How to change perceptions on feeding in neonatal care

Abstract

The transmission of HIV through breastmilk, with the potential to infect the newborn, has had a major impact on child health worldwide. Although South African studies confirmed that exclusive breastfeeding reduced rates of mother-to-child transmission of HIV, the recommendation of formula feeding for HIV-exposed newborn infants, provided their mothers had the facilities for safe preparation of formula milk and complied with the AFASS criteria (formula feeding to be Acceptable, Feasible, Affordable, Sustainable, Safe), was introduced. Observations made by the nursing staff, fully aware of the risks of formula feeding, in the neonatal unit at King Edward VIII Hospital in 2009 showed that an increasing number of small, sick newborns were being formula fed. By conducting focus group discussions with nurses, mothers and counsellors and teasing out the confusions and misconceptions, relevant information was imparted to the groups to allow them to re-consider their misconceptions. Within a period of 2 months nurses were confident about re-counselling mothers with respect to appropriate feeding choices. HIV-positive mothers were trained to flash-heat their milk. Subsequently, policies for the unit were derived from the focus group discussions. In addition, regional hospitals in the Durban area (eThekweni) considered the introduction of flash-heating to their units. The South African Department of Health opted for infants to receive prophylaxis with daily nevirapine as long as they are breastfed, and the Nutrition Directorate decided to withdraw the issue of free replacement feeds in HIV-exposed babies. KZN was the first province to institute this policy. The Department of Health has recommended that neonatal units no longer encourage HIV-infected mothers to flash-heat their breastmilk unless the infant is not receiving ARV prophylaxis or the mother is not on treatment.