Inadvertent breast milk exposure

• 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