Infant born with mother Tuberculosis

Tuberculosis (TB) in neonates While perinatal TB is extremely rare, clinicians should be alert to symptoms. The most effective way to prevent TB in the newborn is to identify and treat the infected mother. Tuberculosis is prevalent in most developing countries and constitutes a special risk during pregnancy and lactation to mothers and infants. Mortality from TB is highest in patients less than five years of age.

Perinatal TB Some factors to note about perinatal TB: It is rare. The placenta may be infected resulting in severe fetal involvement and fetal death. Transplacental infection usually occurs when the pregnant woman has clinical tuberculosis or a recent primary infection. Placental TB can spread to the fetus by the umbilical vein. The primary complex may be in the fetal liver, gastrointestinal tract, or mesenteric nodes. A placental tubercle may rupture causing tubercular amnionitis and possible fetal aspiration with primary complex in the fetal lung. The infant may aspirate infected secretions at the time of birth. Postnatal exposure may be from the infected mother or other infected family members.

Maternal tuberculosis Some factors to note about maternal TB: Identification and treatment of maternal TB is the best way of preventing TB in the newborn. Skin testing and interferon gamma release assay (IGRA) should be done on pregnant women who: are HIV positive are suspected of having been exposed to TB are recent arrivals from a high prevalence area There is no significant increase in malformations for infants born to infected mothers . There is no indication for therapeutic abortion.

Clinical features of perinatal tuberculosis Clinical features may be present at birth or delayed until eight weeks of age. The mean time of onset is 2-4 weeks.

Clinical features of perinatal tuberculosis Clinical features of tuberculosis include: respiratory distress fever hepatosplenomegaly irritability, poor feeding and lethargy lymphadenopathy failure to thrive jaundice

Investigations for tuberculosis The tuberculin skin test (TST) is likely to be negative for the first few weeks of life, even if the neonate has TB. TST conversion may be delayed for up to 6 months. IGRA performance is poorly understood in children and cannot be recommended for children < 5 years of age. If congenital TB is suspected, the placenta should be examined and microscopy, culture and histology performed

Management of tuberculosis If perinatal TB is suspected: C hest x-ray, lumbar puncture and gastric aspirates (x 3) should be taken. Anti-TB therapy should be commenced immediately; the decision regarding number and choice of antibiotics is difficult and warrants specialist advice. Initial treatment should include Isoniazid (INH), Rifampicin P yrazinamide plus Amikacin or Ethionamide until the susceptibility of the infant or mother’s isolate is known. Once antibiotic susceptibilities are known, treatment should continue with at least two antibiotics to which the organism is susceptible. Breastfed infants should receive pyridoxine 10 mg daily.

Management of tuberculosis If the mother has active disease: Chest x-ray and gastric aspirates (x 3) should be taken. If these do not yield evidence of TB, the infant should be treated with INH for 6 months. TST should be performed at 3 and 6 months of age. If positive at any time, the infant must be investigated and treated with anti-TB treatment as above. Anyone with active disease who is in contact with the infant should use a face mask until their sputum is demonstrated to be smear negative. BCG vaccine should be considered if there is any possibility of future exposure to TB. Separation of mother and infant is only necessary if the mother is sick enough to require hospitalisation.

Management of tuberculosis If the mother does not have active disease: The i nfant may be at risk even if the mother's sputum is negative. The infant should be treated with INH 10 mg/kg/day for 6months and should have TST performed at 3 and 6 months of age. If positive at any time, the infant must be investigated and treated with anti-TB treatment as above. BCG vaccine should be considered if there is any possibility of future exposure to TB. Breastfeeding is not contraindicated

Management of tuberculosis Nursery exposure Management of TB due to hospital exposure: Spread can occur from infected personnel or visitors; infants and children rarely transmit TB. If exposure is significant, infants should have TST performed and if negative, treated with INH 10 mg/kg/day for 6 months. TST should be repeated at 6 months . If the TST is positive at any time, the infant must be investigated and treated with anti-TB treatment as above. BCG vaccine should be considered if there is any possibility of future exposure to TB.