Common Congenital Infections

HIV

All newborns born to HIV positive mothers should be managed according to the current Malawi Integrated Guidelines for providing HIV services in Children and Adults (2). The lactating mother should be treated with antiretroviral (ARV) medication.
Nevirapine syrup is given to all HIV exposed babies as soon as possible after birth until six weeks. At six weeks:

A dried blood spot (DBS) is done for HIV PCR
The baby is started on co-trimoxazole preventative therapy (CPT) 120 mg, which they will take until they are confirmed HIV negative at least six weeks after breast feeding has stopped.

Birth weight	Dose of Nevirapine
<2500g	1.0 ml every 24 hours
>2500g	1.5 mls every 24 hours

Syphilis

Treat all infants of mothers who are VDRL seropositive and are untreated or inadequately treated or there is no clear documentation of full treatment. If unsure it is safer to treat.

Clinical findings suggestive of syphilis	Treatment:
Small for dates Jaundice Recurring rashes Anaemia Hepatosplenomegaly "Nuffles" (a serous rhinitis)	Proven or highly probable disease: X-pen 50 000iu/kg bid x for 10 days Emphasize the importance in all cases that both parents receive treatment

Infants of mothers with tuberculosis

If the mother has active lung tuberculosis (TB) in the third trimester or TB was diagnosed after delivery, manage according to the National TB Control Programme, Chapter 5 (3). Examine her baby closely for symptoms and signs of disease. If the baby is well, commence Isoniazid (H) prophylaxis at 10 mg/kg/day and continue for 6 months. Do not give BCG vaccine.

Re-evaluate the infant at the age of 6 weeks, noting weight gain and taking an X-ray of the chest, if possible. If the infant is doing well and tests are negative, continue prophylactic Isoniazid to complete 6 months of treatment.

If any findings suggest active disease, start full anti-TB treatment, according to national guidelines.

Breast feed as normal
Delay BCG vaccination until 2 weeks after treatment is completed.
If BCG has already been given, repeat 2 weeks after the end of Isoniazid treatment.

Dose of Isoniazid (H) for NYI exposed to TB but not infected

Babies weight	Isoniazid dose
< 2500g	25mg (1/4 tablet) every 24 hours
2500-5000g	50mg (1/2 tablet) every 24 hours

If the baby is not well at birth and has signs/symptoms suggestive of TB disease, collect gastric aspirates first thing in the morning using a nasogastric tube. Send for gene Xpert and culture where possible and commence full TB treatment according to national guidelines.