Management of asymptomatic newborns with periportal hypodensity and high serum IgM who were born from untreated tuberculosis mothers

OBJECTIVES: We previously reported the presence of periportal hypodensity on CT image in two newborns and an early infant with congenital tuberculosis as an adjunct diagnostic option. The aim of this study was to determine the degree of treatment based on both periportal hypodensity and serum IgM presented in asymptomatic newborns born from tuberculosis mothers. SUBJECTS AND METHODS: Eight newborns born from mothers with untreated tuberculosis between 1996 and 2002 were retrospectively studied. Newborns who presented periportal hypodensity and high serum IgM were treated with anti-tuberculosis medicines, combination of isoniazid and rifampicin for nine to 12 months with streptomycin in the initial two months, and the outcomes of the treatment were followed for at least two years. RESULTS: All eight newborns had gastric aspirates negative for Mycobacterium tuberculosis. Three of eight newborns (38%) demonstrated periportal hypodensity, and they also demonstrate a tendency of high serum IgM. None of these three newborns treated with combination of isoniazid, rifampin, and streptomycin for 9 to 12 months developed tuberculosis during the observation period. CONCLUSIONS: These results suggest that presence of both periportal hypodensity and high serum IgM in asymptomatic newborns born from mothers with untreated tuberculosis may be one of risk factors of developing congenital tuberculosis, and that anti-tuberculosis treatment for nine to 12 months may prevent them from the disease development despite possible criticism of overdiagnosis and overtreatment.