Care of the normal newborn of the HIV positive mother

Faced with the emergence of AIDS the neonatologists will need to take stock of their practice and that of the neonatal team, and in consultation, the practice of obstetric and midwifery colleagues. While the disadvantageous social associations of AIDS may additionally load HIV positive mothers with further general obstetric risks, such as low birth weight and pre-term delivery, many babies infected with AIDS will not have overt medical problems, and they will require normal patterns of early neonatal care. In the general postnatal wards the normal objectives of neonatal care (Table 1) must be achieved for all babies, whether born to mothers who are HIV positive or negative. But where special measures are required for the baby of the HIV positive mother, these must be humane, economical, unobtrusive and supportive to the general morale of staff, and of course to patients. Although other patients will not know that HIV positive mothers are being cared for, they will gradually and increasingly come to realise that their presence will from time to time be inevitable. They must, therefore, have confidence in the manner in which wards are managed to secure the safety of themselves and their babies. The atmosphere in a modern postnatal ward is open, informal and supportive, features which may initially be at odds with the increased level of care required for the potentially HIV-infected baby. It may be easier to make the necessary policies for babies in need of special care or intensive care, where ward protocols are a regular part of daily routine, and special precautions or segregation are matters of routine management for other purposes.