Background Prevention of vertical transmission of Human Immunodeficiency Virus (HIV) is multifactorial and relies on good compliance with recommended strategies. National guidelines provide a framework for care to reduce the risk of such transmission.

In one tertiary paediatric unit several incidents were reported where guidelines had not been followed and babies had been put at risk of harm. An audit was required to assess whether this was a result of areas of practice that consistently fell short of standards.

Aims To assess whether babies born to HIV positive mothers at a tertiary neonatal and paediatric unit are managed according to guidelines.

Methods A retrospective review of case notes of HIV positive women giving birth at a tertiary neonatal and paediatric unit over a five-year period identified from a database of patients. Management was compared to standards derived from national and trust guidelines to assess compliance.

Results 25 mother and baby pairs identified, with 18 suitable for inclusion. There was no evidence of vertical spread of HIV in patient pairs investigated. Compliance with guidelines was very high, with 100% of mothers being advised not to breast-feed and 100% of babies being formula fed. All babies had blood sent for HIV PCR at birth and were started on appropriate single antiretroviral therapy (ART). Three babies experienced a delay in receiving ART within four hours as stated by guidelines, with no obvious reason for delay. One baby missed a single dose of ART, with again no obvious reason found. One patient pair did not have an overall management plan in their case notes. One patient received BCG vaccination at birth without confirmation of HIV status.

Conclusion High compliance with guidelines was demonstrated by this audit but was not perfect. Small lapses in care can lead to vertical transmission of HIV but in this cohort of patients it did not. The risk of major harm if care falls short of guidelines should prevent complacency even when audit shows good compliance. Improving communication and documentation, strict adherence to drug prescribing and greater involvement of the baby’s caregiver can increase compliance and therefore further reduce the risk of vertical transmission.