NCP The Infant of an HIV-Positive Mother

Frequently, the newborn who is subsequently determined to be HIV-positive will be asymptomatic during the nursery stay. The CDC classifies HIV-positive newborns as indeterminate, asymptomatic, or symptomatic. Between 20% and 65% of infants born to HIV-positive mothers are themselves infected.
This plan of care is to be used in conjunction with the previous newborn plans of care.

NEONATAL ASSESSMENT DATA BASE

As a rule, the neonate is asymptomatic at birth, although a few may show signs of opportunistic infections within several days of birth. In addition, the effects of maternal substance use/abuse and/or prematurity may be present.

Circulation

Prolonged bleeding, petechiae (thrombocytopenia) noted on occasion

Elimination

Diarrhea
Enlarged liver, spleen may be noted

Food/Fluid

LBW
Feeding difficulties
Oral lesions (candidiasis)

Neurosensory

Neurological deficits
Microcephaly

Respiration

Varied degree of impairment (relative maternal drug use, cesarean birth)

Safety

Swollen glands (lymphadenopathy) noted on occasion
Maternal Factors
History of high-risk behaviors, STDs
Seropositive HIV

Sexuality

Maternal Factors
History of multiple sexual partners

Teaching/learning

Prematurity
Developmental delays
Maternal Factors
History of parental drug use (mother or partner)

DIAGNOSTIC STUDIES

CBC and Total Lymphocyte Count: Provides baseline immunologic data regarding WBC and lymphocyte counts to monitor disease progression.
Enzyme immunoassay or Enzyme-Linked Immunosorbent Assay and Western Blot Test (EIA/ELISA): May be positive, but invalid because test does not distinguish between maternal and infant antibodies. (The infant may test negative by 9–15 mo of age.)
HIV Cultures (with peripheral blood mononuclear cells and, if available, plasma): Diagnostic for infants under 15 mo of age.
Polymerase Chain Reaction Test: Detects nucleic acid in small quantities of infected peripheral mononuclear cells.
Serum or Plasma p24 Antigen: Increased quantitative values can be indicative of progression of infection (may not be detectable during very early stages of HIV infection) in infants 30 days or older and who have had the second dose of hepatitis vaccine.
Quantitative Serum IgG, IgM, and IgA Determinations: Nondiagnostic in newborns, but provide baseline immunologic data.
Blood/Lesion/Urine Cultures: Diagnostic for opportunistic infections.
X-ray: May reveal lymphoid interstitial pneumonia.

NURSING PRIORITIES

1. Prevent/minimize infections.
2. Maximize nutritional intake.
3. Promote attachment, growth, and development.
4. Provide information to parent(s)/caregivers about disease process/prognosis and treatment needs.

DISCHARGE GOALS

1. Free of opportunistic/nosocomial infection.
2. Gaining weight appropriately.
3. Perform skills typical of age group within scope of present developmental level.
4. Parent/caregiver understands condition/prognosis and treatment needs.
5. Plan in place to meet specialized needs after discharge.