varicella in the mother and breastfeeding

[vijayashankara]

a fullterm born to the mother who is having varicella lesions one day prior to delivery.

baby shifted to isolation care, given varicella zoster immunoglobulin. is breast feeding contraindicated in the first week of life?

[Stefan Johansson]

According to the Swedish guidelines - breast feeding ok.

(Here, in Swedish, but try Google translate... http://www.medscinet.se/infpreg/specinfo/specinfo.asp)

[vijayashankara]

thank you Stefan, i did the googling, no definite answer though i believe it is ok. BNF mentions the virus is present in the breast milk and that was reason for different opinions. i am not sure ingesting a virus can cause infection, others were positive about it, and all the confusion.

[Stefan Johansson]

I instinctively feel that there are different opinions about this question, (even without a serious literature searches), and "local"/national guidelines can be wrong. Even Swedish...

Generally, I think one cannot exclude the possibility of viral spread through breast milk, one needs to consider risks/benefits.

I would personally feel uncomfortable to let a preterm infant get breastmilk.

CMV for example can definitely spread through breastmilk: http://fn.bmj.com/content/87/2/F75.abstract

[Guest afaf]

mother can breastfeed if there are no lesions on the breast or if breast lesions are covered, so she at this time could express it . breast milk possible because these women have antibodies to chicken pox virus,fatty acid which destroy the virus and immunoglobulin A, that are passed through the breast milk to the infant, conferring additional protection against the disease.

Women with active herpes lesions on the breast should not breastfeed until the lesions have completely healed and symptoms have cleared.

Read more at http://www.wrongdiagnosis.com/b/breast_feeding/book-diseases-19b.htm?ktrack=kcplink

[vijayashankara]

4 days ago the baby was readmitted with chicken pox lesions in spite of receiving the HVIG prophylaxis, isolating the baby from the mother and not breastfed for the 7 days.

[Stefan Johansson]

It is possible that the baby was transplacentally infected, before birth. As immunoglobulin is given after birth, the baby is not fully protected.

According to the Swedish guidelines, the baby would be given p.o. acyclovir 20 mg/kg x4/24hours during 5 days, (term infant given IG) if mild disease.

If the baby is more severely ill (or preterm) - our guidelines advice i.v. acyklovir 20 mg/kg x3/24h

[vijayashankara]

Yes, we do use acyclovir if neonate develops rash in the first one month, but would it of any use when there is no rash?

[Stefan Johansson]

According to the Swe guidelines (again...) one may consider acyklovir prophylaxis in term infants if immunoglobulin has been delayed after birth (10 mg/kg x4/24h during 14 days p.o.)

Infants born before 30 weeks or with birth weights below 1000 grams, are considered candidates for immunoglobulins AND acyklovir prophylaxis, dose as above.

(but this case you discuss, that baby has a rash, right?)

[vijayashankara]

At birth when the child received HVIG, no rash, rash developed at one week of age! Then we used acyclovir