Should a newborn take Hepatitis B Immunoglobulin (HBIG) if the mother is Hepatitis B surface antibody (HBsAb) positive and Hepatitis B surface antigen (HBsAg) positive?

From the Guidelines

A newborn should receive hepatitis B immunoglobulin (HBIG) if the mother is HBsAg positive, as this indicates active hepatitis B infection and poses a risk of transmission to the baby. According to the recommendations of the Advisory Committee on Immunization Practices 1, all infants born to HBsAg-positive women should receive HepB vaccine and HBIG within 12 hours of birth, administered at different injection sites. The key points to consider are:

• The mother's HBsAg status determines the need for HBIG in the newborn
• HBsAg positivity indicates active infection and risk of transmission to the baby
• HBIG should be administered within 12 hours of birth, along with the first dose of HepB vaccine
• The HepB vaccine series should be completed according to the recommended schedule, with the final dose not administered before age 24 weeks (164 days)
• Postvaccination serologic testing for anti-HBs and HBsAg should be performed after completion of the vaccine series at age 9–12 months. In this case, since the mother is HBsAg positive, the newborn should receive HBIG and the HepB vaccine series as recommended 1.

From the FDA Drug Label

For an infant with perinatal exposure to an HBsAg-positive and HBeAg-positive mother, a regimen combining one dose of Hepatitis B Immune Globulin (Human) at birth with the hepatitis B vaccine series started soon after birth is 85%–95% effective in preventing development of the HBV carrier state. Hepatitis B Immune Globulin (Human) (0. 5 mL) should be administered intramuscularly (IM) to the newborn infant after physiologic stabilization of the infant and preferably within 12 hours of birth.

The answer is yes, a newborn should take hepatitis B immunoglobulin if the mother has HBsAg positive, as it is indicated for post-exposure prophylaxis in infants born to HBsAg-positive mothers. The recommended dose is 0.5 mL administered intramuscularly within 12 hours of birth, in combination with the hepatitis B vaccine series started soon after birth 2.

From the Research

Hepatitis B Immunoglobulin for Newborns

• The administration of hepatitis B immunoglobulin (HBIG) to newborns born to HBsAg-positive mothers is a recommended practice to prevent hepatitis B infection 3, 4, 5, 6.
• Studies have shown that HBIG, alone or in combination with hepatitis B vaccine, can reduce the occurrence of hepatitis B infection in newborns 3, 4.
• However, the use of HBIG may not prevent occult HBV infection in babies, which can occur in up to 40% of cases 4.
• The current practice of administering HBIG and hepatitis B vaccine at birth to babies born to HBsAg-positive mothers is effective in preventing overt HBV transmission, but may not prevent occult HBV infection 4, 5.

Recommendations for HBIG Administration

• The American Academy of Pediatrics and other organizations recommend that all newborns born to HBsAg-positive mothers receive HBIG and hepatitis B vaccine at birth 5, 6.
• The use of HBIG is also recommended for individuals who have been exposed to HBsAg-positive blood or bodily fluids, or who have had sexual contact with an HBsAg-positive person 6.
• HBIG is not indicated for the treatment of acute or chronic hepatitis B infection 6.

Safety and Efficacy of HBIG

• HBIG has been shown to be safe and effective in preventing hepatitis B infection in newborns and other individuals at risk of exposure 3, 4, 5, 6.
• However, the administration of HBIG may delay or reduce the response to hepatitis B vaccine, particularly if administered at the same site 7.
• Further research is needed to fully understand the effects of HBIG on the immune response to hepatitis B vaccine and to determine the optimal dosing and administration schedule for HBIG 7.