Peripartum HIV infection in very low birth weight infants fed 'raw' mother's own milk.

BACKGROUND: HIV-exposed very low birth weight (VLBW) infants (≤ 1500 g) are considered at high risk of peripartum mother-to-child HIV transmission (MTCT). In the past, they received formula to prevent breast milk related HIV transmission. This denied them the benefits of breast milk, thus exposing the infant to the risk of necrotising enterocolitis (NEC). From 2010, 'raw' mother's own milk (rMOM) has been recommended for term infants whose mothers' received antenatal antiretroviral therapy (ART). At the same time, the infant received antiretroviral (ARV) prophylaxis as per the National Prevention of MTCT programme. OBJECTIVES: To determine the cumulative incidence of peripartum HIV infection by 4-6 weeks of age in HIV-exposed VLBW infants, who received rMOM and infant ARV prophylaxis. METHOD: A retrospective, observational audit over 3 years at a single institution was undertaken. The study population comprised HIV-exposed VLBW infants who received both nevirapine prophylaxis and rMOM from birth until discharge. A positive HIV-PCR by 4-6 weeks of life was used to confirm maternal to infant HIV transmission. RESULTS: Of the 80 eligible infants admitted between 2010 and 2013, 63 (79%) were exposed to antenatal ART. Seventy-eight (97.5%) tested HIV-PCR negative at 4-6 weeks. Of the two infants who tested positive, both presented with features of an acute HIV infection. The absence of MTCT in the remaining 78 infants given ARV prophylaxis and rMOM suggests that rMOM is an unlikely source of infection in the two infected infants. CONCLUSION: rMOM, in the presence of infant prophylaxis, was a safe feeding option for HIV-exposed VLBW infants. It should be strongly considered for these infants, as rMOM likely provides additional maternal and child benefits.

Impact of haemophilus influenzae type b conjugate vaccine in South Africa and Argentina.

INTRODUCTION: Haemophilus influenzae type b (Hib) persists as a major cause of pediatric meningitis and pneumonia in developing countries in which Hib conjugate vaccines are not used. Demonstration of decreases in severe Hib disease after countries introduce Hib conjugate vaccine will help justify the resources necessary to purchase and provide the vaccine. Because surveillance for culture-confirmed Hib meningitis is not available in many countries, alternative means to measure the impact of Hib conjugate vaccine would be useful. METHODS: Laboratory records from the years before and after introduction of the Hib conjugate vaccine were reviewed at 4 hospitals, 2 in Argentina and 2 in South Africa. Potential indicators of bacterial meningitis including cerebrospinal fluid (CSF) culture, white blood cell count, appearance, protein and glucose were recorded. RESULTS: After introduction of Hib conjugate vaccine, culture-confirmed Hib meningitis declined significantly at 3 of 4 hospitals (2 in Argentina and 1 in South Africa). In the same 3 hospitals, there was a significant decline after vaccine introduction in some of the following CSF indicators of bacterial meningitis: proportion of CSF specimens with white blood cell count > or = 100 x 10(6)/L, 500 x 10(6)/L and 1,000 x 10(6)/L; glucose <40 mg/dL; protein >100 mg/dL; and turbid appearance. CONCLUSIONS: Culture-confirmed Hib meningitis declined at 3 of the 4 hospitals after Hib vaccine introduction. Surrogate indicators of bacterial meningitis also declined and might be useful measures of Hib conjugate vaccine impact at hospitals where capacity to culture Hib is not available.

Incidence of retinopathy of prematurity in very-low-birth-weight infants born at Kalafong Hospital, Pretoria.

INTRODUCTION: Retinopathy of prematurity (ROP) is a complication of prematurity, is diagnosed by ophthalmological screening of infants at risk (birth weight < or = 1,500 g), and may lead to blindness. The incidence of ROP is under-reported in developing countries, including South Africa. Published data from the USA (CRYO-ROP) show that black infants have a lower incidence of threshold ROP than their white counterparts (3.2% v. 7.4%). Preliminary results of a screening programme initiated at Kalafong Hospital in 1999 are reported. AIM: To determine the incidence of ROP in infants with a birth weight of < or = 1,500 g born at Kalafong Hospital. PATIENTS AND METHODS: Consecutive infants were enrolled at birth and screened for ROP 4-6 weeks later by indirect ophthalmoscopy. Repeat examinations were performed until vascularisation was complete or until the infant reached a postconceptional age of 40 weeks. Infants with stage 3 ROP who developed threshold disease were treated with cryotherapy or laser therapy. RESULTS: One hundred and forty-five infants were enrolled over 10 months (15 February 1999-25 December 1999); of these 94 were screened. Of the remaining 51 infants, 24 died before screening and 27 were discharged before screening and were lost to follow-up. ROP was diagnosed in 23 of the 94 infants screened (24.5%). Stage 1 and 2 ROP occurred in 17 of the infants screened (18.1%) and stage 3 ROP in 6 (6.4%), of whom 4 (median birth weight 995 g, range 900-1,450 g) developed threshold ROP and were treated. CONCLUSIONS: The incidence of ROP in black very-low-birth-weight infants born at Kalafong Hospital is 24.5%. The incidence of threshold ROP is 4.3% (3.2% in infants < or = 1,250 g) and correlates with published data from the USA. Infants with a birth weight < or = 1,500 g should receive ophthalmological screening to diagnose stage 3 ROP timeously.