TB Exposed Newborn: Management Guidelines

Definition

Management

Nursery and KMC room policies

Definition of TB exposed neonate 

• Suspected maternal TB 
• Known maternal TB, compliant but on TB Rx <2months 
• Maternal TB Rx >2months, but: Non-compliant/symptoms, signs or results showing persistent TB (NB: high risk for MDR/XDR TB) 

Management 

1. If placenta is still available: Ask for placental histology and culture (placenta in plastic bag, no formalin). 
2. Careful examination of the neonate (RD, HSM, NNJ, abdominal distension): 
   • If infant unwell: Admit and discuss with senior. Investigate further for congenital TB (G/W, CXR, abdominal U/S, TA, CSF etc). Notify and treat. Rif 15mg/kg/d (range 10-20), INH 10mg/kg/d (range 10-15), PZA 35mg/kg/d(range 30-40) and Ethion 15-20mg/kg/d. 
   • If infant well: can stay with mother in ward NB: Check mom’s presumed TB diagnosis: history, notes, CXR, results. No prophylaxis needed if mother compliant on TB treatment > 2 months and well, no cough. Do 2x gastric washings for AFB and TB culture. Start prophylaxis: INH 10mg/kg/day (range 10-15mg/kg/d). In case of suspected MDR TB: Check all cultures and sensitivities, discuss with IDC*. Refer to local TB clinic for surveillance & continuation of prophylaxis for 6 months (letter). 
3. Do NOT give BCG at birth! (TB clinic to give BCG after 6 months prophylaxis in HIV unexposed/known HIV PCR negative infants). 
4. Well MDR-exposed infant: discuss with IDC. 
   • WHO recommends high dose INH prophylaxis (15-20mg/kg/d for 6 months) 
   • Current Red Cross Children’s Hospital and Tygerberg MDR recommendations: 3-drug prophylaxis approach recommended by Simon Schaaf ie INH 15-20mg/kg/d plus ethionamide 15-20mg/kg/d plus ofloxacin 15-20mg/kg/d or ciprofloxacin 20mg/kg/d for 6 months. 

Nursery and KMC room policy regarding mothers with known/suspected TB 

Any mother suspected of TB should only come to the nursery if she is wearing a mask and preferably after 48 hrs of TB treatment. No mother with suspected active TB may sleep in the mother’s lodger/KMC room. No mother with known TB, treated for <3 months and without a latest negative culture result may sleep in KMC.