From the Guidelines
For a newborn with an HBV-positive mother, immediate implementation of hepatitis B immune globulin (HBIG) and hepatitis B vaccine is essential. The infant should receive HBIG as soon as possible but no later than age seven days, and the vaccine series should be completed according to the recommended schedule for infants born to HBsAg-positive mothers, with the final dose not administered before age 24 weeks (164 days) 1.
- The birth dose of vaccine should not be counted as part of the 3 doses required to complete the vaccine series; 3 additional doses of vaccine (for a total of 4 doses) should be administered according to a recommended schedule on the basis of the mother’s HBsAg test result 1.
- Postvaccination serologic testing for anti-HBs and HBsAg should be performed after completion of the vaccine series at age 9–12 months 1.
- Infants born to HBsAg-positive mothers and receive postexposure prophylaxis may be breastfed beginning immediately after birth 1.
- Antiviral treatment of HBV pregnant women could be an effective strategy to reduce HBV mother-to-child transmission (MTCT), and tenofovir disoproxil fumarate (TDF) administered from week 30 of gestation is safe and effective in preventing HBV transmission in mothers with high viral load 1.
- Breastfeeding should be regarded as safe for infants born to HBV mothers treated with tenofovir 1.
From the Research
Management of Newborn with HIV Positive Mother
- The risk of mother-to-child transmission of HIV can be significantly reduced with effective preventive measures, including maternal and infant antiretroviral therapy and formula-feeding instead of breastfeeding 2.
- All infants born to mothers with HIV infection should receive antiretroviral postexposure prophylaxis as soon as possible, ideally within six hours after delivery 2.
- The type of prophylaxis depends on whether the mother has achieved virologic suppression and if the infant is at high risk of vertical transmission of HIV 2.
Antiretroviral Therapy for Newborns
- Antiretroviral drugs are used in neonates for prevention and treatment of HIV infection, with zidovudine, lamivudine, lopinavir/ritonavir, nevirapine, and raltegravir being the currently recommended antiretrovirals for use in neonates 3.
- Early identification of neonates infected with HIV and rapid initiation of combination antiretroviral treatment during the neonatal period is now recommended by WHO and DHHS 3.
- The use of combination antiretroviral regimens in high-risk infants reduces intrapartum transmission, and prolonged prophylaxis in breastfed infants reduces breastfeeding transmission rates 4.
Safety of Antiretroviral Prophylaxis in Newborns
- Triple antiretroviral prophylaxis during pregnancy and breastfeeding is safe and reduces the risk of HIV transmission to infants 5.
- The use of zidovudine/lamivudine/nevirapine for neonatal postexposure prophylaxis in high-risk HIV-exposed infants did not significantly increase the risk of short-term toxicity compared with zidovudine monotherapy prophylaxis 6.
- However, infants on triple antiretroviral prophylaxis had a higher proportion of anemia grade 2 or higher at 1 and 2 months of life compared to those on zidovudine alone 6.