Neonate born to a mother with pulmonary TB during pregnancy who is infectious at delivery
If a mother with pulmonary TB during pregnancy has received less than 2 months of TB treatment before delivery or is still infectious despite treatment (no clinical improvement, or smear- or culture-positive), there is a significant risk of transmission to the neonate.
If there is no clinical suspicion of congenital TB in the neonate, start presumptive therapy for latent TB promptly. Use:
1isoniazid 10 mg/kg orally, daily for 3 months12 isoniazid
PLUS
rifampicin 15 mg/kg orally, daily for 3 months rifampicin
OR
1isoniazid 10 mg/kg orally, daily for 6 months12 isoniazid
OR
1rifampicin 15 mg/kg orally, daily for 4 months. rifampicin
The infant should have monthly clinical review up to 3 months of age and drug doses should be adjusted for weight gain in the infant.
Perform a TST on the infant at 3 months of age. If the TST is:
- positive—assess the infant for active TB and seek expert advice
- negative—stop presumptive therapy, including in infants on the 4-month rifampicin or 6-month isoniazid regimens. Recommend BCG vaccination if the infant is at risk of future exposure to TB. Wait one week after stopping presumptive therapy before administering the BCG vaccine, as the therapy may inactivate the vaccine. If the mother is HIV positive, exclude HIV infection in the infant before giving BCG.
The mother does not need to be separated from the infant, but should wear a surgical mask when in close contact (including while breastfeeding). This should be implemented from the time of delivery until the mother becomes smear-negative and more than 2 months of TB treatment has been administered. Consider having the infant sleep in a separate room at night until the mother is smear-negative.