Guideline: infant feeding in areas of Zika virus transmission - 2 ed

    Año de publicación: 2021

    In 2018, the World Health Assembly, through resolution WHA71.9 on infant and young child feeding, affirmed that “the protection, promotion and support of breastfeeding contributes substantially to the achievement of the Sustainable Development Goals on nutrition and health and is a core element of quality health care” recognized that “appropriate, evidence-based and timely support of infant and young child feeding in emergencies saves lives, protects child nutrition, health and development and benefits mothers and families”. The World Health Assembly requested WHO “to continue to update and generate evidence-based recommendations”. WHO recommends exclusive breastfeeding for infants 0–6 months of age and continued breastfeeding to 2 years and beyond. WHO interim guidance published during the Zika virus outbreak was based on a limited volume of evidence under an emergency process during a Public Health Emergency of International Concern. Subsequent rapid advice and a WHO toolkit for supporting people affected by complications associated with Zika virus recommended that mothers with possible or confirmed Zika virus infection or exposure continue to breastfeed, since the benefits of breastfeeding outweigh any potential risk of Zika virus infection through breastmilk. Concerns about possible Zika virus transmission during breastfeeding remain, since the virus has been detected in breast-milk samples. It is not clear whether breast-milk from women with Zika virus has enough viral load or infectivity to lead to infection among infants. Also, during breastfeeding, other bodily fluids could be exchanged, such as sweat and blood, in addition to breast-milk. There are also concerns related to the transmission of Zika virus infection from the mother to the fetus during pregnancy. Zika virus infection during pregnancy can result in microcephaly and other congenital anomalies among affected infants, known as congenital Zika syndrome. Zika virus infection is also associated with other complications, including preterm birth and miscarriage. An increased risk of nervous system complications is associated with Zika virus infection among children, including Guillain-Barré syndrome, neuropathy and myelitis. Infants with congenital Zika syndrome may have a decline in nutritional status owing to hypotonia, abnormal metabolic demands because of spasticity and difficulties feeding. Among the latter, infants with congenital Zika syndrome are especially affected by dysphagia, difficulty feeding, gastroesophageal reflux and delayed gastric emptying. There are certain modifications to feeding depending on the spectrum of manifestations and their severity, which may include postural correction, adjustment of the environment and thickening feeds, among others, as age appropriate. Support for the caregivers of infants with congenital Zika syndrome may aid the infants in achieving improved growth and nutritional status, attaining developmental milestones and enhancing the quality of life. WHO published guidelines for screening, assessment and management of neonates and infants with complications associated with Zika virus exposure in utero in 2016. Although there is no longer an outbreak, Zika virus transmission continues in some areas. As of July 2019, 87 countries and territories across four of the six WHO regions (African Region, Region of the Americas, SouthEast Asia Region and Western Pacific Region) had evidence of autochthonous mosquito-borne Zika virus transmission. It is important to have a standard guideline as part of efforts to manage infant feeding in areas where there is transmission as the data about long-term outcomes associated with Zika virus infection among infants are becoming available.

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