How to prevent a neonate from risk of HIV infection

Mothers exposed to HIV should not breastfeed their newborn babies early in life to protect them from HIV Infection even though alternative diets are grossly inadequate to replace breast milk.

Mothers exposed to HIV should not breastfeed their newborn babies early in life to protect them from HIV Infection even though alternative diets are grossly inadequate to replace breast milk.

Note that the health of the mother and her own treatment has a direct influence to the health of the newly born in so many aspects. There is proven evidence that mothers exposed to the human immune virus and on anti-retro viral drugs can breast feed their babies with out transmission of the virus to their infants. However, this is possible after a few months of life.

Protection of the infant begins at the in-born stage. HIV-positive pregnant women are people who need adequate care to safeguard their inborn babies. Our community sometimes tends to neglect or forget such mothers yet the baby’s health is another main focus.

Prevention of transmission and the health of the inborn baby have a direct link to the health of the mother. Prenatal counseling for HIV-positive woman should always include; advice and discussion about how to prevent mother to child transmission, information about treating the mother’s own HIV during pregnancy and information about treating the mother’s HIV in the future.

Healthcare workers should provide information, education and counseling that is impartial, supportive and non judgmental. HIV should be intensively monitored during pregnancy. This is particularly important as the time of delivery approaches.

Opportunistic infections should be treated appropriately. Anti-HIV drugs should be used to reduce viral load to undetectable levels. Mothers should be treated in the best way to protect them from developing resistance to HIV drugs.

Additionally, mothers should be able to make informed choices regarding how and when their babies will be born.

It is important to note that mother-to-child transmission can occur before, during and after birth.

Scientists have found several possible reasons for infection. Besides the mother’s viral load, her low CD4 count (CD4 are defense cells in the body) and whether she has Aids illnesses make it more likely.

The exposure of the baby to a mother’s infected blood or other body fluids during pregnancy and delivery, as well as breastfeeding are thought to be how transmission happens. But most transmissions happen during delivery when the baby is being born. More rarely, some transmissions happen during pregnancy before delivery. This is called in utero transmission.

Transmission during pregnancy (in utero) might occur if the placenta is damaged, make it possible for HIV-infected blood from the mother to transfer into the blood circulation of the fetus.

This is thought to occure either via infected cells traveling across the placenta, or by progressive infection of different layers of the placenta until the virus reaches the fetus placental circulation.

In utero transmission what happens is a proportion of HIV-positive babies tested when they are a few days old already have detectable virus in their blood. The rapid progression of HIV disease in some babies has also made scientists conclude that this happens.

Circumstances such as high viral load or low CD4 make in utero transmission more likely. Infections such as tuberculosis co-infected with HIV makes in utero transmission more likely.

Transmission during labour and delivery is thought to happen when the baby comes into contact with infected blood and genital fluids and secretions from the mother as it passes through the birth canal. This could happen through ascending infection from the vagina or cervix to the fetus and amniotic fluid (fluid surrounding the fetus), and through absorption in the digestive system of the baby.

Alternatively, during contractions in labour, maternal-fetal transfusion of a small quantity of blood may occur.

Scientists know that transmission occurs during delivery because 50 per cent of HIV-positive babies test HIV-negative in the first few days of life. There is also a rapid increase in the rate of detection of HIV in babies during the first week of life.

The way that the virus and the immune system behave in some newborn babies is similar to that of adults when they first become infected. This can be prevented by lowering the mother’s viral load with ARVs; and delivering the baby by Cesarean section (surgical means) before labour starts.

If it takes long to deliver after the membranes have ruptured (membranes are tissues where a baby is confined and sheltered in the womb),  if there is a prolonged labour, risk of transmission in women not receiving ARV treatment is increased.

A premature baby might be at a higher risk of HIV transmission than a full term baby.

Dr Joseph Kamugisha is a resident oncologist in Jerusalem, Israel.

 

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