Nipple device could deliver drugs to babies

A simple nipple shield could help breastfeeding mothers cut the risk of HIV infection from breast milk, say researchers.

Nipple shields are often used by mothers who have difficulty breastfeeding, and a modified version of the shield has been developed by a team of young engineers with a view to reducing mother-to-child HIV transmission.

The tip contains a removable insert, which can be impregnated with a microbicide designed to inactivate the HIV virus. The drug would be flushed out by breast milk as the baby feeds.

More recently, the team has been exploring whether a similar device could deliver antiretroviral drugs to breastfeeding babies, in light of changing advice from the WHO. The WHO now recommends that babies born to HIV-positive mothers be breastfed and simultaneously receive antiretroviral drugs, unless conditions are safe for formula feeding.

Globally, about 400,000 children a year are infected with HIV, nearly all acquiring the virus from their mothers. The risk of transmission is significantly increased by breastfeeding.

The only way to eliminate this risk is not to breastfeed, but formula feeding is often unsafe, expensive and impractical, especially in developing countries, where formula-fed babies face a higher risk of malnutrition, diarrhoea and other infections. This is particularly the case in Sub-Saharan Africa, where more than 90 per cent of mothers infected with HIV live.

A project to develop the modified shield, called JustMilk, was launched at the International Development Design Summit in 2008. The researchers say it may also be possible to produce inserts containing other medications or nutritional supplements.

The project has attracted much attention, including a US$100,000 Grand Challenges Exploration research grant from the Bill and Melinda Gates Foundation in 2009.

But Stephen Gerrard, a JustMilk researcher at the University of Cambridge in United Kingdom said more research is needed.

"We have to prove without a doubt that if this device is used by a mother, the volume of milk consumed does not change," he said.

Gerrard told SciDev.Net that trials to test this principle are expected to take place within the next year.

"I'm optimistic that we can do good with this device once we are sure that it does not impede breastfeeding and would not create any stigma," he added.

Andrew Tomkins, at the Institute of Child Health in London, said: "The potential problem with a nipple shield device will be making sure that the dose is adequate for the baby."