Neonatal Management
The neonatologist is an important member of the multi disciplinary team and will have discussed the following with the woman before delivery
- HIV exposure does not usually affect birthweight or clinical observations and otherwise well infants do not require admission to NNU
- The baby should be cleaned before leaving labour ward to remove maternal blood
- Neonatal post exposure prophylaxis (PEP) commenced as soon as possible after birth (ideally within 4 hours). The type (zidovudine monotherapy or combination therapy) and duration (2 or 4 weeks) are decided after an assessment of the risk of vertical transmission.
- HIV testing: Blood sample from baby (2ml whole blood in EDTA bottle, not cord blood). Include 5ml sample of maternal whole blood. The neonate is tested for both HIV PCR and HIV antibodies. HIV positive antibody testing in an infant <18 months indicates maternal infection but does not diagnose infection in the infant. If PCR continues to remain negative at 3 months there is a >95% chance of being uninfected
- HIV tests: Day 1, 6 weeks, 3 months, 12 months and 18 months
- FBC, U+E, creat., and LFTs at 2 weeks of age
- Further prophylactic treatment will be assessed on an individual basis by the HIV MDT
- Immunisations:
- Standard immunisations given at the usual times (DTP, Hib, Meningitis C, Polio)
- Hepatitis B immunisation commenced in all infants (given at birth, 1 month, 2 months and 12 months)
- BCG administration is not recommended until the infant has a negative 3 month PCR test (High risk: refer to specialist)
- Consult the Department of Health handbook if in doubt
Here the HIV consultant talks about the role of the neonatologist and subsequent screening of the baby.....