Management of the infant born to a mother with tuberculosis: a systematic review and consensus practice guideline
Nadia Hasan1, Clare Nourse2, H Simon Schaaf3
1Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; General Paediatrics, The Queensland Children's Hospital, Brisbane, QLD, Australia.
Insights
Infants born to mothers with tuberculosis (TB) face higher TB risks. A review of studies and guidelines led to consensus recommendations for managing these infants, aiming for consistent care and better data collection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Infants born to mothers with tuberculosis (TB) have an elevated risk of developing the disease.
- Current evidence for managing these infants is limited, necessitating a consensus-based approach.
Approach:
- A systematic review identified three studies meeting inclusion criteria, insufficient for evidence-based conclusions.
- National and international guidelines were assessed to inform expert consensus.
- Two management algorithms were developed for infants based on maternal infectious status and local TB incidence.
Key Points:
- Limited published research hinders evidence-based management of infants born to mothers with TB.
- Consensus guidelines were developed by international experts addressing different risk scenarios.
- Algorithms differentiate management for potentially infectious versus non-infectious mothers and high/low TB incidence settings.
Conclusions:
- The developed consensus practice guideline aims to standardize clinical management for infants exposed to TB.
- Improved data collection and further research are encouraged to enhance evidence-based care.
- This initiative seeks to reduce the burden of tuberculosis in vulnerable infant populations.
Abstract:
Infants born to mothers with tuberculosis disease are at increased risk of developing tuberculosis disease themselves. We reviewed published studies and guidelines on the management of these infants to inform the development of a consensus practice guideline. We searched MEDLINE, CINAHL, and Cochrane Library from database inception to Dec 1, 2022, for original studies reporting the management and outcome of infants born to mothers with tuberculosis. Of the 521 published papers identified, only three met inclusion criteria and no evidence-based conclusions could be drawn from these studies, given their narrow scope, variable aims, descriptive nature, inconsistent data collection, and high attrition rates. We also assessed a collection of national and international guidelines to inform a consensus practice guideline developed by an international panel of experts from different epidemiological contexts. The 16 guidelines reviewed had consistent features to inform the expert consultation process. Two management algorithms were developed-one for infants born to mothers considered potentially infectious at the time of delivery and another for mothers not considered infectious at the time of delivery-with different guidance for high and low tuberculosis incidence settings. This systematic review and consensus practice guideline should facilitate more consistent clinical management, support the collection of better data, and encourage the development of more studies to improve evidence-based care.
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