Typically, newborns are tested for infectious diseases only if they show signs and symptoms. However, asymptomatic newborns may be screened for HIV or hepatitis B if their mothers have the disease or were not screened for the infection while pregnant. Some states require that all newborns be tested for HIV.
Human immunodeficiency virus is the virus that causes AIDS (acquired immunodeficiency syndrome). The infection can pass from an infected mother to her child during pregnancy, delivery, or breastfeeding. (See HIV Screening during Pregnancy.)
Almost all AIDS cases in children in the United States result from mother-to-baby transmission. If a mother with HIV does not receive treatment during the pregnancy, the child has a 1 in 4 chance of getting HIV. With timely treatment, however, fewer than 2% of children of infected mothers get the virus.
Thanks to aggressive screening and early intervention, the United States has seen a steady decline in new AIDS cases in children. The best way to protect the child's health is to detect the HIV infection during pregnancy, treat the mother with medication, and make birthing plans to help the baby avoid infection (such as a C-section rather than vaginal birth).
If the mother was not tested during the pregnancy or at the time of the delivery, the newborn can be screened and, if positive, treated shortly after birth. HIV testing has become routine prenatal care in this country; some states even require that all pregnant women or their newborns be tested.
- Screening the mother: All pregnant women in the United States should be counseled about HIV early in their pregnancy and receive voluntary HIV testing to protect the child's health. This is the recommendation of many groups, including the Centers for Disease Control and Prevention, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and U.S. Preventive Services Task Force.
- Screening the baby: In the United States, if the mother's HIV status is not determined before or during pregnancy or during labor and delivery, health care providers recommend that the newborn be given an HIV test (see FAQ #2 here). In a few states, this is a requirement. Treatment begun quickly after birth can help to prevent a baby who was exposed to the virus from becoming infected.
It is recommended that a pregnant woman be screened for hepatitis B infection either before or early in her pregnancy, and again in the third trimester if she participates in activities that put her at increased risk, such as unprotected sexual contact or intravenous drug use. Infection with the hepatitis B virus causes an inflammation of the liver. It is important to detect active hepatitis B infections in pregnant women because newborns are especially vulnerable to developing chronic infection, which can over the course of many years cause progressive liver damage. If a hepatitis infection is detected in a pregnant woman, she can be monitored and the baby can receive treatment at birth to minimize the risk of developing hepatitis B.
With the advent of screening pregnant women for hepatitis B and the vaccination of newborns, the number of infected babies has fallen. However, a newborn may be screened if there is concern that the mother is at high risk of infection and/or she was not tested during the pregnancy.
Sources Used in Current Review
AIDSInfo. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Last updated 9/14/11. Available online at http://aidsinfo.nih.gov/Guidelines/HTML/3/perinatal-guidelines/187/infant-antiretroviral-prophylaxis through http://aidsinfo.nih.gov. Accessed May 2012.
Centers for Disease Control and Prevention. Pregnancy and Childbirth: HIV/AIDS. Available online at http://www.cdc.gov/hiv/topics/perinatal/index.htm through http://www.cdc.gov. Accessed May 2012.
Screening for HIV in Pregnant Women in New Jersey. PDF available for download at http://www.nj.gov/health/fhs/professional/documents/brief_hiv_screening.pdf through http://www.nj.gov. Accessed May 2012.
New York State Department of Health. HIV testing during pregnancy and at delivery. Available online at http://www.guideline.gov/content.aspx?id=34974&search=newborn+screening through http://www.guideline.gov. Accessed May 2012.
U.S. Preventive Services Task Force. Screening for HIV. July 2005. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm through http://www.uspreventiveservicestaskforce.org. Accessed May 2012.
Admission Orders for Labor & Delivery and Newborn Units to Prevent Hepatitis B Virus (HBV) Transmission. PDF available for download at http://www.immunize.org/catg.d/p2130.pdf through http://www.immunize.org. Accessed May 2012.