DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
- Usually the result of:
- maternal history of TB in pregnancy
- baby exposed to a close (usually household) contact with sputum positive TB
- Effective management requires liaison between obstetric, neonatal, TB and paediatric ID teams
Risk factors for TB in newborn period
- Baby is at risk of acquiring TB if:
- mother received treatment for <2 weeks or treated for >2 weeks but sputum smear positive
- mother diagnosed with TB in postpartum period and/or after commencing breastfeeding
- close household contact has sputum positive TB
Congenital TB
- Acquired from transplacental spread or at birth
- Rare but potentially devastating infection with high mortality
- Characterised by primary focus in liver, hepatosplenomegaly and a miliary or disseminated picture including respiratory dissemination and TB meningitis
Neonatal TB
- Much more common than congenital infection
- Baby infected through respiratory route from infected mother or other close contact
- Baby highly susceptible to severe respiratory and disseminated disease including TB meningitis and miliary TB
IMMEDIATE MANAGEMENT
- If no risk factors for neonatal TB or maternal infection fully treated give BCG. No further action required
- If risk factors present liaise with microbiology/TB specialist/paediatric ID consultant. Specialist may advise immediate anti-TB prophylaxis/treatment or investigations before treatment
INVESTIGATIONS
- Gastric washings
- taken early morning pre-feed and transported in alkali medium for microscopy for acid fast bacilli, urgent PCR for M tuberculosis and mycobacterial culture
- liaise with microbiologist before sending
- Chest X-ray
- +/- CSF
- Maternal endometrial or placental samples may also be sent for TB testing
TREATMENT
- If baby has clinical signs, evidence of TB on chest X-ray or positive microbiology local specialist team will advise on treatment
- If baby well with normal investigations
- check liver function
- start isoniazid
- add pyridoxine 1 mg/kg/day if breast fed
- do not give BCG as this will be affected by isoniazid treatment
- check liver function again after 2 weeks
- Mother with active-phase TB can breastfeed once smear negative after appropriate treatment
FOLLOW-UP
- Will be done by local specialist team
- Neonatal team to prescribe sufficient discharge medication to last until first specialist review as GP does not prescribe this