A mother who is HIV-positive has given birth to a term female. What plan of care is most appropriate for this infant?
1. Test with an anti-HIV-1 antibody assay at 8 months.
2. Begin prophylactic AZT (Zidovudine) administration.
3. Provide 4–5 large feedings throughout the day.
4. Encourage the mother to breastfeed the child.
2
Rationale 1: Eight months is too early for this test. The HIV-1 antibody assay becomes accurate at 15–18 months of age, after the maternal antibodies have cleared from the infant's system.
Rationale 2: Prophylactic medication helps reduce the risk of vertical transmission from exposure to maternal blood and body fluids at birth. The dose for term newborns is 2 mg/kg/dose PO every 6 hours.
Rationale 3: GI problems–including lack of weight gain, weight loss, and wasting–are common with HIV-positive infants. Small, frequent feedings are best tolerated and facilitate optimal growth and weight gain. Large feedings should be avoided.
Rationale 4: Breastfeeding is contraindicated for HIV-positive mothers because breast milk has been shown to contain the virus. Bottle-feeding is the recommended feeding method.
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