Special needs

Sometimes special circumstances or particular needs of the baby make feeding the newborn with mother’s milk more difficult. This can be due to a virus infection of the mother.

The World Health Organization (WHO) recommends women with the COVID-19 virus to, if wished, breastfeed their newborns. Studies suggest a low horizontal transmission rate, mild to non-existing symptoms for the baby, and low neonatal death risk. On the other hand, breastfeeding is essential for a baby’s health as it protects against respiratory and gastro-intestinal illnesses and prevents malnutrition and mortality. Precautions (respiratory hygiene including wearing a mask; washing hands routinely) should be taken.

Women who feel too unwell to breastfeed their baby due to COVID-19 or other complications should be supported to safely provide their baby with breast milk in their chosen way. Alternatives are expressing milk, finding a human milk donor, and using infant formula (note that donor human milk is usually reserved for hospitalised preterm or sick babies).

Cytomegalovirus (CMV) is a virus that persists lifelong in blood cells. Approximately half of all adults are carriers. The virus can be reactivated in mothers during the lactation period and transmitted to the infant via breast milk.

In general, infections in term infants stay asymptomatic because of the transmission of protective maternal antibodies in the last trimester of pregnancy. Very preterm born infants cannot be protected by these antibodies and are therefore at higher risk for symptomatic CMV. Even though it is very unlikely, CMV can affect the clinical course of pre-existing diseases in preterm infants.

Preterm infants benefit significantly from mother’s own milk, as it contains many protective enzymes, hormones and growth factors that play important roles in gastrointestinal development and maturation. This is why several experts still recommend breastfeeding for CMV-positive mothers. Pasteurisation effectively deactivates the virus in breast milk and can therefore be a solution for providing preterm infants with safe milk. It is recommended that CMV-positive mothers and healthcare professionals discuss the best solution based on the newborn’s health status.

Hepatitis is an inflammation of the liver caused by a virus, which can lead to various health problems. There are five main strains of the virus, referred to as types A, B, C, D and E. The differentiation point for the different types includes modes of transmission, severity of the illness, geographical distribution and prevention methods. As a relevant example, about 5% of mothers worldwide are chronic hepatitis B virus (HBV) carriers and some others had the symptomatic or acute version by the time of delivery.

Whether breastfeeding plays a significant role in the horizontal transmission of the Hepatitis virus has been discussed for many years. Recent studies regarding Hepatitis B, C and D, indicate that breastfeeding has no additional mother-infant transmission risk and its practice is encouraged. Still, the WHO strongly suggests the first dose of the available vaccines be given to the newborn within 48 hours of birth. Moreover, according to the US Center for Disease Control and Prevention (CDC), Hepatitis C is spread by infected blood, and there is no vaccine available for this particular type. Therefore, if the HCV-positive mother’s nipples and/or surrounding areola are cracked and bleeding, she should stop nursing temporarily. To help prevent the milk from drying up, pumping it and throwing it away is the best solution.

With Hepatitis A and E, the transmission mode is different. These types are transmitted predominantly by the stool-handmouth route or by contaminated food or water. Even during an acute infectious period of the mother, there is no contraindication for breastfeeding. For types A and E of the Hepatitis virus, careful hand washing must be emphasised.

The human immunodeficiency virus (HIV) targets cells of the immune system, called CD4 cells, which help the body respond to infection. In the absence of a combination of antiretroviral (ARV) drugs, the HIV-affected immune system will eventually become weakened to the point that it can no longer fight infections and disease. HIV is found in certain bodily fluids, including blood and breastmilk. HIV-positive mothers can pass the virus to their infant during pregnancy, childbirth or breastfeeding.

The dilemma has been to balance the risk of infants acquiring HIV through breastfeeding with the risk of death from causes related to breastmilk-privation. Nevertheless, it was found that giving antiretroviral drugs (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding.

Since 2010, the WHO recommends that HIV-positive mothers or their infants take ARVs throughout the period of breastfeeding and until the infant is 12 months old, therefore receiving the benefits from breastfeeding with minimal risk of infection. Even when ARV drugs are not available, mothers are encouraged to exclusively breastfeed for the first six months of the baby‘s life, using strategies like expressing and heat-treating breast milk to decrease horizontal transmission rates. As a last resource, formula feeding’s hygienic and nutritional standards should be followed.