Advice regarding breastfeeding for mothers with possible H1N1 infection

"Advice regarding breastfeeding for mothers with possible H1N1 infection
Ruth A. Lawrence, M.D., FAAP and John S. Bradley, M.D., FAAP

As published in AAP News - Official Magazine of the American Academy of Pediatrics

"Neonates and infants younger than 6 months of age are at risk for complications from seasonal influenza and presumably 2009 H1N1 influenza (swine flu), although the morbidity and mortality from this new virus have not yet been described.

"While the advantages 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 handwashing 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.

"For any mother with H1N1 influenza infection who presents in labor to a health care institution, testing and empirically starting therapy for influenza with an antiviral is suggested. Oseltamivir (Tamiflu) or zanamivir (Relenza) will hasten resolution of symptoms and infectivity, particularly if treatment is started within 48 hours of onset of illness. Neonatal exposure to oseltamivir (Tamiflu) excreted in breast milk is extremely low.

"Immediately following delivery, the precautions listed above should be instituted as the newborn infant is first placed into mother’s arms. These precautions should be followed until mother’s illness is resolved, i.e., no fever, as measured without antipyretics, for 24 hours.

"While no data exist to support these suggestions, it is believed that these represent an appropriate balance between the benefits of mother-infant interaction and the risks of serious neonatal infection. Institutions may wish to modify of these suggestions to address their needs and medical practices.

"Dr. Lawrence is chair of the AAP Section on Breastfeeding executive committee. Dr. Bradley is a member of the AAP Committee on Infectious Diseases."