Donor Breastmilk Saved Infant Lives During an Outbreak of Rotavirus in South Africa

Abstract

Rotavirus is the most common cause of severe diarrhea among children, resulting in 600,000 diarrheal deaths every year, 80% of which occur in poorer countries.1 In addition, many more children suffer from dehydration, which requires medical intervention and/or hospitalization. An outbreak of rotavirus occurred between May 22 and June 30, 2008 in the neonatal wards at Tygerberg Children’s Hospital, Capetown, South Africa, a tertiary-care center that cares for an estimated 100 sick newborns at any given time and experiences a high turnover of patients. During the rotavirus outbreak, 307 newborns were admitted, of which 94 became symptomatic with loose stools and 58 tested positive for rotavirus. Only symptomatic infants were tested with enzyme-linked immunosorbent assay on stool specimens because of financial constraints. Several of the newborn infants suffered from dehydration, apnea, and necrotizing enterocolitis (NEC). Breastfeeding is strongly advocated at Tygerberg Children’s Hospital. As such, infants predominantly receive their mother’s own breastmilk. Human immunodeficiency virus (HIV)–positive mothers, estimated at approximately 24.5% of moms, are educated on proper techniques to pasteurize their milk for infant feeding.2 Due to many potential health complications including those associated with HIV, many mothers are not able to express breastmilk. As a result, several infants born preterm and low birth weight at Tygerberg Children’s Hospital do not have access to their mother’s own breastmilk. Breastmilk has many health benefits for infants, including a reduction in the incidence and severity of a wide range of infectious diseases and NEC.3 Furthermore, it has been shown that breastfed infants are less susceptible to rotavirus infection, which is likely because of the presence of anti-rotaviral secretory immunoglobulin A and trypsin inhibitors in the breastmilk.4 These benefits are of particular importance for the subset of infants born low birth weight and preterm who are hospitalized in a neonatal intensive care unit (NICU), in which the environment itself and the many procedures that infants undergo in conjunction with their relatively immunocompromised status place them at increased risk for infection. For these reasons, every attempt is made at Tygerberg Children’s Hospital to provide donor breastmilk to hospitalized infants whose mothers cannot provide their own milk, especially at times of particular vulnerability such as during the rotavirus outbreak. The donor breastmilk is donated by local South African mothers and the International Breast Milk Project (IBMP), a United States-based non-profit organization. As a result of a marked increase in health among infants receiving donor breastmilk overall, Tygerberg has instituted a hospital-wide policy in which all infants weighing less than 1,500 g, who are not receiving their mother’s breastmilk, must receive donor breastmilk as opposed to formula. Anecdotal evidence from hospital staff indicates that infants fed donor milk are experiencing fewer infections and episodes of NEC and experiencing better health outcomes overall. For example, a 20-year-old mother delivered twins on January 1, 2009 who weighed 1.2 kg (1,200 g) and 1.24 kg