Neonates exposed to a mother with TB

Clinical description

If a mother is diagnosed with TB before the third trimester of pregnancy, is taking TB medications with good adherence and is clinically well:

• Examine the new-born for signs of disease such as hepatosplenomegaly. If the baby is

well, no action is required.

If a mother is diagnosed with TB in the third trimester of pregnancy or shortly after delivery:

• Examine her baby closely for symptoms and signs of disease. If the baby is well,

commence isoniazid (H) prophylaxis at 10 mg/kg/day and continue for 6 months.

• BCG should be administered upon completion of IPT. All other vaccines should be

given as per the current EPI guidelines.

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• Infants need to be reviewed at 1, 3 and 6 months after commencing INH. Infants’

weights must be checked regularly and their INH dosages increased as they grow.

As BCG is a live vaccine, INH will kill the vaccine and prevent an effective immune response from developing.

• If INH is commenced within 12 weeks of receiving BCG vaccination, the infant will need

repeat BCG vaccination at the end of treatment.

• If no BCG vaccine was given at birth, then vaccinate the baby two weeks later.

A significant number of mothers reactivate latent TB infection in the third trimester of pregnancy or around the time of delivery or in the immediate post-partum period.

• Any mother in whom TB is suspected should be sent for CXR and two sputum samples

collected for smear microscopy (and Xpert MTB/RIF, where available).

Table 5.4-1: IPT dosages for neonates and infants Baby’s weight Isoniazid dose <2.5 kg 25 mg (1/4 tablet) every 24 hours 2.5-5.0 kg 50 mg (1/2 tablet) every 24 hours 5.0-10.0 kg 100 mg (1 tablet) every 24 hours