Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 13#

A 22-year-old G1 at 34 weeks is tested for tuberculosis because her father, with whom she lives, was recently diagnosed with tuberculosis. Her skin test is positive and her chest x-ray demonstrates a granuloma in the upper left lobe.

Which of the following is true concerning infants born to mothers with active tuberculosis? 

A. The risk of active disease during the first year of life may approach 90% without prophylaxis
B. Bacille Calmette-Guérin (BCG) vaccination of the newborn infant without evidence of active disease is not appropriate
C. Future ability for tuberculin skin testing is lost after BCG administration to the newborn
D. Neonatal infection is most likely acquired by aspiration of infected amniotic fluid
E. Congenital infection is common despite therapy

Correct Answer is C

Comment:

The goal of management in the infant born to a mother with active tuberculosis is prevention of early neonatal infection. Congenital infection, acquired either by a hematogenous route or by aspiration of infected amniotic fluid, is rare. Most neonatal infections are acquired by postpartum maternal contact. The risk of active disease during the first year of life may approach 50% if prophylaxis is not instituted. BCG vaccination and daily isonicotinic acid hydrazide (isoniazid, INH) therapy are both acceptable means of therapy. BCG vaccination may be easier because it requires only one injection; however, the ability to perform future tuberculin skin testing is lost.