 |
Indian Pediatrics 1999;36: 1175-1176 |
Reader's Forum |
| Ramesh Kumar, Bharat Balani, A.K. Patwari, S. Aneja and V.K. Anand |
| Hepatitis B Virus Infection and Pregnancy I seek clarification on the following points: 1. Hepatitis B virus (HBV) infection from mother to baby occurs mainly during the birth process in birth canal. Is cesarean section a safe alternative to normal delivery for prevention of HBV infection to newborn? 2. Should HBsAg positive but HBe antigen negative mother be allowed to breastfeed her baby? What precautions should be taken during breast feeding to prevent infection to newborn? Kalpana Mishra, Reply . Dr. Mishra has rightly pointed out that hepatitis B virus (HBV) infection from mother to infant mainly takes place intrapartum. In fact, it is estimated that over 90% of transmission takes place in the intrapartum period. However, transplacental leakage of blood or micro-transfusion from mother to fetus during labor, rather than exposure in the birth canal, appears to be the major mode of transmission of infection during this period(1). Thus, the risk of transmission of virus is significantly lower when elective Caesarean delivery is performed before the onset of labor(1,2), whereas Caesarean section after the onset of labor does not result in lower rates of transmission of infection from mother to child(1). Despite these findings, Caesarean delivery is not recommended to mothers with HBV infection. This is because passive-active immunoprophylaxis (hepatitis B immune globulin plus vaccine) administered starting at birth is highly effective in preventing infection acquired in the perinatal period. Though HBsAg was detected in cord blood of infants born by vaginal or emergency Caesarean delivery, none of them became chronically infected when they were administered adequate immuno-prophylaxis(2). Thus, elective Caesa-rean delivery offers no additional advantage over immunoprophylaxis in preventing perinatal transmission of HBV infection, whereas it is more expensive and may be associated with higher risk to the mother and the baby. Though hepatitis B surface antigen has been detected in the milk of women with HBV infection, there is not evidence to show that the virus is transmitted via breastfeeding. Moreover, the theoretical risk of transmission via this method is overcome by immunoprophylaxis to the infant. Thus, infants born to mothers with HBV infection, irrespective of the mother's HBe antigen status, should be provided immunoprophylaxis and breastfeeding need not be withheld(3). Thomas Cherian, References 1. Lin H, Kao J, Hsu H, Mizokami M, Hirano K, Chen D. Least microtransfusion from mother to fetus in elective Caesarean delivery. Obstet Gynecol 1996; 87: 244-248. 2. Lee SD, Lo KJ, Tsai YT, Wu JC, Yang ZL, Ng HT. Role of Caesarean section in prevention of mother-infant transmission of hepatitis B virus. Lancet 1988; 2: 833-834. 3. American Academy of Pediatrics. Recommenda-tions for care of children in special circumstances: Human milk. In: 1997 Red Book: Report of the Committee on Infectious Diseases. 24th Edn. Ed. Peter G. Elk Grove Village, IL: American Academy of Pediatrics: 1997; pp 73-79.
Concomitant Steroid and Albendazole for Treating Neurocysticercosis Steroids are recommended for use in neurocysticercosis along with albendazole. I want to know whether the steroids have a prophylactic or only therapeutic use in such cases. Also which is the steroid preferred, what should be the dosage prescribed, at what intervals and for how long? Some pediatricians have advocated initiation of steroids 2 days prior to the albendazole therapy? Is this useful? Sukhbir Kaur Shahid, Reply . Steroids are used in neurocysticercosis to reduce the inflamatory reaction and edema around active (degenerating) cysts. The usual practice of starting steroids two days before starting albendazole has been advocated to minimize the risk of aggravation of edema which may occur after starting albendazole. In general oral steroids, prednisolone 2mg/kg is given for 5-7 days. In children who present with frank features of raised intracranial pressure, intravenous dexamethasone may be needed and one would have to individualize the therapy according to severity of the problem. In such children albendazole therapy should not be given until raised pressure is brought under control. Pratibha D. Singhi, |
