TB Exposed children/neonate and IPT

• TB exposed child
• Neonate exposed to a SSP mother
• Isoniazid prophylaxis

TB-exposed child

Neonates exposed to an SSP Mother

• A sizeable number of mothers reactivate latent TB infection in the third trimester of pregnancy or around the time of delivery/immediate post-partum period.
• Any mother in whom TB is suspected should be sent for a CXR and a minimum of x2 sputum samples collected for AFB microscopy.

Two common scenarios

Mother was diagnosed with TB prior to the third trimester of pregnancy, is taking TB medications with good adherence and is clinically well:

• Examine the new-born for signs of disease. If the baby is well, no action is required.
• Refer all other household children <5 years of age to the TB clinic for clinical assessment.

Mother is diagnosed with TB in the third trimester of pregnancy or shortly after delivery

Examine her baby closely for symptoms and signs of disease - two further possible scenarios

• If the baby is well, commence isoniazid (H) prophylaxis at 10 mg/kg/day and continue for 6 months. Do not give BCG vaccine.

Isoniazid dose

Infants need to be reviewed at 1, 3 and 6 months after commencing isoniazid. Infants' weights must be checked regularly and their isoniazid dosages increased as they grow. Refer all other household children to the TB clinic for clinical assessment and screening. As BCG is a live vaccine, isoniazid will kill the vaccine and prevent an effective immune response from developing. If isoniazid is commenced within 2 weeks of receiving BCG vaccination, the infant will need repeat BCG vaccination following the end of treatment. If no BCG vaccine was given at birth, then vaccinate the baby two weeks after completing isoniazid.