pediatrics
Neonatal Hepatitis B Virus (HBV) Infection
Prevention of Neonatal HBV Infection
Pregnant women should be tested for HBsAg during an early prenatal visit. Failing that, they should be tested when admitted for delivery. Some women who are HBsAg-positive are treated withlamivudineor telbivudine during the 3rd trimester, which may prevent perinatal transmission of HBV. should be given 1 dose of HBIG 0.5 mL IM within 12 hours of birth. Hepatitis B (HepB) Vaccine should be given IM in a series of 3 doses, as is recommended for all infants in the US. (NOTE: Doses vary among proprietary vaccines.) The first dose is given concurrently with HBIG but at a different site. The 2nd dose is given at 1 to 2 months, and the 3rd dose is given 6 to 18 months after the first. If the infant weighs Neonates whose mothers have unknown HBsAg statusat the time of delivery should also receive their first dose of vaccine within 12 hours of birth. For infants < 2 kg, the first dose is given concurrently with HBIG (0.5 mL IM) at a different site. For infants ≥ 2 kg and whose mothers can be tested for HBsAg and in whom follow up is ensured, HBIG (0.5 mL IM) can be delayed up to 7 days pending a positive maternal test for HBsAg. Testing for HBsAg and anti-HBs at 9 to 15 months is recommended for all infants born to HBsAg-positive mothers. Neonates whose mothers are known HBsAg–negativeshould receive their first dose of vaccine within 24 hours of birth if they are medically stable and weigh ≥ 2 kg. For infants < 2 kg, administer 1 dose at age 1 month or before hospital discharge. Separating a neonate from its HBsAg-positive mother is not recommended, and breastfeeding does not seem to increase the risk of postpartum HBV transmission, particularly if HBIG and HBV vaccine have been given. However, if a mother has cracked nipples, abscesses, or other breast pathology, breastfeeding could potentially transmit HBV. 