Do pediatricians or neonatologists administer Hepatitis B Immune Globulin (HBIG) to newborns born to Hepatitis B (HBV) positive mothers?

Administration of HBIG to Newborns Born to Hepatitis B Positive Mothers

Yes, pediatricians and neonatologists should administer Hepatitis B Immune Globulin (HBIG) to all newborns born to HBsAg-positive mothers within 12 hours of birth, along with the first dose of hepatitis B vaccine. 1

Standard Protocol for Infants Born to HBsAg-Positive Mothers

The management of infants born to HBsAg-positive mothers follows a clear algorithm:

1. Immediate post-birth intervention (within 12 hours):

   • Administer single-antigen hepatitis B vaccine (first dose)
   • Administer 0.5 mL of HBIG
   • These should be given at different injection sites (e.g., separate limbs) 1

2. Complete the vaccine series:

   • Follow the recommended schedule for infants born to HBsAg-positive mothers
   • The final dose should not be administered before 24 weeks (164 days) of age 1

3. For preterm infants weighing <2,000 grams:

   • The initial birth dose should not be counted as part of the vaccine series
   • Administer 3 additional doses (total of 4 doses) beginning at 1 month of age 1

Follow-up Testing

Post-vaccination serologic testing is essential and should be performed:

• At 9-12 months of age (after completing the vaccine series)
• Testing should include both anti-HBs and HBsAg
• Testing should not be performed before 9 months to avoid detection of passive anti-HBs from HBIG 1

Management Based on Test Results

• HBsAg-negative infants with anti-HBs ≥10 mIU/mL: Protected, no further medical management needed
• HBsAg-negative infants with anti-HBs <10 mIU/mL: Should be revaccinated with a single dose of HepB vaccine and retested 1-2 months later 1
• If anti-HBs remains <10 mIU/mL after single dose: Complete a second series with two additional doses, followed by testing 1-2 months after final dose 1
• HBsAg-positive infants: Should be referred for appropriate follow-up 1

Management of Infants Born to Mothers with Unknown HBsAg Status

When maternal HBsAg status is unknown:

1. Test the mother for HBsAg as soon as possible
2. Administer hepatitis B vaccine to the infant within 12 hours of birth (without HBIG initially)
3. If mother is later found to be HBsAg-positive, administer HBIG as soon as possible but no later than 7 days of age 1

For preterm infants weighing <2,000 grams with mothers of unknown status:

• Administer both hepatitis B vaccine AND HBIG within 12 hours of birth
• This is due to potentially decreased immunogenicity of the vaccine in these infants 1

Evidence of Effectiveness

The combination of HBIG and hepatitis B vaccine has proven highly effective in preventing perinatal transmission of HBV. Research has shown that this dual approach provides better protection than vaccine alone, especially for infants born to highly infectious mothers (HBeAg-positive) 2, 3.

Common Pitfalls to Avoid

1. Delaying administration beyond 12 hours: Both HBIG and the first dose of hepatitis B vaccine should be given within 12 hours of birth
2. Using combination vaccines for the birth dose: Only single-antigen hepatitis B vaccine should be used for the birth dose 1
3. Administering HBIG and vaccine at the same site: These should be given at different injection sites
4. Failing to complete follow-up testing: Post-vaccination serologic testing is essential to confirm protection
5. Testing too early: Testing before 9 months may detect passive antibodies from HBIG rather than vaccine-induced immunity 1

The evidence strongly supports this approach, with guidelines from the Advisory Committee on Immunization Practices (ACIP) consistently recommending HBIG plus hepatitis B vaccine for all infants born to HBsAg-positive mothers to prevent perinatal HBV transmission and its long-term consequences of chronic liver disease and hepatocellular carcinoma.