Replacement-Fed Infants Born to HIV-Infected Mothers in India Have a High Early Postpartum Rate of Hospitalization

Abstract

Access to safe breast-feeding alternatives for HIV-infected mothers and their infants in many settings is limited. We compared the rates of early postpartum hospitalization of infants born to HIV-infected mothers using different infant-feeding practices in a large government hospital in Pune, India. From March 1, 2000 to November 30, 2001, infants born to HIV-infected mothers were followed in a postpartum clinic. All mothers had received a standard short course of antenatal zidovudine. Infant-feeding practices were assessed within 3 d of delivery, prior to postpartum hospital discharge. Sixty-two of 148 mothers (42%) were breast-feeding their infants. Eighty-six of the mothers (58%) were providing replacement feeding, primarily diluted cow, goat or buffalo milk (top feeding). Twenty-one of the 148 participating infants (14.2%) born during the study period required hospitalization within the 1st 6 mo of life and 6 infants required repeat hospitalization. All hospitalized infants were receiving replacement feeding with a rate of 0.093 hospitalizations per 100 person-days (95% CI, 0.062 to 0.136). The reasons for hospitalization included acute gastroenteritis (48.1%), pneumonia (18.5%), septicemia (11.1%) and jaundice (11.1%). A high risk for early postpartum hospitalization was seen in replacement-fed infants born to HIV-infected mothers in Pune, India. In settings such as India, where access to safe replacement feeding is limited, interventions making exclusive breast-feeding safer for HIV-infected mothers and infants are needed. Such interventions would be valuable additions to the very effective national prevention programs that currently rely on the provision of short-course zidovudine and nevirapine.

Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic Perspectives

“…It is, however, no longer recommended for feeding infants < 6 mo because of insufficient macro-and micronutrient content, concerns about the safety of storage, and occult bleeding that nonhuman milks can cause (7,57). Indeed, data from the main study of replacement feeding with nonformula modified animal milks indicated that Indian infants who were primarily fed modified animal milks had a greatly increased rate of hospital admission than those who were breastfed, mainly due to gastroenteritis with dehydration (58). In industrialized countries, replacement feeding has been AFASS for most HIV-positive women, and it is now standard practice for women there to feed their infants formula.…”

“…Although the risk of HIV transmission continues for as long as breastfeeding continues (32), HIV-free survival of HIV-exposed infants who breastfed beyond 6 mo was similar to that of infants who received no breast milk after 6 mo (86,87). Infants given replacement foods after a period of breastfeeding also suffered increased serious infections, including diarrhea and pneumonia, growth faltering, and death (45)(46)(47)50,51,58). The importance placed on maximizing an infant's continued access to breast milk in the 2010 recommendations reflects the immunological benefits of breast milk as well as the importance of breast milk in providing adequate nutrition to infants > 6 mo of age.…”

Anthropometric Measurements Determinant Nutritional Status of Urban Primary School Children in Selected Areas of Iran and India: A Comparative Study

“…These observations are similar to trends observed in the present study. [12] In a previous study conducted by Lunn [13] a much higher percentage of children were found to be overweight and obese (57.4%), with not much difference between boys and girls.…”

“…In a study conducted at SNDT Women's University in Mumbai, 7.7 percent of children aged 7 to 10 years were overweight and 13.2 percent were obese. [12] Phadke et al observed that a higher percentage of boys were overweight or obese compared to girls. These observations are similar to trends observed in the present study.…”

Effectiveness of Infant Feeding Strategies to Prevent Mother-to-Child HIV Vertical Transmission in Ekiti State

“…Avoidance of breastfeeding eliminates the risk of HIV transmission, but is detrimental in terms of child survival. Increased infant morbidity and mortality associated with replacement feeds have been reported in several sub-Saharan African countries [18,[23][24][25][26]. Replacement feeding is the feeding of an infant who is receiving no breast milk but is given a diet that provides all the nutrients the infant needs until the age at which he/she can be fully fed with family foods.…”