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. DESIGN AND SETTING: 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.