Herpesviruses and breast milk

Abstract

Breast milk has always been the best source of nourishment for newborns. However, breast milk can carry a risk of infection, as it can be contaminated with bacterial or viral pathogens. This paper reviews the risk of acquisition of varicella-zoster virus (VZV) and cytomegalovirus (CMV), herpesviruses frequently detected in breastfeeding mothers, via breast milk, focusing on the clinical consequences of this transmission and the possible strategies for preventing it. Maternal VZV infections are conditions during which breastfeeding may be temporarily contraindicated, but expressed breast milk should always be given to the infant. CMV infection acquired through breast milk rarely causes disease in healthy term newborns; an increased risk of CMV disease has been documented in preterm infants. However, the American Academy of Pediatrics (AAP) does not regard maternal CMV seropositivity as a contraindication to breastfeeding; according to the AAP, in newborns weighing less than 1500 g, the decision should be taken after weighing the benefits of breast milk against the risk of transmission of infection. The real efficacy of the different methods of inactivating CMV in breast milk should be compared in controlled clinical trials, rigorously examining the negative consequences that each of these methods can have on the immunological and nutritional properties of the milk itself, with a view to establish the best risk-benefit ratio of these strategies before they are recommended for use in clinical practice. RiassuntoIl latte materno rappresenta da sempre il migliore alimento per il neonato. Esso, tuttavia, può comportare un rischio infettivo, in quanto può essere contaminato sia da agenti batterici sia da agenti virali. Lo scopo di questa revisione è quello di descrivere lo "stato dell'arte" sul rischio di trasmissione con il latte materno degli herpesvirus di più frequente riscontro nella donna che allatta: varicella-zoster virus (VZV) e cytomegalovirus (CMV), sulle conseguenze cliniche di questa trasmissione e sulle possibili strategie di prevenzione. Per quanto riguarda l'infezione da VZV, le linee guida formulate per l'Unione Europea, che raccomandano di separare la madre con varicella in atto dal neonato durante la fase contagiosa, ma di alimentare sempre ed esclusivamente il neonato protetto con le immunoglobuline specifiche anti-VZV con il latte materno spremuto, appaiono appropriate, in quanto tengono in considerazione sia il rischio potenziale di acquisire una varicella postnatale sia gli innumerevoli benefici del latte materno. Per quanto riguarda l'infezione da CMV, allattare o no con latte materno i neonati prematuri nati da madre CMV-positiva rimane ad oggi una questione controversa. L'Accademia Americana di Pediatria considera la sieropositività materna per CMV come una condizione che non controindica l'allattamento materno, anche nei neonati prematuri. I diversi metodi di inattivazione del CMV nel latte umano dovrebbero essere confrontati in trials clinici controllati, valutando rigorosamente le r...

<p>The effect of storytelling on anxiety and behavioral disorders in children undergoing surgery: a randomized controlled trial</p>

“…Another study by Zarei et al (2013) about the effectiveness of storytelling on physiological anxiety, worry, and social anxiety in hospitalized school-age children suggests that storytelling could reduce all sub-scales of anxiety (RCMAS). These authors introduced storytelling as an effective, inexpensive method and the child’s favorite non-pharmaceutical intervention.20 Tabrizi et al (2015) also evaluated the effect of preoperational education on reducing anxiety among children aged 8–10 years and showed that storytelling for children significantly reduced separation anxiety during anesthesia.21 Rice et al (2008) showed that educational programs that aimed at preoperative anxiety among children reduced their anxiety during hospitalization and caused stable vital signs.22 Messina et al (2014) tried to reduce children’s anxiety before surgery by using clown therapy for distraction and significantly decreased anxiety among children who entered the operating room with the clown.23…”

Hygiene und Infektiologie in Frauenheilkunde und Geburtshilfe – Teil 2

“…Für die Therapie stehen antivirale Medikamente zur Verfügung, deren Einsatz gezielt auf die jeweilige Situation angepasst erfolgt und bei der Frage der Behandlung der maternalen Infektion einer Einzelfallentscheidung und Aufklärung über einen eventuellen Off-Label-Use bedarf [4]. Eine Übertragung des Virus durch Muttermilch findet nicht statt [46], folglich ist betroffenen Müttern das Stillen ihres Kindes gestattet, vorausgesetzt die Brust ist frei von frischen Effloreszenzen ist, und alle anderen Läsionen/Bläschen sind zwingend abgedeckt [43]. Selbstverständlich ist das Berühren der Bläschen zu vermeiden und die Händehygiene konsequent vor jedem Kontakt zum Kind obligatorisch.…”

Hygiene und Infektiologie in Frauenheilkunde und Geburtshilfe – Teil 2

“…angepasst erfolgt und bei der Frage der Behandlung der maternalen Infektion einer Einzelfallentscheidung und Aufklärung über einen eventuellen Off-Label-Use bedarf[4]. Eine Übertragung des Virus durch Muttermilch findet nicht statt[46], folglich ist betroffenen Müttern das Stillen ihres Kindes gestattet, vorausgesetzt die Brust ist frei von Hingegen stellt jede Person mit einem floriden Herpes Zoster ein Infektionsrisiko für alle nichtimmunisierten Personen, vor allem seronegative Schwangere dar. Daher ist die Impfung von Frauen im gebärfähigen Alter vor Eintritt der Schwangerschaft die wichtigste Präventionsmaßnah-me.…”