6.2 Breast-feeding women

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Breast feeding mothers with TB should receive the full course of anti-TB treatment. Proper treatment is the best way of preventing transmission of TB to the baby. All anti-TB drugs are compatible with breast-feeding. Breast feeding should be continued in the normal manner while the mother is taking anti-TB treatments. Breastfeeding should be avoided only in cases where the mother has TB/HIV co-infection.

Breast-feeding women on ATT should routinely receive preventive treatment for isoniazid-related peripheral neuropathy. For this, they should be given oral Vit B6 (Pyridoxine) at a dosage of 10 mg/day along with their anti-TB drugs for the entire duration of treatment. In addition, the breast-fed infant should receive INH preventive therapy after ruling out active TB.

The mother should be advised about cough hygiene measures such as covering the nose and mouth while coughing, sneezing or any act which can produce sputum droplets. Constant use of a face mask by the mother should be encouraged. She should breast feed the infant in an adequately ventilated place and minimise sharing common breathing space with the infant.

6.2.1 Management of a new-born child of a mother with active TB

  • Do not separate the child from the mother unless she is acutely ill.
  • If the mother is sputum smear negative, and if the infant has no evidence of congenital TB, BCG is given to the infant.
  • If the mother is sputum smear-positive at the time of delivery, infant should be carefully examined for evidence of active disease.

- If the infant is ill at birth and congenital TB is suspected, a full course of anti-TB treatment should be given.

- If the child is well, give prophylactic treatment of daily INH and Rifampicin for 3 months (3RH regimen) at recommended dosages. BCG is withheld till completion of prophylactic treatment.

  • The Mantoux skin test is done after three months of prophylactic treatment.

- If the Mantoux test is negative and the child is well, prophylactic treatment with 3RH is stopped and child is given BCG.

- If the Mantoux test is positive, careful examination of the child for active TB is carried out using Chest X-ray, GeneXpert (sputum/ BAL/ gastric lavage/ stool) etc.

  • If active disease is diagnosed, a full course of anti-TB treatment should be initiated.