You are rounding one morning in the newborn nursery with an eager third-year medical student shadowing you. You have a 3-hour-old baby whose mom's prenatal hepatitis lab was positive for HbsAg. You explain that you have standing orders for this situation and the baby will receive HBIG and hepatitis B (HBV) vaccine within 12 hours of birth. The student then asks you, “I remember yesterday in your office we saw a 5-day-old baby who had vomited up blood from the mom's cracked nipples. Is it safe for this mother to breast feed? Was this a mode of transmission before we had HBIG and HBV vaccine?”
Since you are an “experienced” pediatrician (that sounds so much better than an “old” pediatrician), you practiced in the era before routine vaccination and know the answer.
You tell the student:
A. Before we had HBIG and HBV vaccine, we encouraged formula feeding because of the small, but real, risk of HBV transmission to the infant in breastfed babies versus bottle-fed babies.
B. Once the baby gets the HBIG, it will be safe for mom to breastfeed and since mom will be unlikely to have cracked nipples now, she can breastfeed immediately.
C. A and B are both true.
D. Before we had HBIG and the HBV vaccine we still encouraged breastfeeding since there was no increased risk of HBV transmission in HbsAg-positive moms who breast fed compared to those who formula-fed their newborns.
Immunization Action Coalition. Ask the Experts: Diseases & Vaccines, Hepatitis B. Accessed August 17, 2015 and available at: http://www.immunize.org/askexperts/experts_hepb.asp