Peripartum ttt of infant of HIV +ve mother ( case report )


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How to manage a baby of HIV +ve Mother

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Peripartum ttt of infant of HIV +ve mother ( case report )

  1. 1. Peripartum Treatment of Infant of HIV+ve Mother Dr.Ahmed Talaat
  2. 2. Maternal history : P2 , 35+6 weeks cephalic in labor (HIV +ve) By history taking : -mother acquired HIV disease 7 years ago from husband who had a previous blood transfusion in a hospital in Egypt following an accident. -Results for HBV and HCV are negative -mother is on Nevirapine 200mg/dose (reverse transcriptase inhibitor) reverse transcriptase enzyme, an essential viral enzyme which transcribes viral RNA into DNA. -No history of blood transfusion -No history of any other disease -Mother has 2 previous children one of them with –ve PCR for HIV DNA, the other is +ve .
  3. 3. Admission : - mother was admitted to the ER at 12:15 a.m. contracting with cervical dilatation 8cm - A decision of CS was made by the senior staff …by the time the mother was fully dilated and the baby’s head was on the perineum - Infection control nurse was called and informed about the maternal history - We were advised to wear overhead cover, mask, double safe gloves and gown and to be cautious in dealing with needles and instruments On delivery : - baby was delivered normally as there was no time for CS - Baby was delivered active crying with a good tone - Apgar score 8/9 by air and no suction to avoid injury since the baby was already vigorous - Full examination of the baby was done with no abnormal findings - Baby passed meconium during resuscitation - Vitamin K IM was given - Chest , heart , abd  NAD with good suckling
  4. 4. Infection control : -The mother was isolated form other patients -laryngoscope and ambu bag was left inside the room together with everything used during resuscitation -All gloves was put in red bags together with the gown mask and overhead -the operative room was closed for the whole day -clamping and cutting of the cord was done under complete aseptic condition -Immediate washing and cleaning of the baby was done following delivery -Removal of any remains of maternal blood on the baby
  5. 5. On discharge of the baby • • • • • • • • Artificial feeding was recommended Nevirapine (50mg/5m) was only available this time and according to the HIV protocol it is given as a single dose in the first 6 hours orally at a dose of 2mg/kg so the baby took 0.6cc orally with a syringe HBV vaccine was ordered but was not available at the time Ziduvidine was also not available at the time which should be introduced in the first 48 hours at a dose of 4mg/kg twice if non breast feeding PCR for HIV DNA should be done at the age of : In the first 48 hours 6 weeks 4 to 6 month 18 month Stop zidovudine after 2 successive –ve PCR if not breast fed Pneumococcal vaccination is mandatory BCG vaccination and any live attenuated vaccine (oral polio) is not recommended
  6. 6. HIV follow up care • If the infant looks clinically unwell at any stage (even without a positive • HIV PCR) consider measuring CD4 lymphocyte count and percentage • With respiratory distress, PCP pneumonia should be considered (also Chlamydia, CMV). • It is thought that a positive PCR within 48 hours of life (not cord blood) represents in utero infection . • By one month the PCR should detect >90% of infant infections.
  7. 7. • 4 weeks: • Full clinical examination monitoring for growth and development. • CBC. • HIV PCR . • Prescribe co-trimoxazole suspension (240 mg/5 ml) 5 ml three times weekly PO for PCP prophylaxis to be started after stopping triple therapy. • As a simple guideline, infants > 2000 g will receive 5 ml daily MWF, and those below that 2.5 ml MWF.
  8. 8. • 6-8 weeks: • This will be the first outpatient appointment for most infants. • Full clinical examination monitoring for growth and development. • CBC to monitor for bone marrow depression. • Continue cotrimoxazole . • HIV PCR . • Ensure Hepatitis B Vaccine has been given and that immunisation • schedule is being followed.
  9. 9. 12 weeks: • Full clinical examination monitoring for growth and development. • HIV PCR ,If this PCR is negative then the infant is very unlikely to be infected and cotrimoxazole if previously commenced may be discontinued. • CBC. • Ensure Hepatitis B Vaccine has been given and that immunisation schedule is being followed. • If the third PCR is negative then the infant should routinely be offered BCG vaccination. 12 months: • General clinic review. 18 months: • General clinic review. • HIV PCR , HIV antibody If both negative and the infant is well then discharge from clinic.
  10. 10. Vaccination Hepatitis B Vaccine • First dose (0.5 ml IM) to be given while in the hospital. In Hep. B positive mothers this should be given within the first 24 hours
  11. 11. • Measles and Chickenpox • Clarify with parents about the risks of exposure to measles, chickenpox • Chickenpox exposure: varicella zoster immunoglobulin is recommended following exposure to chickenpox (8-21 days following outbreak) or those with varicella zoster. • Measles: human normal immunoglobulin is recommended after exposure to measles.
  12. 12. Bacille Calmette–Guérin Vaccine • Recent data have demonstrated, that children who are HIV infected when immunized with BCG at birth, and who later progress to AIDS, are at increased risk of developing disseminated BCG disease later in life. In 2007 the WHO recommended that BCG vaccine not be given to any child known to be HIV infected (symptomatic or asymptomatic).
  13. 13. Polio vaccine • Inactivated polio vaccine (IPV) is considered the safer choice and is used for HIV-infected children and household contacts in countries where it is available.
  14. 14. Thank you