Chapter 3.13 Babies of mothers with infections

Chapter 3.13.1 congenital syphilis

Clinical signs

  • Often low birth weight
  • Palms and soles: red rash, grey patches, blisters or skin peeling
  • ‘Snuffles’: highly infectious rhinitis with nasal obstruction
  • Abdominal distension due to enlarged liver and spleen
  • Jaundice
  • Anaemia

Some very low birth weight babies with syphilis have signs of severe sepsis with lethargy, respiratory distress, skin petechiae or other bleeding.

If you suspect syphilis, do a VDRL test if possible


  • Asymptomatic neonates born to women with a positive VDRL or rapid plasma reagin test should recieve 37.5 mg/kg (50 000 U/kg) of benzathine benzylpenicillin in a single IM dose.
  • Symptomatic infants should be treated with:
    • procaine benzylpenicillin at 50 mg/kg as a single dose by deep IM injection daily for 10 days, OR
    • benzylpenicillin at 30 mg/kg every 12 h IV for the first 7 days of life and thend 30 mg/kg every 8 h for a further 3 days
  • Treat the mother and her partner for syphilis and check for other sexually transmitted infections.

Chapter 3.13.2 infants of mothers with tuberculosis

See Chapter 8 for guidance

If the mother has active lung tuberculosis (TB) and was treated for < 2 months before the birth, or TB was diagnosed after the birth:

  • Reassure the mother that it is safe for her to breastfeed her infant
  • Do not give the TB vaccine (BCG) at birth
  • Give prophylactic isoniazid at 10 mg/kg by mouth once daily
  • Re-evaluate the infant at the age of 6 weeks, noting weight gain and taking an X-ray of the chest, if possible.
  • If any findings suggest active disease, start full anti-TB treatment according to national guidelines.
  • If the infant is doing well and tests are negative, continue prophylactic isoniazid to complete 6 months of treatment
  • Delay BCG vaccination until 2 weeks after treatment is completed.  If BCG has been given already, repeat 2 weeks after the end of isoniazid treatment.

Chapter 3.13.3 infants of mothers with HIV infection

See Chapter 8 for guidance