All newborns born to HIV positive mothers should be managed according to the current Malawi Integrated Guidelines for providing HIV services in Children and Adults (2). The lactating mother should be treated with antiretroviral (ARV) medication.
Nevirapine syrup is given to all HIV exposed babies as soon as possible after birth until six weeks. At six weeks:
|Birth weight||Dose of Nevirapine|
|<2500g||1.0 ml every 24 hours|
|>2500g||1.5 mls every 24 hours|
Treat all infants of mothers who are VDRL seropositive and are untreated or inadequately treated or there is no clear documentation of full treatment. If unsure it is safer to treat.
|Clinical findings suggestive of syphilis||Treatment:|
|Small for dates
"Nuffles" (a serous rhinitis)
|Proven or highly probable disease:
X-pen 50 000iu/kg bid x for 10 days
Emphasize the importance in all cases that both parents receive treatment
If the mother has active lung tuberculosis (TB) in the third trimester or TB was diagnosed after delivery, manage according to the National TB Control Programme, Chapter 5 (3). Examine her baby closely for symptoms and signs of disease. If the baby is well, commence Isoniazid (H) prophylaxis at 10 mg/kg/day and continue for 6 months. Do not give BCG vaccine.
Re-evaluate the infant at the age of 6 weeks, noting weight gain and taking an X-ray of the chest, if possible. If the infant is doing well and tests are negative, continue prophylactic Isoniazid to complete 6 months of treatment.
If any findings suggest active disease, start full anti-TB treatment, according to national guidelines.
Dose of Isoniazid (H) for NYI exposed to TB but not infected
|Babies weight||Isoniazid dose|
|< 2500g||25mg (1/4 tablet) every 24 hours|
|2500-5000g||50mg (1/2 tablet) every 24 hours|
If the baby is not well at birth and has signs/symptoms suggestive of TB disease, collect gastric aspirates first thing in the morning using a nasogastric tube. Send for gene Xpert and culture where possible and commence full TB treatment according to national guidelines.