Use of human milk from HIV +ve mothers in neonatal units (5)

21 March, 2020

Dear All,

I'm afraid that I missed writing a few points in my earlier email related to the request I made.

I have a special interest in human milk as I was privileged to have been the principal investigator in the randomized control trial that proved for the first time in world literature the clinical implications of of human milk in protecting against infections in high risk and small babies-

(Narayanan I, Prakash K, Murthy NS. Randomized con­trolled trial of the effect of raw

and holder pasteurized human milk and of formula supplements on incidence

of neonatal infection. Lancet; ii: 1111-1113, 1984.)

I realize that a number of countries have milk banking and can safely give appropriately pasteurized human milk to babies who cannot accept direct breast feeding, when the mother is HIV +ve.

I am involved in training related to newborn care in some African hospitals *where there are no milk banks* and where HIV +ve mothers were also coming into the neonatal special care units/NICUs and giving expressed milk. Both mothers and their were on treatment. However, my concern was for safety, as

(a) Some mothers were not always fully compliant and viral load neardelivery was not known in many and

(b) this was practiced in a number of hospitals.

I personally thought the points noted in the PCI DO NO HARM technical brief may be more appropriate--

" Safe and Effective Human Milk Feeding for Small and Sick Newborns



I was wondering if some of you had similar experiences and what were your standard guidelines for feeding of babies of HIV +ve mothers, who cannot accept direct breast feeding and who are in the neonatal unit. I would value your comments and experiences

Thank you


Indira Narayanan MD

CHIFA Profile:

Indira Narayanan is currently Adjunct Professor, Pediatrics/Neonatology at the Georgetown University Medical Center, Washington DC, USA and Independent Consultant, Global Maternal and Newborn Health. Professional interests: Maternal and Newborn Health, research, improving newborn care with emphasis on compassionate/respectful quality of care, health policies, program implementation, capacity building, social and behavior change communication. Her research includes the seminal randomized controlled studies on proving for the first time in world literature the clinical implications of the anti-infective properties of raw and heated human milk in neonatal units carried out during her work of 20 years in India.