Understanding AIDS in Children and Pregnancy: Symptoms, Diagnosis, and Care

1. AIDS IN CHILDREN & PREGNANCY

2. AIDS in Children • Perinatal Transmission—Get virus from mother • Blood Products—Hemophiliacs (rare) • At Risk Activities • Sharp rise in number of adolescents contracting the virus

3. Symptoms in Infancy • OK for 18-24 months • Symptoms vary • Recurrent diarrhea, Failure to thrive/developmental delays, Thrush, Splenomegaly, Hepatomegaly, Lymphadenopathy, Recurrent Infections, Mumps, Pneumonitis, CMV • Rapid Progression of Neuro symptoms • AIDS-Defining Illnesses (Box 35-9, p. 1453, Hockenberry & Wilson, 2011, 9th ed.; Box 30-9, p. 1369, 10th ed.)

4. Diagnosis • ELISA (enzyme-linked immunosorbent assay)-NOT good in babies born to HIV + moms passive transfer of virus—up to 18 months of age • PCR (Polymerace Chain Reaction; AIDS culture) detects pre-viral DNA • P24 Antigen = HIV specific • >95% of 1-3 month-olds can be diagnosed; • if 2 + tests on separate samples = HIV dx • CD4 count varies with age; • See next slide

5. Immunologic Categories Based On Age-Specific CD-4 +T-Lymphocyte Counts & % of Total lymphocytes Perry, Hockenberry, Lowdermilk, & Wilson. (2010). 4th ed. Maternal child nursing care. Table 49-4 p. 1518.

6. Medications • Antiretroviral Treatment • AZT • See HIV Handout

7. Immunizations • Polio—inactivated virus • Varicella—AVOID • Flu vaccine • —Get routinely • MMR if NOT severely immunocompromised IV Immunoglobulin

8. Other topics r/t HIV in Children • School/day care concerns • Care of child during mother’s illness

9. HIV in Pregnancy • Virus found in amniotic fluid, Blood, Vaginal fluids and breast milk • Antepartum Care • Testing of women at risk • CDC recommendations 2014 • Counseling • If at high-risk--safe sex practices • Nutrition • Anti-retroviral therapy (ART) • Assess support systems

10. Antepartum Care (Cont.) • Health Hx OB/Gyne hx • Date of HIV testing, # of sex contacts • Physical conditions • Chronic vaginitis • STD’s • Fever, night sweats • Skin, oral lesions • Cough, Shortness of Breath (SOB)

11. Antepartum Care (Cont.) • Physical Exam • Routine Prenatal exam • (Temp, wt., etc.) • Eye exam (every 3 months) • Mouth (thrush) • Skin --note any Kaposi’s Sarcoma Lesions--characteristic skin lesions that range from flat to raised purple plaques. ) • Lungs –diminished breath sounds • Lymph nodes—enlarged with infection

12. Antepartum Care (Cont.) • Labs • test every trimester • IF CD4 < 500  ART • IF CD4 < 200  ART plus Prophylactic antibiotics • ART—many new drugs available • Pregnant women with HIV NO MORE likely to have preterm birth or complications of pregnancy

13. Intrapartum Care • Prevent and ID early fetal/maternal complications • Psychosocial Support • Prevent nosocomial infections • Care is same as NON-HIV-infected mother---USE UNIVERSAL PRECAUTIONS AT ALLTIMES

14. Intrapartum Care • DO Cesarean Section at 39 weeks unless counts are good. CDC • Give ART IV during labor • Deliver within 4 hours after Bag of Waters breaks • Treat newborn with PO AZT for 6 weeks

15. Postpartum Care of Mother • NO Breastfeeding—per CDC • There are some scenarios when it might be less risky to breastfeed for baby • Routine PP care with special attention to • VS—Temp • Worsening of HIV symptoms • Handwashing • Good nutrition • Social support, referrals

16. Care of Newborn • Treat in Normal nursery Universal Precautions • Bathe FIRST, then do DNA testing and Vitamin K injection. WHY??? • Prevent infections, skin abrasions • Teach mother s/s of HIV infection in babies • Frequent G & D assessments, blood testing