Neonate born to a mother with extrapulmonary TB

Congenital TB may occur in a neonate if the mother has disseminated or miliary TB, TB meningitis, primary pleural TB or genital tract TB.

If a full course of TB treatment has been completed before delivery in mothers with disseminated or miliary TB, TB meningitis, primary pleural TB or genital tract TB, there is a low risk of transmission to the neonate. Congenital TB should still be excluded in the neonate, but they do not require presumptive treatment for latent TB.

Clinically assess the infant and perform a TST at 3 months of age. If the TST is:

• positive—assess the infant for active TB and seek expert advice
• negative—recommend BCG vaccination if the infant is at risk of future exposure to TB. If the mother is HIV positive, exclude HIV infection in the infant before giving BCG.

If the mother is still on TB treatment at delivery for disseminated or miliary TB, TB meningitis, primary pleural TB or genital tract TB—seek expert advice.

For all other forms of extrapulmonary TB, if congenital TB has been excluded, no further intervention is required.