Risk of infectious diseases associated with emerging alternative birth practices: AAP report

USA: A recent report by the American Academy of Pediatrics (AAP) published in the journal Pediatrics, provides information on the risk of infectious diseases associated with emerging alternative peripartum and neonatal practices. This may be used by pediatricians to counsel families before birth and for appropriate evaluation and treatment of neonates who have been exposed to these practices.

Alternative birth practices discussed in the report include vaginal seeding, water immersion for labor and delivery, placentophagy (placental consumption), umbilical cord non severance, nonmedical deferral of birth hepatitis B vaccination, deferral of ocular prophylaxis, and delayed bathing.

"Discussion of these practices should not serve as an endorsement by the American Academy of Pediatrics (unless endorsement has been given in other AAP policies)," Dawn Nolt, Division of Infectious Diseases, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, and colleagues wrote in their report.

Water Immersion for Labor and Delivery

Water immersion birth refers to giving birth in warm water with the objective of creating a gradual transition from the in utero environment while decreasing stress and increasing comfort for the pregnant individual.

Water immersion for labor and birth has been shown to improve the comfort of the pregnant person in the first stage of labor but has not shown benefit for the second stage of labor or delivery. Potential neonatal infections associated with this practice, such as with Legionella and Pseudomonas species, are rare but serious.

Vaginal Seeding

Vaginal seeding is the practice of inoculating an infant born by cesarean section with a sampling of fluid from the vagina of the birth parent. The process involves inoculating a cotton gauze or swab with vaginal fluids from the mother and transferring the gauze or swab to the mouth, nose, and/or skin of a newborn infant.

Vaginal seeding may expose infants to vaginal pathogens such as GBS or HSV and has no known benefits. Evaluation of symptomatic infants born by cesarean section after exposure to vaginal seeding should be the same as for those who are delivered vaginally.

Umbilical Nonseverance

Umbilical non severance, colloquially known as lotus birth, is meant to allow the umbilical cord, and hence the placenta, to remain attached to the infant after birth.

Umbilical nonseverance has no clear benefit to date and may possibly increase risk of neonatal sepsis attributable to the presence of necrotic umbilical or placental tissue.

Placentophagy

Placentophagy (otherwise known as placental consumption) is the practice of ingesting the entire placenta or portions of it.

Placentophagy should be avoided because there is no evidence of benefit to the caregiver, and one case report links this to recurrent GBS sepsis in a neonate. Evaluation of symptomatic infants exposed to this practice should not differ from other neonates.

Nonmedical Deferral of the Hepatitis B Vaccine Birth Dose

HBV is a sexually transmitted and blood-borne pathogen that is transmitted perinatally from birth parent to infant in a highly efficient manner. Infants exposed to HBV perinatally have a high likelihood of developing infection.

The birth dose of HepB serves as a critical safety net for the prevention of HBV infection, and nonmedical deferral of the birth dose should be discouraged.

Deferral of Ocular Prophylaxis

Ophthalmia neonatorum is defined as conjunctivitis presenting in the first 4 weeks of life. Although there are numerous potential etiologies, historically, the most important has been Neisseria gonorrhea because of the potential for corneal scarring and blindness as a result of infection.

Ocular prophylaxis is effective for treating some causes of ophthalmia neonatorum, particularly in high-risk situations, such as limited prenatal testing for causative organisms in high-risk populations and in areas with high endemicity. Adequate prenatal testing significantly reduces the risk of ophthalmia neonatorum. Deferral of ocular prophylaxis may be considered in low-risk situations but may be impacted by state legislation.

Delayed Bathing

Delayed bathing is the practice of not performing the first bath for several hours after birth. This practice has been integrated into many hospital programs to improve rates of breastfeeding initiation and exclusivity.

Delayed bathing may have benefits in promoting initiation and exclusivity of breastfeeding. Delayed bathing in neonates exposed to active HSV genital lesions or with a known history of HIV infection in the birth parent should be discouraged.

Reference:

"Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices," is published in the journal Pediatrics.

DOI: https://doi.org/10.1542/peds.2021-055554