A descriptive study of neonates born to mother with tuberculosis in a low middle income country
da Silva, Sonia Mariza Neves
Background. Tuberculosis (TB) in pregnancy is associated with unfavourable maternal and neonatal outcomes. A paucity of South African (SA) data exists regarding the impact of maternal TB on neonates. Objectives. To describe demographical and clinical characteristics and outcomes of mothers diagnosed with TB and their neonates and compare it to TB negative mothers and their neonates. Methods. This was a retrospective unmatched case-control study of sick and premature neonates admitted to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between 1 January 2013 and 31 December 2017. Cases were identified as neonates born to mothers with TB. Controls included the next two inborn neonates delivered to TB negative mothers. Results. Maternal TB prevalence in this study was 0.9%. The majority of mothers confirmed human immunodeficiency virus (HIV) positive had TB and few were on antiretroviral (ARV) therapy. If taking ARVs, these mothers commonly defaulted treatment, had a higher viral load (VL) and a lower cluster of differentiation 4 (CD4) compared to the control group. Likewise, TB exposed neonates were more likely to be HIV positive. Mothers with TB were at higher risk for spontaneous abortions, preeclampsia, maternal anaemia, chorioamnionitis, pneumonia and more likely to require ventilation. Tuberculosis exposed neonates had higher rates of early-onset sepsis (EOS), late-onset sepsis (LOS), respiratory distress syndrome (RDS), chronic lung disease (CLD) and need for ventilation. The only factor associated with a high risk of TB in mothers was CD4. Conclusion. Unfavourable neonatal and maternal outcomes associated with TB found at CMJAH were consistent with that reported globally.
A research report submitted in fulfilment of the requirements for the degree of Master of Medicine in Paediatrics to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2021