How to change perceptions on feeding in neonatal care

ABSTRACT

The transmission of HIV through breastmilk; with the potential to infect the newborn; has had a major impact on child health worldwide. Although South African studies confirmed that exclusive breastfeeding reduced rates of mother-to-child transmission of HIV; the recommendation of formula feeding for HIV-exposed newborn infants; provided their mothers had the facilities for safe preparation of formula milk and complied with the AFASS criteria (formula feeding to be Acceptable; Feasible; Affordable; Sustainable; Safe); was introduced. Observations made by the nursing staff; fully aware of the risks of formula feeding; in the neonatal unit at King Edward VIII Hospital in 2009 showed that an increasing number of small; sick newborns were being formula fed.By conducting focus group discussions with nurses; mothers and counsellors and teasing out the confusions and misconceptions; relevant information was imparted to the groups to allow them to re-consider their misconceptions. Within a period of 2 months nurses were confident about re-counselling mothers with respect to appropriate feeding choices. HIV-positive mothers were trained to flash-heat their milk. Subsequently; policies for the unit were derived from the focus group discussions. In addition; regional hospitals in the Durban area (eThekweni) considered the introduction of flash-heating to their units. The South African Department of Health opted for infants to receive prophylaxis with daily nevirapine as long as they are breastfed; and the Nutrition Directorate decided to withdraw the issue of free replacement feeds in HIV-exposed babies. KZN was the first province to institute this policy. The Department of Health has recommended that neonatal units no longer encourage HIV-infected mothers to flash-heat their breastmilk unless the infant is not receiving ARV prophylaxis or the mother is not on treatment