7.2.3. Management of asymptomatic neonates of mothers with TB

TB disease should be excluded in neonates born to women with presumptive or confirmed TB. The level of infectiousness and drug susceptibility in the mother should be determined. It is not necessary to separate the neonate from the mother. Breastfeeding should be continued and the mother advised to wear a surgical mask when close to the baby (191). While screening for TB disease or TB infection is ongoing, BCG should be postponed in neonates exposed to TB; the main reason for this is that BCG will interfere with the interpretation of TST, reducing the effectiveness of the test for diagnosing infection. 

Neonates diagnosed with HIV infection, as confirmed by early virological testing, should not receive BCG at birth. Vaccination should be delayed until ART has been started and the infant is confirmed to be immunologically stable (CD4 >25% for children aged under 5 years; CD4 count ≥200 for children aged over 5 years) (see Chapter 3).

Neonates born to women with bacteriologically confirmed PTB and who are well (without any signs or symptoms of TB) should receive preventive treatment once TB disease has been excluded. BCG vaccination should be delayed until after completion of TPT. 3HR using the child-friendly HR 50/75 mg FDC is a good option for infants who have not been exposed to HIV, but consultation with a neonatal specialist is advised. If the infant has been exposed to HIV (e.g. mother is living with HIV) and is on NVP, IPT should be started (TPT with rifamycins cannot be given along with NVP prophylaxis since these decrease NVP levels, which may result in increased vertical transmission of HIV). Infants on TPT should receive pyridoxine 5–10 mg/day. They should be regularly followed up and monitored for the development of symptoms and signs suggestive of TB. If the infant remains asymptomatic after completion of TPT, TB infection testing (TST or IGRA) should be performed if available. If TST or IGRA is negative or not available, and the infant is HIV-negative, BCG vaccination should be provided using a normal infant dose, 2 weeks after completion of the full course of TPT (15, 31).

If the mother is non-infectious, the infant should be screened for TB. If there is no evidence of TB disease, the infant should be followed up regularly to ensure TB disease does not develop, and TPT should be considered.

Neonates born to women with MDR/RR-TB should be referred to a local expert in the management of paediatric MDR/RR-TB. Infection control measures such as wearing masks are required to reduce the likelihood of transmission to the neonate (6).


Box 7.4 Management of babies born to women with TB disease (15)

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