What is the management of a newborn infant if the mother has tuberculosis?

  1. If the mother has untreated pulmonary tuberculosis, or has not been on treatment for at least 4 weeks before delivery, the infant should have prophylactic treatment. The same will apply if another family member has active pulmonary tuberculosis. Usually INH 5 mg/kg/day is given. Some services use INH plus rifampicin.
  2. The mother should be allowed to care for and breastfeed her infant. The infant need not be isolated but can stay with the mother. The mother must receive a full course of treatment.
  3. BCG should not be given at birth (as the BCG bacillus could be killed by the anti-TB drugs).
  4. At 3 months, a Mantoux skin test must be done:
    • If the infant is thriving and the skin test is negative, the infant has not been infected with TB bacilli. BCG should now be given after the prophylactic treatment has been stopped for 3 days. No further treatment is needed.
  5. A Mantoux skin test of 5 mm or more indicates that the infant has been infected by TB bacilli despite the prophylactic treatment. Do not give BCG but treat the child for tuberculosis.

Prophylactic treatment of newborn infants remains controversial. The choice of 1 or more drugs and the duration of treatment is still debatable. Therefore, some authorities use both INH and rifampicin for 3 months.

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