-
1.
FPIES in exclusively breastfed infants: two case reports and review of the literature.
Baldo, F, Bevacqua, M, Corrado, C, Nisticò, D, Cesca, L, Declich, V, Dall'Amico, R, Barbi, E
Italian journal of pediatrics. 2020;(1):144
Abstract
BACKGROUND Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non IgE-mediated food allergy that generally affects children in the first year of life. Usually symptoms break out when formula milk or solid foods are introduced for the first time but they might also appear in exclusively breastfed infants, since the trigger elements, especially cow's milk proteins, can be conveyed by maternal milk as well. FPIES in exclusively breastfed babies is a very rare clinical condition and only few cases have been reported in the medical literature. CASE PRESENTATION We describe two cases of FPIES in exclusively breastfed babies. The first one is a two-month-old infant with a brief history of vomit and diarrhea that presented to the Emergency Department in septic-like conditions. The main laboratory finding was a significant increase in methemoglobin (13%). Clinically, we noted that, when breastfeeding was suspended, diarrhea drastically improved, and vice versa when maternal milk was reintroduced. An amino acid-based formula allowed a complete normalization of the symptoms. The second one is a three-month-old infant admitted for a 3 days history of persistent vomit and diarrhea. Blood tests showed a raised level of methemoglobin (7%). An esophagogastroduodenoscopy was performed and biopsies showed an eosinophilic infiltration of the duodenal mucosa. A maternal exclusion diet and an amino acid-based formula allowed a rapid regularization of the bowel function. CONCLUSIONS We searched all the cases of FPIES in exclusively breastfed babies reported in the medical literature, identifying eight patients, with an average age of 3 months (range 15 days - 6 months). The majority of the cases were initially diagnosed as gastroenteritis or sepsis, five cases were characterized by an acute on chronic scenario and cow's milk was the most frequently involved food. Methemoglobin was never tested. An oral food challenge test was performed in two patients. FPIES in exclusively breastfed infants is a rare condition that, in the presence of compatible history and symptoms, should be considered also in exclusively breastfed babies. The evaluation of methemoglobin can simplify the diagnostic process.
-
2.
An Uninfected Preterm Newborn Inadvertently Fed SARS-CoV-2-Positive Breast Milk.
Lugli, L, Bedetti, L, Lucaccioni, L, Gennari, W, Leone, C, Ancora, G, Berardi, A
Pediatrics. 2020;(6)
Abstract
There are increasing concerns regarding coronavirus disease, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approaches to breastfeeding and the management of neonates born to pauci-symptomatic mothers with coronavirus disease vary worldwide, although some scientific societies across Europe and the United States have emphasized the benefits of breastfeeding, even with expressed breast milk. Because SARS-CoV-2 has been, thus far, only exceptionally detected in breast milk, the risk of disease transmission has remained hypothetical.We herein report the case of a healthy preterm newborn who was inadvertently fed SARS-CoV-2-positive breast milk. Two different samples, collected with and without strict hygiene precautions, were both confirmed to be SARS-CoV-2 positive. However, the newborn was not infected, supporting the protective role of breast milk. Furthermore, in this report, we highlight the difficulties in the practical management of a neonate whose breastfeeding mother was confirmed as positive for SARS-CoV-2 after delivery.
-
3.
Can SARS-CoV-2-infected women breastfeed after viral clearance?
Lang, GJ, Zhao, H
Journal of Zhejiang University. Science. B. 2020;(5):405-407
-
-
Free full text
-
Abstract
The recently emerged novel coronavirus pneumonia, named the coronavirus disease 2019 (COVID-19), shares several clinical characteristics with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and spread rapidly throughout China in December of 2019 (Huang et al., 2020). The pathogen 2019 novel coronavirus (2019-nCoV) is now named SARS coronavirus 2 (SARS-CoV-2) and is highly infectious. As of Apr. 9, 2020, over 80 000 confirmed cases had been reported, with an estimated mortality rate of 4.0% (Chinese Center for Disease Control and Prevention, 2020). Person-to-person transmission and familial clustering have been reported (Chan et al., 2020; Nishiura et al., 2020; Phan et al., 2020). However, there is no evidence of fetal intrauterine infection in pregnant women who have been infected with SARS-CoV-2 in their third trimester (Chen et al., 2020). It is unclear whether breastfeeding transmits the virus from previously infected and recovered mothers to their babies. Here we report the clinical course of a pregnant woman with COVID-19. In order to determine whether SARS-CoV-2 can be transmitted to newborns through breastfeeding, we measured viral RNA in the patient's breastmilk samples at different time points after delivery.
-
4.
Bacillus cereus infection in neonates and the absence of evidence for the role of banked human milk: Case reports and literature review.
Lewin, A, Quach, C, Rigourd, V, Picaud, JC, Perreault, T, Frange, P, Domingo, MC, Lalancette, C, Delage, G, Germain, M
Infection control and hospital epidemiology. 2019;(7):787-793
Abstract
BACKGROUND Banked human milk (BHM) has inherent infectious risks, even when pasteurized. Because of the ubiquity of Bacillus cereus in the environment and its ability to resist the Holder pasteurization process, there is a concern that BHM might lead to severe B. cereus infections. OBJECTIVE We reviewed observed and published cases to determine the potential causal role of BHM as the source of these infections. METHODS Two infants in the province of Québec (Canada) developed a B. cereus neonatal infection, and both had received BHM. We conducted bacteriological studies to compare clinical isolates and those found in these cases. RESULTS After extended culture of BHM retention lots, B. cereus was found to have been involved in batches related to the first case. However, molecular typing showed that the strain was different from the clinical isolate, therefore excluding BHM as the source of contamination. In the second case, a Brevibacillus spp was isolated, a species distinct from the clinical isolate. CONCLUSION Based on these cases and others reported in the literature, a causal link between B. cereus contaminated BHM and preterm neonatal infection has never been documented. Therefore, the risk that BHM can cause this infection remains theoretical. Given the widespread presence of B. cereus in the hospital environment and its capacity to resist standard cleaning procedures, it seems likely that airborne or direct or indirect contact are the main sources of most, if not all, cases of severe B. cereus neonatal infections, even in babies exposed to BHM.
-
5.
Intravenous single administration of amiodarone and breastfeeding.
Javot, L, Pape, E, Yéléhé-Okouma, M, Barotte, E, Divoux, E, Gillet, P, Gambier, N, Scala-Bertola, J
Fundamental & clinical pharmacology. 2019;(3):367-372
-
-
Free full text
-
Abstract
Amiodarone treatment is contraindicated during breastfeeding. As the regional pharmacovigilance centre, we were contacted for information relative to the possibility of breastfeeding after single intravenous administration of 450 mg amiodarone to a breastfeeding woman. A monitoring of amiodarone concentration in plasma and milk was performed in the mother. At day 4, milk concentration of amiodarone reached a peak (233 μg/L) and milk to plasma ratio was determined to 3.5. Milk concentration was still detectable at day 10 (132 μg/L). The maximal relative infant dose was estimated to be 0.6% of the maternal weight-adjusted dosage, corresponding to 0.18% of the usual posology used in children by parenteral route. The review of the literature retrieved one publication suggesting that a single intravenous administration of 150 mg of amiodarone to a mother represents a negligible infant risk based on low breast milk concentration. The French National Pharmacovigilance database query did not disclose any case of side effects during breastfeeding after a single dose of amiodarone. A very limited exposition of breastfed newborns to amiodarone, as well as a low risk of side effects, is expected after a single administration of amiodarone to their mothers.
-
6.
Genetic evidence of Zika virus in mother's breast milk and body fluids of a newborn with severe congenital defects.
Giovanetti, M, Goes de Jesus, J, Lima de Maia, M, Junior, JX, Castro Amarante, MF, Viana, P, Khouri Barreto, F, de Cerqueira, EM, Pedreira Santos, N, Barreto Falcão, M, et al
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2018;(10):1111-1112
-
7.
Serratia marcescens Colonization Causing Pink Breast Milk and Pink Diapers: A Case Report and Literature Review.
Quinn, L, Ailsworth, M, Matthews, E, Kellams, A, Shirley, DA
Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. 2018;(5):388-394
Abstract
INTRODUCTION Serratia marcescens is an opportunistic pathogen and common cause of infectious outbreaks in pediatric units, leading to both significant morbidity and mortality in immunocompromised hosts. Environmental and some clinical strains may produce a characteristic red pigment, prodigiosin. Colonization can hence turn breast milk and fecally-soiled diapers pink, which can lead otherwise unaffected patients to present to their physicians and also interrupt breastfeeding. No clear guidance exists regarding the outpatient management of breastfeeding mothers and infants colonized with S. marcescens. METHODS Our aim was to understand the significance of pigment-producing S. marcescens colonization of breast milk and stools in healthy infants in the community setting. We describe the case of a healthy 9-week-old infant presenting with pink soiled diapers secondary to S. marcescens colonization and systematically review previously reported cases of infants diagnosed with pink diapers or milk published in PubMed between 1958 and 2017. RESULTS Six publications describing seven additional mother-infant cases were selected for inclusion. In all, 8 mother-infant groups of colonization were reviewed, involving 10 infants (there were 2 sets of twins). Good clinical outcomes were reported in all cases regardless of whether antibiotic treatment was prescribed. CONCLUSION Providers evaluating mother-infant dyads with S. marcescens colonization causing pink milk or pink infant soiled diapers should assess for manifestations of systemic infection. In the absence of evidence of clinical infection, expectant management is appropriate and continued breastfeeding can be supported.
-
8.
Maternal Carbamazepine Therapy and Unusual Adverse Effects in a Breastfed Infant.
Antonucci, R, Cuzzolin, L, Manconi, A, Cherchi, C, Oggiano, AM, Locci, C
Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. 2018;(2):155-157
Abstract
BACKGROUND Usually, no adverse effects are observed in breastfed infants whose mothers are treated with the anti-epileptic carbamazepine. In this article, we described unusual short-term adverse effects observed in a young infant after exposure to carbamazepine during pregnancy and lactation. CASE REPORT A 40-day-old female infant, born at term, was admitted to the Pediatric Clinic at University of Sassari, Italy, for recurrent regurgitations and vomiting. She was breastfed since birth and her mother was under chronic carbamazepine therapy. Gastroesophageal reflux was initially suspected; therefore, thickening of feeds and postural therapy were applied without any benefit. Subsequently, high levels of carbamazepine were detected in infant serum and in maternal breast milk. After an unsuccessful attempt to combine breastfeeding with formula feeding, the switch to exclusive formula feeding was made, with subsequent rapid resolution of symptoms and body weight increase. DISCUSSION AND CONCLUSIONS The use of carbamazepine is considered compatible with breastfeeding, even if the potential risk of adverse reactions in breastfed infants exists. In this case, the discontinuation of breastfeeding resulted in the complete resolution of symptoms, suggesting a correlation between the observed manifestations in the infant and her exposure to maternal therapy.
-
9.
Dolutegravir in breast milk and maternal and infant plasma during breastfeeding.
Kobbe, R, Schalkwijk, S, Dunay, G, Eberhard, JM, Schulze-Sturm, U, Hollwitz, B, Degen, O, Teulen, M, Colbers, A, Burger, D
AIDS (London, England). 2016;(17):2731-2733
-
10.
Acquired zinc deficiency in full-term newborns from decreased zinc content in breast milk.
Haliasos, EC, Litwack, P, Kristal, L, Chawla, A
Cutis. 2007;(6):425-8
Abstract
Zinc deficiency occurs in children when the demand for zinc exceeds its supply. Malnutrition, prematurity, total parenteral nutrition dependence, and burns increase the demand for zinc, whereas congenital malabsorption syndromes represent clinical situations where less zinc is supplied to the growing child. Clinical recognition of acral eczematous lesions, alopecia, and gastrointestinal tract symptoms in settings of the aforementioned medical history often lead to the diagnosis. Zinc deficiency in healthy, full-term, breast-fed infants can occur. The cause of these deficiencies has been attributed to decreased zinc levels in maternal breast milk. We present a case of acquired zinc deficiency in a healthy breast-fed infant, with a review of the English language literature of reported cases.