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Thursday, April 17, 2014
Varicella and zoster
Is there a risk for a newborn feeded by his mother who have zoster to develop varicella ?
It is not clear from the question whether the mother in question currently has chickenpox or shingles. If discussing shingles, would the newborn's mouth come in contact with any lesions/sores during feedings? If so, it is possible for a newborn to contract the virus from contact with a lesion.
It usually isn't necessary to isolate the newborn from the mother if a mother develops shingles during the newborn period. However, it is important to determine whether the newborn could come in contact with any lesions during feedings. Unless the newborn's mouth will come in contact with lesions, usually lesions can be covered and breastfeeding can continue. A newborn's mouth may come in contact with lesions on or very near the nipple or areola, and the baby should not feed on the affected breast. If there are no lesions on/near the nipple or areola of the other breast, the newborn should be able to continue breastfeeding on the unaffected breast. (To maintain milk production in the affected breast, the mother should express/pump milk about 8 times a day, but any milk pumped from that breast should be discarded until the lesion(s) clears.) Breastfeeding on the affected breast may resume in several days when the lesion heals and is no longer considered infectious. If a mother has been expressing/pumping her milk for the newborn, expressed (pumped) breastmilk is discarded only if the pumping equipment is in contact with a lesion during milk expression.
A newborn may contract chickenpox when a mother develops chickenpox (varicella-zoster virus or VZV) just prior to or soon after birth. Chickenpox is more serious when contracted in the first weeks after birth and because droplet transmission (through the respiratory tract) of the virus is likely, a mother and newborn occasionally must be isolated from one another. (This would depend on the point before/after birth at which the mother first exhibits symptoms of chickenpox.) In these cases, isolation would occur regardless of the infant feeding method. When a mother and newborn must be isolated from one another due to maternal chickenpox, the mother should express/pump her breasts at least 8 times in 24 hours to establish, or maintain, milk production. The newborn usually can receive the mother's expressed (pumped) breastmilk if there are no chickenpox lesions on the breast that could come in contact with breast-pump equipment/breastmilk.
If isolation has been necessary, determining when a newborn can begin direct breastfeeding will depend on the mother's level of contagion. When a newborn is not considered at risk for severe neonatal chickenpox or isolation no longer is necessary, breastfeeding usually can begin. Chickenpox lesions on the breast would be treated the same as shingles lesions. Cover lesions that the newborn might come in contact with during feedings (but are not lesions the newborn's mouth would touch). Avoid feeding (or giving the newborn expressed/pumped breastmilk) from a breast that has lesions on, or near, the nipple or areola that could come in contact with the newborn's mouth. (See above.)
I hope this answers your question. If you have additional questions about VZV and breastfeeding, don't hesitate to contact NetWellness again.
References: Riordan J & Auerbach K (Eds.) (1998). Breastfeeding and human lactation (2nd ed.). Sudbury, MA: Jones & Bartlett.
Lawrence RA & Lawrence RM (1998). Breastfeeding: A guide for the medical profession (5th ed.). St. Louis: CV Mosby.
Mohrbacher N & Stock J (1997). The breastfeeding answer book (rev. ed.). Schaumburg, IL: La Leche League International.
Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati