CASE REPORT

Niger J Paed 2014; 41 (1): 78 –80

Ntia HU

Udo JJ

Eyong ME

HIV transmission to an infant from

cross nursing: a case report

DOI:http://dx.doi.org/10.4314/njp.v41i1,15

Accepted: 25th June 2013

Abstract Summary: Mother to

child transmission of HIV infec-

tion (MTCT) is the commonest

mode of infection in children es-

pecially in resource limited set-

tings. Routine HIV screening dur-

ing antenatal period is recom-

mended to prioritize treatment of

seropositive mothers according to

standard protocol.

have been recommended by the

World Health Organization

(WHO) to reduce MTCT of HIV

infection. The use of a cross-nurse

who is documented HIV-negative

is one of such options though not

widely practiced.

We present a case of HIV infection

in an infant acquired through wet-

nursed.

Ntia HU⁽

)

Udo JJ, Eyong ME

Department of Paediatrics,

University of Calabar Teaching

Hospital, Calabar.

Nigeria

Email : happinessntia@yahoo.com

Various infant feeding options

Introduction

bleeding per vaginam. She was thus placed on bed rest

in the hospital but she continued to bleed and needed

intervention. Baby was delivered at a gestational age of

seven months and three weeks. The birth weight was

1.4kg. The baby spent six weeks in the intensive care

baby unit before discharged at a weight of 2.0kg. Baby

was predominantly breastfed by the mother. From the

age of two months the baby was cross-nursed by his

paternal aunt in preparation for the mother to return to

work. The HIV sero- status of the cross-nurse was not

known. She had never nursed a baby before but started

lactating after repeatedly putting the index baby to

breast. The decision to cross-nurse the baby was taken

by the family without seeking advice from the Paediatri-

cian. Complimentary feed of pap mixed with NAN were

introduced at five months of age. He was fully immu-

nized for age.

Mother to child transmission of HIV infect_-i₄on is the

1

commonest mode of transmission to infants. This can

5

,6

have

occur before, during or after delivery. Studies,

shown the risk of HIV transmission is highest in the

early months of breastfeeding. Other modes of transmis-

sion such as b_-l₈ood transfusion and needle piercing are

7

less common. Routine HIV screening during antenatal

period is done in Nigeria to prioritize treatment of sero-

positive mothers according to standard protocol. For

instant, the World Health Organization (WHO) recom-

mends exclusive breastfeeding with antiretroviral drugs

(

ARV) therapy in resource limited settings for HIV sero-

9-13

positive mothers among several feeding options.

Mothers may elect other options such as wet nursing,

cross nursing or infant formula. Cross nursing mothers

are supposed to be screened for HIV but surprisingly,

routine HIV screening in the developing countries

among mother₁s₄_,₁w₅ho intend to wet nurse or cross nurse is

physical examination revealed a moderately dyspnoeic

infant with flaring alae nasi, int₀ercostal recession, py-

rexia with a temperature of 38 C with bilateral pedal

oedema. He was also wasted and had an occipitofrontal

circumference of 34cm and a length of 46cm. The

weight was 3.9kg (55% expected for age). Coarse crepi-

tations were heard in all the lung fields. The child had a

significant head lag. He was admitted with a working

diagnosis of marasmic-kwashiokor and bronchopneu-

monia.

still very low.

through cross nursing practice of a child whose parents

were seronegative.

We report a case of HIV transmission

Case

We present a six- month old infant that presented to the

Children’s Emergency Room of the University of Cala-

bar Teaching Hospital, Nigeria. He presented in July

2

011 with a history of fever, cough and fast breathing of

one week duration. He was brought to our center be-

cause of non-response to medications from a peripheral

hospital. The baby was born to a 27-year old para two

lady who is a banker and a 35-year old businessman.

The mother had antenatal care (ANC) at a gestational

age of twenty weeks. The pregnancy was uneventful

until the gestational age of thirty weeks when she had a

domestic accident involving hitting of the abdomen and

Results

Results of investigation are shown in table 1. The baby

received gentamycin at a dose of 2.5mg/Kg per dose 8

hourly and ceftriazone at 100mg/kg in two divided

doses. About 72hours into admission there was still no

appreciable improvement and on further review, a diag

7

9

nosis of Paediatric HIV/AIDS with Pneumocystic ji-

rovicii pneumonia was entertained. This was confirmed

with HIV RNA PCR test. Chest x-ray requested could

not be done because patient was oxygen dependent.

Cotrimoxazole was added to the treatment regimen and

first line antiretroviral drugs commenced. The parents

were rescreened and were still negative for HIV. The

aunt however, was HIV sero-positive and was recruited

into the treatment regimen. Unfortunately the baby died

after a week of admission.

By parental consent, the index infant was cross nursed

by his aunt while the mother was away at work. This

agreement was based on their beliefs in benefits of hu-

man breast milk to the baby. The mother had intended to

practice exclusive breast feeding having done so for her

first baby. It is not clear why she opted to use her un-

married sister in-law who had never breastfed a baby

and whose sero status was unknown. It is possible the

parents were so interested in exclusive breast feeding

that they down-played taking precautions. From per-

sonal observation cross nursing is not common in our

culture. The findings from the case have shown very

clearly the risk of breastfeeding by mothers whose HIV

status are not known. Perhaps if the parents had sort

professional opinion screening of the prospective wet-

nurse might have been done and or use of breast milk

substitutes prescribed. To our knowledge this is the first

case of HIV/AIDS that has been reported following

cross nursing practice in Nigeria.

Table 1: Results of investigations

Investigation

Result

Serum urea

Sodium

Potassium

Chloride

Bicarbonate

Creatinine

PCV

1.0mmol/l

141mmol/l

4.4mmol/l

108mmol/l

19mmol/l

61umol/l

25%

Neutrophilia

Basophils

32%

0%

Lymphocytes

Anisocytosis+

Microcytosis ++

Hypochromasia ++

HIV Antibody testing

Malaria Parasite

0%

Conclusion

The risk of HIV transmission through breastfeeding is

real. Mothers who intend to cross nurse or wet nurse

should arrange prior counseling and testing for HIV in-

fection.

Positive

Conflict of interest: None

Funding: None

Discussion

Breast feeding has been the main mode of infant feeding

from origin of mankind. Wet nursing is a situation

where the infant is breastfed by another mother after the

death of the biological mother while in cross nursing the

biological mother is still alive but the baby is breast fed

by another woman. Wet nursing is a common practice in

many par₁ts₇_-₁o₉f the world but cross nursing is less

common.

1

6

Limitation

The conclusion that HIV infection was acquired through

cross-nursing was done by exclusion. The baby had not

been exposed to any other situation or setting capable of

supporting HIV transmission.

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