על ידי מנסה_לעזור* » 20 אוקטובר 2007, 23:26
שאלתי גם את דר' ג'יי גורדון אבל טרם קיבלתי תשובה.
מצרפת את החלק במסמך שנוגע לצהבת:
Hepatitis
There are many viruses which can cause the collection of symptoms which we generally call hepatitis (jaundice, nausea, fatigue, abdominal pain). Seven of these viruses are called “Hepatitis” viruses, and are named Hepatitis A, Hepatitis B, Hepatitis C, down to G viruses. Expect in the next few years that there will be Hepatitis H, I, J, and eventually maybe all the letters of the alphabet will not suffice. Other viruses, however, can also cause hepatitis like illness, including infectious mononucleosis virus (Ebstein-Barr Virus), cytomegalovirus and even some viruses which cause the common cold. It should also be mentioned, that other illnesses, non infectious ones, may cause a hepatitis like illness. Probably the most common of non infectious hepatitis like illness is due to a drug reaction.
Hepatitis is an illness which usually is not severe, though it can be and it can even cause death. Luckily such severe illness is rare. In fact, in many cases, the infection is sub-clinical (that is, the infected person may not know s/he has had the infection).
As with most viruses, by the time a person is aware that they have an illness, they are less infectious, and sometimes not infectious at all. Most viruses have a viremic phase (when the virus is in the blood), again, usually before the person is aware of any illness at all. At this time, small amounts of virus may get into the milk, but the important point is that by the time a nursing mother is aware that she is sick, she has, probably passed the infection on.
Some hepatitis viruses (notably B and C) can cause both chronic carrier states (that is, the person has the virus in their body, but has no evidence of actual infection), and chronic infection. It is particularly in these situations that the question of whether breastfeeding is advisable comes up.
Hepatitis A
Hepatitis A does not cause a chronic carrier state or chronic infection. The acute illness is usually fairly mild, but can be severe and symptoms usually last a fairly long period of time, often several weeks. Loss of appetite, nausea and fatigue are usual, something nursing mothers really could do without.
However, by the time the mother notices a yellow discolouration of her skin, the chances of infecting anyone else are pretty well past. The viremic phase (when the virus is in the milk), has long past, and even excretion of virus in the bowel movements has virtually stopped.
Thus, concern with nursing should not be, really, the worry about passing the virus on to the baby. This is unlikely, perhaps not even possible, but there is no good evidence to say so. Furthermore, immune globulin can be given to the baby if it is felt that transmission should be avoided. Also there is now an immunization for Hepatitis A which will effectively prevent illnesses. Hepatitis A infection in children tends to be particularly mild, though, as with adults, it can be very severe.
The main concern really is keeping breastfeeding while the mother is feeling nauseated, not able to eat and feeling extremely fatigued. The adult with hepatitis will usually be spending his time in bed. The breastfeeding mother should go to bed with her baby and rest, sleep, and allow herself to be coddled. The baby can nurse in bed with her. The older child can be brought when he needs to nurse.
Hepatitis B
Hepatitis B, from the point of view of acute illness, is similar to Hepatitis A, though often it is longer lasting, and it can also give symptoms outside the liver. For example, arthritis may occur with it.
Unlike Hepatitis A, Hepatitis B may cause a chronic carrier state. In some parts of the world, 15% or more of all people are carriers for this virus. The chances of passing the virus on to the baby, either during pregnancy or birth are significant. For this reason, many jurisdictions require screening of pregnant women for Hepatitis B, and protecting the newborn at birth with immune globulin and immunization. The success rate of preventing transmission to the baby is very high.
Even before the immunization was available, however, there was no proof that babies breastfed got the infection more frequently than those fed artificially. Indeed, at least a couple of good studies showed that the risk to the baby was the same regardless of the method of feeding. Despite that many physicians still counsel mothers who are Hepatitis B positive not to breastfeed. They should, in fact, counsel them to breastfeed, especially now that the risk of transmission is virtually zero with the immunizations.
Hepatitis C
Hepatitis C can cause acute illness, similar to Hepatitis A and B, but it tends to be more frequently subclinical, and when obvious, tends to be very mild. The main issue with Hepatitis C is the chronic carrier state. A significant percentage of adults with chronic carrier states do have chronic infection which will eventually go on to cirrhosis. What happens to babies infected with Hepatitis C during pregnancy or delivery is not known. This is not just a question of not having done the studies. Children are not adults, and they react differently to many infectious diseases, sometimes more severely, sometimes less, and babies infected during pregnancy or at birth might react quite differently from older children.
Present evidence suggests that there is no increased risk of the baby picking up Hepatitis C through breastfeeding. There are some problems with these studies. One is that these studies, though showing no increase in risk, also are based on studying only small numbers of mothers and babies. Everyone would feel more secure if larger numbers of women and their babies were involved in these studies. It is also possible that the situation could change, as maternal antibody in the baby’s blood, decreases and thus decreases the baby’s resistance to the virus.
Overall, given the risks of not breastfeeding, women should breastfeed when they are Hepatitis C positive.
Hepatitis D, E, F, G
Not much is known about these viruses and the risk of breastfeeding while positive for these is not known, but appears to be negligible.
שאלתי גם את דר' ג'יי גורדון אבל טרם קיבלתי תשובה.
מצרפת את החלק במסמך שנוגע לצהבת:
Hepatitis
There are many viruses which can cause the collection of symptoms which we generally call hepatitis (jaundice, nausea, fatigue, abdominal pain). Seven of these viruses are called “Hepatitis” viruses, and are named Hepatitis A, Hepatitis B, Hepatitis C, down to G viruses. Expect in the next few years that there will be Hepatitis H, I, J, and eventually maybe all the letters of the alphabet will not suffice. Other viruses, however, can also cause hepatitis like illness, including infectious mononucleosis virus (Ebstein-Barr Virus), cytomegalovirus and even some viruses which cause the common cold. It should also be mentioned, that other illnesses, non infectious ones, may cause a hepatitis like illness. Probably the most common of non infectious hepatitis like illness is due to a drug reaction.
Hepatitis is an illness which usually is not severe, though it can be and it can even cause death. Luckily such severe illness is rare. In fact, in many cases, the infection is sub-clinical (that is, the infected person may not know s/he has had the infection).
As with most viruses, by the time a person is aware that they have an illness, they are less infectious, and sometimes not infectious at all. Most viruses have a viremic phase (when the virus is in the blood), again, usually before the person is aware of any illness at all. At this time, small amounts of virus may get into the milk, but the important point is that by the time a nursing mother is aware that she is sick, she has, probably passed the infection on.
Some hepatitis viruses (notably B and C) can cause both chronic carrier states (that is, the person has the virus in their body, but has no evidence of actual infection), and chronic infection. It is particularly in these situations that the question of whether breastfeeding is advisable comes up.
Hepatitis A
Hepatitis A does not cause a chronic carrier state or chronic infection. The acute illness is usually fairly mild, but can be severe and symptoms usually last a fairly long period of time, often several weeks. Loss of appetite, nausea and fatigue are usual, something nursing mothers really could do without.
However, by the time the mother notices a yellow discolouration of her skin, the chances of infecting anyone else are pretty well past. The viremic phase (when the virus is in the milk), has long past, and even excretion of virus in the bowel movements has virtually stopped.
Thus, concern with nursing should not be, really, the worry about passing the virus on to the baby. This is unlikely, perhaps not even possible, but there is no good evidence to say so. Furthermore, immune globulin can be given to the baby if it is felt that transmission should be avoided. Also there is now an immunization for Hepatitis A which will effectively prevent illnesses. Hepatitis A infection in children tends to be particularly mild, though, as with adults, it can be very severe.
The main concern really is keeping breastfeeding while the mother is feeling nauseated, not able to eat and feeling extremely fatigued. The adult with hepatitis will usually be spending his time in bed. The breastfeeding mother should go to bed with her baby and rest, sleep, and allow herself to be coddled. The baby can nurse in bed with her. The older child can be brought when he needs to nurse.
Hepatitis B
Hepatitis B, from the point of view of acute illness, is similar to Hepatitis A, though often it is longer lasting, and it can also give symptoms outside the liver. For example, arthritis may occur with it.
Unlike Hepatitis A, Hepatitis B may cause a chronic carrier state. In some parts of the world, 15% or more of all people are carriers for this virus. The chances of passing the virus on to the baby, either during pregnancy or birth are significant. For this reason, many jurisdictions require screening of pregnant women for Hepatitis B, and protecting the newborn at birth with immune globulin and immunization. The success rate of preventing transmission to the baby is very high.
Even before the immunization was available, however, there was no proof that babies breastfed got the infection more frequently than those fed artificially. Indeed, at least a couple of good studies showed that the risk to the baby was the same regardless of the method of feeding. Despite that many physicians still counsel mothers who are Hepatitis B positive not to breastfeed. They should, in fact, counsel them to breastfeed, especially now that the risk of transmission is virtually zero with the immunizations.
Hepatitis C
Hepatitis C can cause acute illness, similar to Hepatitis A and B, but it tends to be more frequently subclinical, and when obvious, tends to be very mild. The main issue with Hepatitis C is the chronic carrier state. A significant percentage of adults with chronic carrier states do have chronic infection which will eventually go on to cirrhosis. What happens to babies infected with Hepatitis C during pregnancy or delivery is not known. This is not just a question of not having done the studies. Children are not adults, and they react differently to many infectious diseases, sometimes more severely, sometimes less, and babies infected during pregnancy or at birth might react quite differently from older children.
Present evidence suggests that there is no increased risk of the baby picking up Hepatitis C through breastfeeding. There are some problems with these studies. One is that these studies, though showing no increase in risk, also are based on studying only small numbers of mothers and babies. Everyone would feel more secure if larger numbers of women and their babies were involved in these studies. It is also possible that the situation could change, as maternal antibody in the baby’s blood, decreases and thus decreases the baby’s resistance to the virus.
Overall, given the risks of not breastfeeding, women should breastfeed when they are Hepatitis C positive.
Hepatitis D, E, F, G
Not much is known about these viruses and the risk of breastfeeding while positive for these is not known, but appears to be negligible.