[CIS PIDD] [cis-pidd] breastfeeding during pre-conditioning chemotherapy

Tue Jun 2 10:01:01 EDT 2015

Jen, Joe, and Jen:

To paraphrase Jerry Maguire: "Show me the Literature"!

[that is not based on preterm, LBW or VLBW newborns]

It might be helpful for us to know what the actual risk of CMV transmission, etc. is. This way we can have a discussion with the parents (mother) based on concrete data rather than perpetuating "knowledge" from yesteryear. Something like: "as far as we know the risk of CMV transmission through breastmilk is between X and Y%", and let them weigh in on feeding preferences.

And if there is no data, we can tell the parents that we don't really know, but this (or that) is what we recommend.

Regards,

JB

From: Leiding, Jennifer [mailto:jleiding at health.usf.edu]
Sent: Tuesday, June 02, 2015 9:52 AM
To: CIS-PIDD
Subject: RE:[cis-pidd] breastfeeding during pre-conditioning chemotherapy

Thank you for the quick comments. Just to clarify, we are checking Mom's serologic status of CMV, not the breast milk itself. For this family, I think this issue is more about the nursing, not the milk. It is this child's major form of comfort. Although I completely appreciate the risk of infection, I feel bad taking this away from him in the midst of transplant.

Thanks again,
Jen Leiding

From: Heimall, Jennifer [mailto:heimallj at email.chop.edu]
Sent: Tuesday, June 02, 2015 9:37 AM
To: CIS-PIDD
Subject: RE:[cis-pidd] breastfeeding during pre-conditioning chemotherapy

I would agree.

For families that strongly prefer breast milk, pasteurized breast milk from the breast milk banks may be an option.

Jen
Jennifer Heimall, MD
The Children's Hospital of Philadelphia
Medical Director Day Medicine
Allergy/Immunology Attending Physician
3550 Market Street
3rd Floor
Philadelphia, PA 19104
215-590-2549 (p)
215-590-4529 (f)
________________________________
From: Church, Joseph <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>>
Sent: Tuesday, June 2, 2015 9:35 AM
To: CIS-PIDD
Subject: RE:[cis-pidd] breastfeeding during pre-conditioning chemotherapy

Jen:

I would be very concerned about the potential transmission of CMV in this situation.  I would avoid breast feeding unless the mom is seronegative for CMV, even if the breast milk currently tests negative.  If the mom is seropositive she could reactivate and shed CMV at any time.

Joe Church
Children's Hospital Los Angeles

From: Leiding, Jennifer [mailto:jleiding at health.usf.edu]
Sent: Tuesday, June 02, 2015 6:09 AM
To: CIS-PIDD
Subject: [cis-pidd] breastfeeding during pre-conditioning chemotherapy

Hi all:

This question came up among our group concerning a 13m old XL CGD boy that we are preparing for MUD HSCT. He will be receiving a preparative regimen consisting of busulfan/fludarabine/ATG. He has been breastfeeding since birth and in addition to nutrition, nursing is his main form of comfort. With the concern for CMV transmission via breast milk in SCID patients (especially those picked up via newborn screening), should there be a concern about CMV transmission via breast milk in this patient or any other transplant patient in which we are essentially making T cell deficient? This patient is CMV negative and we are in the process of checking his mother.

Thanks,

Jen Leiding

Jennifer Leiding, MD
Assistant Professor
University of South Florida
Department of Pediatrics
Division of Allergy, Immunology, and Rheumatology
Children's Research Institute
140 - 7th Avenue South Box 9680
St. Petersburg, Florida 33701
Phone: 727.553.1304
Fax: 727.553.1295

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