Baquero-Artigao F, Mellado Peña M J, del Rosal Rabes T, Noguera Julián A, Goncé Mellgren A, de la Calle Fernández-Miranda M, Navarro Gómez M L
Grupo de Infección Congénita y Perinatal de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España.
Grupo de Tuberculosis de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España.
An Pediatr (Barc). 2015 Oct;83(4):286.e1-7. doi: 10.1016/j.anpedi.2015.01.010. Epub 2015 Mar 6.
In pregnant women who have been exposed to tuberculosis (TB), primary isoniazid prophylaxis is only recommended in cases of immunosuppression, chronic medical conditions or obstetric risk factors, and close and sustained contact with a patient with infectious TB. Isoniazid prophylaxis for latent tuberculosis infection (LTBI) is recommended in women who have close contact with an infectious TB patient or have risk factors for progression to active disease. Otherwise, it should be delayed until at least three weeks after delivery. Treatment of TB disease during pregnancy is the same as for the general adult population. Infants born to mothers with disseminated or extrapulmonary TB in pregnancy, with active TB at delivery, or with postnatal exposure to TB, should undergo a complete diagnostic evaluation. Primary isoniazid prophylaxis for at least 12 weeks is recommended for those with negative diagnostic tests and no evidence of disease. Repeated negative diagnostic tests are mandatory before interrupting prophylaxis. Isoniazid for 9 months is recommended in LTBI. Treatment of neonatal TB disease is similar to that of older children, but should be maintained for at least 9 months. Respiratory isolation is recommended in congenital TB, and in postnatal TB with positive gastric or bronchial aspirate acid-fast smears. Separation of mother and infant is only necessary when the mother has received treatment for less than 2 weeks, is sputum smear-positive, or has drug-resistant TB. Breastfeeding is not contraindicated, and in case of mother-infant separation expressed breast milk feeding is recommended.
对于接触过结核病（TB）的孕妇，仅在存在免疫抑制、慢性疾病或产科危险因素，以及与传染性结核病患者有密切且持续接触的情况下，才建议进行异烟肼预防性治疗。对于与传染性结核病患者密切接触或有进展为活动性疾病危险因素的女性，建议进行异烟肼预防性治疗以预防潜伏性结核感染（LTBI）。否则，应推迟至分娩后至少三周。孕期结核病的治疗与一般成年人群相同。母亲在孕期患有播散性或肺外结核病、分娩时患有活动性结核病或产后接触过结核病的婴儿，应进行全面的诊断评估。对于诊断检查结果为阴性且无疾病证据的婴儿，建议进行至少12周的异烟肼预防性治疗。在中断预防性治疗之前，必须多次进行阴性诊断检查。LTBI建议使用异烟肼治疗9个月。新生儿结核病的治疗与大龄儿童相似，但应持续至少9个月。先天性结核病以及胃或支气管吸出物抗酸涂片阳性的产后结核病建议进行呼吸道隔离。只有在母亲接受治疗少于2周、痰涂片阳性或患有耐药结核病时，才需要母婴分离。母乳喂养并非禁忌，若母婴分离，建议采用挤出母乳进行喂养。
