Newborns and AH1N1

[ferac]

Hello.

An request from Ecuador.

Somebody knows about the handling of new borns of mothers with infection AH1N1.

In the same way, somebody knows the handling of a new born one infected with infection AH1N1.

Sincerely,

Fernando Agama C.

Hospital "Dr. Enrique Garcés"

Quito-Ecuador

[Stefan Johansson]

I have been wondering the same.

According to the current guidelines I briefed, mothers with H1N1 needs to be isolated post-partum and the well infant does not need profylaxis unless the "situation is critical" (for the mother). Breast feeding is ok.

Preterm infants with suspected H1N1-infection would need isolation in the NICU and be candidates for treatment with Tamiflu (2 mg/kg once daily over five days).

But, I would like to express a word of caution about the guidelines I refer to. I would think it is hard to generalize guidelines about H1N1 since the virulence may differ between countries, and that different health authorities come to different conclusions, given the scarce amount of documentation for various strategies/dose regimes etc.

I am sure many members would like to hear from other corners of the world, about other strategies. Please share how you tackle H1N1 in NICU settings.

PS. Here's a link about a H1N1 case in a NICU in the US.

http://cbs4.com/local/H1N1.Swine.Flu.2.1074463.html

[ferac]

Thank you for the answer.

In fact, very little information exists in this respect.

In our hospital, we have not had any mother infected with AH1N1 up to now but it is foreseen that, in the event of she being, it isolates them and start treatment with oseltamivir. According to that foreseen by the CDC, the breastfeeding is not contraindicated.

For the newborn one any prevention is not foreseen. In the event of requiring treatment, we will have to use oseltamivir, but frighten us their side effects and the shortage of information regarding their security when it is used in children smaller than a year of age.

Sincerely,

Fernando Agama C.

Hospital "Dr. Enrique Garcés"

Quito-Ecuador

[Guest urai06]

Dear Sir,

I would like to share idea in practice in our hospital.We found 4 cases of H1N1 in mothers.Only one case is preterm delivery at29week gestation.Mother died first and also baby died later .In this case mother was on respirator and care in ICU and baby was born.We give drug to both of them.Baby has RDS and respiratory failure was transfer to our hospital at 24 hour old without receiving surfactant.

Urai06

[JACK]

Thought these will be useful:

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2704420&blobtype=pdf

http://www.bmj.com/cgi/reprint/339/aug10_1/b3172?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22Neuraminidase+inhibitors+for+treatment+and+prophylaxis+of+influenza+in+children%22&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT

[Guest Dukstar]

Hello,

We had our first case of proven H1N1 in a 3 month old ex-27 WG premature baby who suffered from pulmonary bronchodysplasia were significant pulmonary hypertension (under NO + sildenafil at 1 month then oral sildenafil at 2 months of age). The infection was well tolerated without worsening of pulmonary hypertension and the baby was isolated & treated by Tamiflu under French recommandations.

[KJM]

We have not (thankfully) had a proven case of H1N1 in a newborn in Northern Australia (as yet). We have however had in-utero deaths. The most important recommendation to come from this experience is that pregnant women should take tamiflu ASAP (within 1st 48 hours of illness); 4 hourly paracetamol and HIGH dose folate. This appears to minimise the damaging effects of cytokines on the foetus.

For suspected neonatal cases we have been isolating baby from all family and all others in the NICU. There have been criticisms of seperating mother and baby, but obviously, once H1N1 was disproven, mum was able to see baby again. This of course has the potential to expose other babies in the NICU. Luckily we have a handful of negative pressure isolation rooms, which avoided this.

[Stefan Johansson]

We have however had in-utero deaths.

Regarding the fetal deaths; has H1N1 been identified in fetal tissue by PCR or culture?

[KJM]

To our knowledge, the virus does not cross the placenta; it is merely the effects of the virus (cytokine release. etc) that causes the damage.

I would of course be very interested to hear anything to the contrary.

[JACK]

New recommendations (for mather and baby) for managing intrapartum and post partum situation for a mother with suspected/confirmed H1N1 Influenza

LINK