High tuberculosis exposure among neonates in a high tuberculosis and human immunodeficiency virus burden setting.
BACKGROUND
Maternal and neonatal tuberculosis (TB) are under-recognised, particularly in settings with a high burden of human immunodeficiency virus (HIV) infection.


METHODS
Retrospective audit of neonates routinely screened for TB in a South African hospital during  2009. Surveillance sources reviewed included routine clinical, laboratory and pharmacy records.


RESULTS
Among 70 neonates (60% HIV-exposed) screened for TB, the median gestational age was 35.5 weeks (IQR 33-38), and the median birth weight was 2000 g (IQR 1530-2484). The neonates  were grouped according to a history of documented TB exposure: maternal TB in 41/70 (59%), suspected maternal TB in 9/70 (13%), other documented household TB exposure in 5/70 (7%), and no known TB exposure 15/70 (21%). Of the 50 neonates exposed to confirmed or suspected maternal TB, 36 (72%)  were initiated on TB chemoprophylaxis, 5 (10%) received TB treatment and 9 (18%) received no intervention. Eight (8/50, 16%) were diagnosed with TB, all of whom were born to mothers with suspected or proven TB.


CONCLUSIONS
Maternal TB, primarily among HIV-infected women, was the main indication  for TB screening of neonates. Routine TB screening of pregnant women and TB care in mothers and infants should be improved in settings with a high burden of TB and HIV.
Division of Neonatology, Department of Paediatrics and Child Health, Faculty of Health Science, Stellenbosch University, Cape Town, South Africa. adrie@sun.ac.za
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Bekker
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Du Preez
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Schaaf
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MF
Cotton
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Hesseling
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001724:Birth Weight; D060085:Coinfection; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy / Q000635:transmission; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D018811:Maternal Exposure; D015997:Neonatal Screening / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission; D055815:Young Adult
D000995:Antitubercular Agents