NurseReview.Org - The infant of an hiv positive mother

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THE INFANT OF AN HIV-POSITIVE MOTHER

Frequently, the newborn who is subsequently determined to be HIV-positive will be asymptomatic during the nursery stay. The CDC classifies HIV-positive newborns as indeterminate, asymptomatic, or symptomatic. Between 20% and 65% of infants born to HIV- positive mothers are themselves infected.

This plan of care is to be used in conjunction with the previous newborn plans of care.

NEONATAL ASSESSMENT DATA BASE

As a rule, the neonate is asymptomatic at birth, although a few may show signs of opportunistic infections within several days of birth. In addition, the effects of maternal substance use/abuse and/or prematurity may be present.

Circulation

Prolonged bleeding, petechiae (thrombocytopenia) noted on occasion

Elimination

Diarrhea

Enlarged liver, spleen may be noted

Food/Fluid

LBW

Feeding difficulties

Oral lesions (candidiasis)

Neurosensory

Neurological deficits

Microcephaly

Respiration

Varied degree of impairment (relative maternal drug use, cesarean birth)

Safety

Swollen glands (lymphadenopathy) noted on occasion
MATERNAL FACTORS
History of high-risk behaviors, STDs

Seropositive HIV

Sexuality

MATERNAL FACTORS

History of multiple sexual partners

Teaching/learning

Prematurity

Developmental delays

MATERNAL FACTORS

History of parental drug use (mother or partner)

DIAGNOSTIC STUDIES

CBC and Total Lymphocyte Count: Provides baseline immunologic data regarding WBC and

lymphocyte counts to monitor disease progression.

Enzyme Immunoassay or Enzyme-Linked Immunosorbent Assay and Western Blot

Test (EIA/ELISA): May be positive, but invalid because test does not distinguish between

maternal and infant antibodies. (The infant may test negative by 9–15 mo of age.)

HIV Cultures (with peripheral blood mononuclear cells and, if available, plasma):

Diagnostic for infants under 15 mo of age.

Polymerase Chain Reaction Test: Detects nucleic acid in small quantities of infected

peripheral mononuclear cells.

Serum or Plasma p24 Antigen: Increased quantitative values can be indicative of

progression of infection (may not be detectable during very early stages of HIV infection)

in infants 30 days or older and who have had the second dose of hepatitis vaccine.

Quantitative Serum IgG, IgM, and IgA Determinations: Nondiagnostic in newborns, but

provide baseline immunologic data.

Blood/Lesion/Urine Cultures: Diagnostic for opportunistic infections.

X-ray: May reveal lymphoid interstitial pneumonia.

NURSING PRIORITIES

1. Prevent/minimize infections.

2. Maximize nutritional intake.
3. Promote attachment, growth, and development.
4. Provide information to parent(s)/caregivers about disease process/prognosis and treatment

needs.

DISCHARGE GOALS

1. Free of opportunistic/nosocomial infection.
2. Gaining weight appropriately.
3. Perform skills typical of age group within scope of present developmental level.
4. Parent/caregiver understands condition/prognosis and treatment needs.
5. Plan in place to meet specialized needs after discharge.

NURSING DIAGNOSIS:

INFECTION, risk for

Risk Factors May Include:

Immature immune system, inadequate acquired
immunity, suppressed inflammatory response, invasive
procedures, malnutrition, chronic disease (infections)

Possibly Evidenced By:

[Not applicable; presence of signs/symptoms

establishes anactual diagnosis]

DESIRED OUTCOMES/EVALUATION

Be free of opportunistic infection.

CRITERIA—NEONATE WILL:

PARENT/CAREGIVER WILL:

Verbalize understanding of individual risk factors.
Identify interventions to reduce risk of infection.
Provide safe environment for infant.

ACTIONS/INTERVENTIONS

RATIONALE

Independent

Note maternal HIV status/presence of high-risk

Affects care of neonate from time of delivery. Anti-

behaviors, and prenatal/intrapartal use of

HIV antibodies are transmitted across the placenta

zidovudine (AZT).

and are present in all infants of HIV-seropositive
mothers. Between 20% and 67% of these infants will
themselves eventually test positive for HIV. Note:
Maternal antibodies may not be cleared from infant’s
system until 9–15 mo of age.

Use mechanical suction or bulb syringe in place of

Prevents exposure of healthcare provider to virus.
oral mucus extractors (e.g., DeLee trap) to clear
airways. Avoid mouth-to-mouth contact for
resuscitation.

Wash neonate at time of delivery, or as soon as

Although maternal blood is contaminated, at birth

possible, using warm water and mild soap.

infant may not be HIV-positive. Prompt care may

Minimize exposure to maternal blood and

help reduce risk to infant.

body fluids.

Provide customary physical care of neonate (e.g.,

Universal precautions are routinely required for

skin care, eye care, vitamin K administration) the

contact with body fluids/blood products to protect

same as for all newborns, using universal

the healthcare provider from potential infection.

precautions.

Stress need for care providers/family members

Reduces risk of cross-contamination and risk to

washing hands before and after contact with infant.

care providers.
Wear gloves for contact with secretions (e.g.,
diapering, cord care, injections, handling of blood/
blood by-products).

Sealed soiled tissues, paper wipes/trash, and

Reduces risk of cross-contamination and alerts

disposable diapers in plastic bags per protocol.

appropriate personnel/departments to exercise

specific hazardous materials procedures.

Apply mittens; file infant’s nails, as indicated.

Protects skin from injury that can provide additional

portals of entry for infectious agents.

Monitor temperature and secretions. Auscultate

HIV-seropositive infants have increased risk for

breath sounds. Note behavioral changes, e.g.,

developing recurrent upper respiratory infection,

irritability, lethargy. Palpate lymph node chains.

otitis media, thrush, cytomegalovirus, erythematous

rash, and lymphadenopathy. Note: Although

Pneumocystis carinii pneumonia (PCP) is common is

both infants and adults, lymphocytic interstitial
pneumonitis (LIP) is rarely seen in adults and is the
second most common indicator disease for
diagnosing AIDS in infants.

Prepare skin with soap and water and then alcohol

Proper preparation and handling reduces risk of

prior to injections/heel-sticks. Notify laboratory of

cross-contamination for infant and care

HIV status and mark specimens accordingly.

providers/laboratory staff.

Monitor/limit contact with care providers and

Reduces number of pathogens presented to the

family members, as appropriate.

infant’s immune system and decreases possibility of
infant’s contracting a nosocomial infection. Note:
Depending on specific facility policy, pregnant care
providers may be excluded from caring for infant to
reduce risk of HIV contamination.

Provide for complete isolation as indicated.

Presence of enteritis, congenital syphilis, CMV, or
other viral infections increases risk of cross-
contamination to other infants.