Management of Newborns and Healthcare Workers Exposed to Isoniazid-Resistant Congenital Tuberculosis in the Neonatal Intensive Care Unit

Background Management of newborns and healthcare workers (HCWs) exposed to congenital tuberculosis (TB) in neonatal intensive care unit (NICU) has been rarely reported. Aim To outline a contact investigation process for individuals exposed to congenital TB in the NICU and investigate nosocomial transmission. Additionally, to assess the efficacy and safety of window prophylaxis in exposed newborns. Methods A baby, born at a gestational age of 28+1 weeks, was diagnosed with isoniazid-resistant congenital TB on the 39th day of admission to the level IV NICU. Newborns and HCWs exposed cumulatively for ≥8 hours underwent contact investigation and follow-up for a year. Findings Eighty-two newborns underwent contact investigation. All newborns displayed normal chest X-rays, and 42 hospitalised newborns tested negative for acid-fast bacilli stain and Xpert® MTB/RIF assay in their endotracheal sputum or gastric juices. Eighty received window prophylaxis: six out of 75 on rifampin experienced mild adverse events, and none in the five on levofloxacin. After 12 weeks, five (6.1%) had a positive tuberculin skin test, all of whom had already received the Bacillus Calmette-Guérin vaccine and tested negative on TB interferon-gamma releasing assay. Out of 119 exposed HCWs, three (2.5%) were diagnosed with latent TB infection and completed a 4-month rifampin therapy. There was no active TB disease among exposed newborns and HCWs during a 1-year follow-up. Conclusion Timely diagnosis of congenital TB is crucial for minimizing transmission among exposed neonates and HCWs in the NICU setting. In cases of isoniazid-resistant index patients, even premature newborns may consider the use of rifampin or levofloxacin for window prophylaxis.