We report two cases of Herpes Simplex Virus (HSV) induced hemophagocytic lymphohistiocytosis (HLH). These cases highlight that neonates with HSV may have concurrent secondary HLH, a life threatening condition in which prompt diagnosis and treatment can drastically improve survival. Therefore, a low index of suspicion is needed to send, cost effective, sensitive screening blood tests for HLH in critically ill neonates with viral infections. Ferritin is especially useful as a diagnostic tool.
Purpose: In premature infants, breast milk feedings are associated with a decreased risk of necrotizing enterocolitis, sepsis, and improved neuro-cognitive development. Despite these benefits, not all premature infants receive exclusive breast milk feedings. The Hill and Humenick (H&H) scale has been used to assess maternal confidence and commitment to breastfeeding in term infants. Our goal was to test the validity of a modified H&H scale in premature infants. We examined the effect of maternal postnatal attitudes about providing breast milk using a modified H&H scale to see if maternal attitude affects the amount of breast milk fed to infants.
Subjects: Mothers of infants born ≤32 weeks gestation admitted to the Montefiore Weiler Neonatal Intensive Care Unit whose mothers could provide breast milk were eligible.
Design: Within 48 hours of delivery, mothers completed a survey exploring their previous experience regarding breast-feeding, breast milk production, and attitudes towards providing breast milk for their infant.
Methods: Percentage of breast milk enteral feeds was calculated from the electronic medical record. Enteral feeds were calculated until feeding volume equaled a minimum of 120ml/kg/day. Data was analyzed using linear regression.
Main outcome measures: Premature infants and their mothers (n=24) were enrolled. Average birth weight and gestational age were 1067gm (range 520-2000) and 28 weeks (range 24-32). On average, infants initiated enteral feeds by day of life four (range 2-9). The mean percentage of breast milk enteral feeds was 75% (range 13-100).
Principal results: Maternal motivation for providing breast milk, after controlling for education and prior breast-feeding experience, was not associated with increased percentage of breast milk enteral feedings.
Conclusions: In this ethnically diverse urban setting, postnatal maternal motivation, based on a modified H& H scale, was not predictive of percentage breast milk enteral feeds among premature infants. Further study is needed to better delineate the precise factors that lead to increased breast milk provision to premature infants.
Keywords: Breast milk, Premature, Maternal motivation