Neonatal exposure to active pulmonary tuberculosis in a maternity ward: Screening and clinical course of a cohort of exposed infants

Few data are available on the impact of a tuberculosis exposure on newborns in a maternity ward. Objectives. To describe the screening and clinical course of infants exposed during the neonatal period to a caregiver with bacillary tuberculosis. Patients and methods. Infants exposed during the postnatal period in a maternity unit in Paris, from March to August 2005, to a caregiver with bacillary tuberculosis were included in a standardized screening protocol. The screening performed at baseline (M0) and at 3 months (M3) included a clinical evaluation, a tuberculin skin test (TST), and a chest X-ray. A preventive treatment for tuberculosis with isoniazid and rifampicin for 3 months was systematically proposed. Results. At MO, 182 of the 217 infants (84%) with significant exposure were evaluated. Data were available for 172 infants. The median age at MO was 4.9 months (IQR = 3.8-6.2). At M0, 4 of 172 infants (2.3%) had latent TB infection. Between M0 and M3, 19 infants (11%) were lost to follow-up and on 153 developed a latent TB infection. No cases of tuberculosis disease were diagnosed. The treatment was administered properly in 83% of cases and side effects were observed in 11% of infants without any serious adverse event. Four infants received no treatment and 11 stopped their treatment prematurely. Conclusion. In the absence of neonatal massive exposure, although low (2.9%), the risk of latent TB infection requires close monitoring of the infants exposed. However, in the context of a mild exposure in the maternity unit, surveillance without systematic initiation of TB preventive treatment could be discussed. (C) 2012 Elsevier Masson SAS. All rights reserved.