Table 4.

Recommended supportive care anticipatory guidelines for infants with suspected severe combined immunodeficiency.

Guideline	Reason
Avoid public places, daycare	Prevent transmission of community-acquired diseases
Limited contact with young children
Strict hand washing
No breastfeedinga	Prevent transmission of cytomegalovirus (CMV)
Boil ingestible water, including bottled water	Prevent cryptosporidium infection
Avoid all live and live attenuated vaccines (MMR, Varicella, Rotavirus, Flu-Mist)	Prevent infection with vaccine-related viruses
Blood products—leukodepletion and irradiation essential; CMV negative when available	Prevent transmission of CMV and graft versus host disease

^aBreastfeeding could be reinitiated if maternal CMV demonstrates no prior exposure (IgG and IgM are both negative, and CMV PCR is negative). If CMV IgG is positive, breastfeeding is strongly discouraged.