母亲常见感染与母乳喂养指导的专家共识中华医学会围产医学分会  

Expert consensus on breastfeeding in case of maternal infections

作　　者：中华医学会围产医学分会 周乙华[2] 杨慧霞[3] 刘兴会 Society of Perinatal Medicine,Chinese Medical Association;Zhou Yihua;Yang Huixia;Liu Xinghui(不详;Departments of Laboratory Medicine and Infectious Diseases,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008;Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034;Department of Obstetrics and Gynecology,West China Second University7 Hospital of Sichuan University,Chengdu 610041)

机构地区：[1]不详 [2]南京大学医学院附属鼓楼医院科研部、感染科,210008 [3]北京大学第一医院妇产科,100034 [4]四川大学华西第二医院妇产科,成都610041

出　　处：《中华围产医学杂志》2021年第7期481-489,共9页Chinese Journal of Perinatal Medicine

摘　　要：母乳是婴儿的最佳食物,但母亲存在感染时,因担心母乳喂养可将病原体传给子代,造成母乳喂养困惑,甚至不必要地放弃母乳喂养。围产医学专家组根据病原体母婴传播的研究进展,对母亲常见感染时能否母乳喂养达成以下共识:(1)母亲肝炎病毒感染,包括甲型、乙型、丙型和戊型肝炎,均建议母乳喂养;(2)母亲巨细胞病毒感染,足月儿和晚期早产儿(出生胎龄≥32周或出生体重≥1500 g)建议母乳喂养;早期早产儿(出生胎龄<32周或出生体重<1500 g)建议母乳经消毒后喂养,待校正胎龄≥32周或体重≥1500 g时直接哺乳;(3)其他各种疱疹病毒感染时,除乳房感染外,均可直接哺乳;(4)流感或新型冠状病毒感染,母乳挤出后由他人间接哺乳,乳汁无需消毒;(5)HIV感染时,尽可能放弃母乳喂养,采取完全人工喂养,禁忌混合喂养;(6)母亲存在结核菌、梅毒螺旋体、钩端螺旋体、弓形虫或疟原虫感染时,经规范治疗后均可以直接哺乳,治疗前和治疗期间的母乳经巴氏消毒后可哺乳;(7)除黄热病毒疫苗母乳喂养可能引起子代感染外,母亲哺乳期接种所有灭活疫苗和减毒活疫苗,对子代无不良影响;(8)婴儿母乳喂养期间,可接种任何疫苗;(9)尽管巴氏消毒能部分破坏母乳的营养和活性成分,但对子代的益处仍优于配方奶。Human breast milk is the best food for infants.However,maternal infection may result in cessation of breastfeeding,because of concerns on mother-to-child transmission(MTCT)of pathogens,even in the absence of relevant evidence.Based on the progress on MTCT,Chinese experts group on perinatal medicine developed the following consensus on maternal infections and breastfeeding:(1)Mothers infected with hepatitis viruses,including hepatitis A,B,C,and E,are recommended to breastfeed their infants;(2)When mothers are positive for cytomegalovirus IgG,for full-term or late preterm infants(gestational age≥32 weeks at birth or birth weight≥1500 g),breastfeeding is recommended,but for early preterm infants(gestational age<32 weeks at birth or birth weight<1500 g),sterilized breast milk is recommended first and then breastfeeding when corrected gestational age≥32 weeks or≥1500 g;(3)Mothers infected with viruses in Herpes viridae,except for infection on breast,can directly breastfeed their infants;(4)Infants born to mothers with influenza virus or SARS-CoV-2 can be fed with expressed breast milk with no requirement for sterilization;(5)Infants of HIV-infected mothers are recommended to receive exclusive formula feeding whenever possible,while mixed feeding is contraindicated;(6)When mothers are infected with tuberculosis,Treponema Pallidum,Leptospira,Toxoplasma Gondii or Plasmodium,infants can receive pasteurized breast milk before and during pathogen-specific treatment and switch to direct breastfeeding after standard treatment;(7)None of the inactivated or attenuated live vaccines inoculation for lactating women can cause adverse effects for their infants,except yellow fever live vaccine which may cause infant infection via breastfeeding;(8)Infants can receive vaccination whilst breastfeeding;(9)Although pasteurization can partially damage some bioactive components and nutrients in breast milk,pasteurized breast milk is still more beneficial for the offspring than formula.

关 键 词：母亲暴露 感染 母乳喂养 共识 

分 类 号：R174.4[医药卫生—妇幼卫生保健]