Impact of AIDS on neonatal care.

I greatly enjoyed Tom Lissauer's annotation on the impact of AIDS (does he mean HIV infection?) on neonatal care. ' I beg to differ, however, on his conclusion that we should avoid the 'two tier' system of neonatal care. At delivery, where there is much blood and liquor and the potential for staff to become infected (although none have yet been shown to have been infected at delivery), the Royal College of Obstetricians and Gynaecologists have not unreasonably proposed a general improvement in standards of hygiene, and extra precautions for delivery of women who are HIV seropositive or from high risk 2 groups. Their proposals regarding precautions to be taken by paediatric staff at delivery also seem eminently reasonable. The risk to staff of contracting HIV infection from a baby postnatally, however, is exceedingly low and there may be virtually no risk. To suggest that we should be wearing gloves and eye protection whenever we are taking blood or performing any invasive procedure on any newborn must be an over reaction. Why should the risk stop in the newborn period? The corollary is surely that we should wear gloves whenever we take blood from any child, or adult for that matter. Yet, as Dr Lissauer himself states, the major risk is of accidental autoinoculation with HIV positive blood against which gloves provide very little protection. In many hospitals in New York gloves are worn for all procedures as Dr Lissauer's statement implies. The annual gloves bill for one hospital in the Bronx is over 5 million dollars (A Mezey, personal communication). I think this is illogical, expensive, and off putting to parents and children. I believe staff with open lesions (cuts, eczema) should cover these with waterproof tape. I will wear gloves to take blood from babies and children I know to be, or suspect of being, HIV positive and try to avoid needle stick injuries at all times. But I will not wear gloves and eye protection to take blood from or handle other newborns or older children.