1137. Mother-to-Infant Transmission of 2009 H1N1 Influenza in the Postpartum Period: How Best to Prevent It?
Session: Poster Abstract Session: Influenza and H1N1 Diagnosis, Epidemiology, and Viral Outcome
Saturday, October 22, 2011
Room: Poster Hall B1
Background: The optimal management of newborns of mothers with peripartum 2009 influenza A (H1N1) infection is not known. During the recent pandemic, the Centers for Disease Control and Prevention recommended isolation of the infant from the mother until she received 48 hours of antiviral therapy and was afebrile. However, at Parkland Memorial Hospital, Dallas, TX, an infection prevention protocol was implemented in which infants born to mothers with suspected or confirmed influenza were allowed to room-in with their mothers. Mothers wore a mask and were encouraged to perform hand hygiene before infant contact. Breastfeeding was encouraged.  Our objective is to determine the effect of this protocol on transmission of 2009 H1N1 influenza from mothers to their infants.

Methods: Medical records of all mothers with laboratory-confirmed influenza A infection and their infants were reviewed for demographic, clinical, laboratory, and outcome data. Telephone follow-up was performed to assess for influenza illness among infants in the first month of age.

Results: 19 mothers with 2009 influenza A (H1N1) infection during the two weeks before delivery were identified. All mothers had influenza A infection diagnosed by direct fluorescent antibody (DFA) testing (42%, n=8) or viral culture (58%, n=11). All mothers were ill for a median of 3 days (interquartile range [IQR], 1-5 days) with cough (84%), fever (47%), pharyngitis (42%), and myalgias (21%). 37% (7/19) had a sick household contact. The symptoms began a median of 3 days (IQR, 1-4 days) before delivery. All received oseltamivir (75 mg PO BID for 5 days). 19 infants were born to influenza-infected mothers. The median gestational age was 40 weeks; no infant was preterm. All but one (95%) infant was breastfed. At 1 month follow-up, only 1 infant had been hospitalized; this infant had fever at 17 days of age. Influenza DFA and polymerase chain reaction tests of nasopharyngeal secretions were negative. The other 18 infants remained well.

Conclusion: Peripartum maternal influenza A infection was not associated with neonatal transmission despite rooming-in and encouragement of breastfeeding when precautions consisting of masking and hand hygiene were used in the immediate postpartum period.


Subject Category: P. Pediatric and perinatal infections

Joseph Cantey, MD1, Susan Bacsik, DO1, Greg Jackson, MD2, Jeanne Sheffield, MD3, Sylvia Trevino, MT4 and Pablo J. Sanchez, MD1, (1)Pediatrics, University of Texas Southwestern, Dallas, TX, (2)University of Texas Southwestern, Dallas, TX, (3)University of Texas Southwestern Medical Center, Dallas, TX, (4)Infection Prevention, Parkland Health & Hospital System, Dallas, TX

Disclosures:

J. Cantey, None

S. Bacsik, None

G. Jackson, None

J. Sheffield, None

S. Trevino, None

P. J. Sanchez, None

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