Tuberculosis, Perinatal
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: P37.0 *Notifiable condition. DESCRIPTION Tuberculosis acquired in the first 3 months of life . Perinatal tuberculosis may be acquired in one of the following ways: Transplacental transmission – usually extrapulmonary or disseminated TB. Via the passage of swallowed maternal blood or amni
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: P37.0
*Notifiable condition.
DESCRIPTION
Tuberculosis acquired in the first 3 months of life. Perinatal tuberculosis may be acquired in one of the following ways:
- Transplacental transmission – usually extrapulmonary or disseminated TB.
- Via the passage of swallowed maternal blood or amniotic fluid during delivery – usually extrapulmonary TB.
- Inhalation of the bacilli during the neonatal period – usually pulmonary TB.
DIAGNOSTIC CRITERIA
- Hepatosplenomegaly, a suggestive chest X-ray, TB exposure via a mother or close contact with another source case.
- Positive smear or culture on any suitable sample e.g. gastric aspirate in the neonate or tissue histology suggestive of TB.
- Endometrial swabs or sputum samples in the mother positive for M. tuberculosis. See: Tuberculosis, Pulmonary.
GENERAL AND SUPPORTIVE MEASURES
- Have a low threshold for starting presumptive treatment based on clinical assessment.
- Check drug sensitivity of the source. If drug resistant, refer.
- Check HIV status of the mother and, if positive, test the baby with HIV PCR.
- Screen all household contacts.
- Monitor the nutritional status of the neonate closely.
- Do not give BCG vaccine at birth but administer BCG after completing TB treatment or prophylaxis.
MEDICINE TREATMENT
Treatment for Drug Sensitive (DS) Tuberculosis
Newborn infant of mother with DS tuberculosis with newborn having any signs suggestive of illness:
| Intensive Phase | Continuation Phase |
|
- Rifampicin, oral, for 2 months. PLUS Isoniazid, oral, for 2 months. PLUS - Pyrazinamide, oral, for 2 months |
- Isoniazid, oral, for 4 months. PLUS Rifampicin, oral, for 4 months.
|
TB Preventative Therapy (TPT)
Click on the image to enlarge
All asymptomatic neonates:
- Rifampicin/Isoniazid, oral, once daily for 3 months (3RH) – HIV-unexposed or HIV-exposed, uninfected, not on NVP.
| Weight band | Daily Rifampicin/Isoniazid 75/50 mg tablet | |
| 75/50 | If dispersed in 10 mL water | |
| 2–2.9 kg | ½ tablet | 5 mL |
| 3–3.9 kg | ¾ tablet | 7.5 mL |
| 4–5.9 kg | 1 tablet | 10 mL |
| 6–7.9 kg | 1½ tablets | 15 mL |
- Isoniazid, oral, 10 mg/kg/dose once daily for 6 months (IPT) – HIV-infected or HIV-exposed, on NVP.
| Weight band | Daily Isoniazid (H) 100 mg tablet |
| 2–3.4 kg | ¼ tablet |
| 3.5–4.9 kg | ½ tablet |
| 5–7.4 kg | ¾ tablet |
During prophylaxis, monitor the infant for active TB disease (including growth monitoring) and re-evaluate for TB if necessary. Administer BCG vaccine after completing TPT to prevent inactivation of BCG by TB medication.
In severely immunosuppressed patients, the tuberculin reaction test can be negative in the presence of active tuberculosis.
REFERRAL
- Patients not responding to adequate therapy.
- Perinatal TB with a drug resistant (DR) source.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 10: Tuberculosis, 10.1 Tuberculosis, Perinatal