Peripartum ttt of infant of HIV +ve mother ( case report )
Peripartum Treatment of
Infant of HIV+ve Mother
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
-Results for HBV and HCV are negative
-mother is on Nevirapine 200mg/dose (reverse transcriptase
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 .
- mother was admitted to the ER at 12:15 a.m. contracting with cervical
- 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
- 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
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
On discharge of
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
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
4 to 6 month
Stop zidovudine after 2 successive –ve PCR if not
Pneumococcal vaccination is mandatory
BCG vaccination and any live attenuated vaccine
(oral polio) is not recommended
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
• 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.
• 4 weeks:
• Full clinical examination monitoring for growth
• 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
• As a simple guideline, infants > 2000 g will receive
5 ml daily MWF, and those below that 2.5 ml
• 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.
• 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.
• 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
• General clinic review.
• General clinic review.
• HIV PCR , HIV antibody
If both negative and the infant is well then
discharge from clinic.
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
• Measles and Chickenpox
• Clarify with parents about
the risks of exposure to
• Chickenpox exposure:
exposure to chickenpox (8-21
days following outbreak) or
those with varicella zoster.
• Measles: human normal
exposure to measles.
• 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
• Inactivated polio vaccine
(IPV) is considered the
safer choice and is used for
HIV-infected children and
household contacts in
countries where it is