Inadvertent breast milk exposure
From IDWiki
- Women often pump breast milk for neonates in hospital, and mix-ups occasionally happen
- Risk of infection is low, but includes hepatitis B, HIV, and HTLV
Investigations
- From donor mother, send the following:
- HBsAg and HIV serology, STAT
- HCV and HTLV serology
- CMV serology (if the recipient baby is less than 32 weeks old)
- If the donor mother is positive for any of the above, also test the recipient's mother
Management
- Inform infection control, nurse manager, etc.
- Investigations as above, and management as below
| Donor mother | Recipient mother | Suggested management |
|---|---|---|
| Hepatitis B | ||
| HBsAg negative | HBsAg negative | Routine immunization for hepatitis B |
| HBsAg positive | Administer hepatitis B vaccine and immune globulin (HBIG), if not yet given | |
| HBsAg positive | HBsAg negative | Administer hepatitis B vaccine, if not yet given, and HBIG |
| HBsAg positive | Administer hepatitis B vaccine and HBIG, if not yet given | |
| HIV | ||
| HIV negative | HIV negative | Routine care |
| HIV positive | Continue standard prophylactic therapy | |
| HIV positive | HIV negative | Could consider zidovudine in high-risk situations, though no routine recommendation |
| HIV positive | Continue standard prophylactic therapy | |
- If given, HBIG should be given within 24 hours and vaccine within 7 days
- If given, HIV prophylaxis should be started within 1 to 2 hours of exposure, but can be started up to 48 hours later
