separation may create more long-term problems in breastfeeding success and mother-infant bonding than any potential benefit achieved from avoiding infection in the newborn infant.


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