the Necessity of Hepatitis B Immunoglobulin for Newborns

Hepatitis B immunoglobulin (HBIG)

Hello, I am currently 33 weeks pregnant.
My hepatitis B test results show HBsAg positive with a titer less than 25600 and HBeAg negative.
The obstetrician mentioned that there is generally no need for immunoglobulin administration, but asked if I would like to pay out of pocket for my baby to receive immunoglobulin.
I would like to ask you: 1.
How necessary is it? 2.
What is the approximate cost? 3.
Does this increase any other risks for the baby? Thank you.

amy, 20~29 year old female. Ask Date: 2004/03/20

Dr. Wu Zongcheng reply Obstetrics and Gynecology

Tainan Hospital, Department of Obstetrics and Gynecology, Dr.
Wu Zongcheng's response: (1) For pregnant women, if HBsAg is positive and HBsAg is negative, there is generally no need to administer immunoglobulin.
(2) Immunoglobulin is a serum product derived from animals; it is essentially a type of heterologous protein that can temporarily boost the baby's immunity, but it will become ineffective within 1 to 2 weeks.
There is also a possibility of allergic reactions due to the heterologous protein.
(3) There is no need for administration.
Wishing you good health and all the best from Tainan Hospital.

Reply Date: 2004/03/20

More Info

When it comes to the prevention of Hepatitis B transmission from mother to newborn, the use of Hepatitis B immunoglobulin (HBIG) is a critical component of the strategy, especially in cases where the mother is a carrier of the virus. In your situation, where you are 33 weeks pregnant and have tested positive for HBsAg, it is essential to understand the implications of this result for your baby.

1. Necessity of HBIG: The necessity of administering HBIG to your newborn largely depends on your Hepatitis B viral load and the presence of HBeAg. Since you mentioned that your HBsAg is positive but your HBeAg is negative and the viral load is below 25,600, the risk of transmitting the virus to your baby is lower compared to a mother with a high viral load and positive HBeAg. However, the Centers for Disease Control and Prevention (CDC) recommends that all infants born to HBsAg-positive mothers receive HBIG within 12 hours of birth, regardless of the mother's viral load. This is because HBIG provides immediate passive immunity and significantly reduces the risk of the baby contracting Hepatitis B, even if the risk is lower in your case.

2. Cost of HBIG: The cost of HBIG can vary depending on the healthcare facility and your location. In the United States, the price for HBIG can range from $100 to $300 per dose. It's important to check with your healthcare provider or insurance company to understand the specific costs involved and whether they are covered under your insurance plan.

3. Increased Risks for the Baby: If HBIG is not administered, there is a risk that the baby could contract Hepatitis B, especially if there are any breaches in the standard precautions during delivery. While the risk of transmission is lower with a negative HBeAg and lower viral load, it is not zero. Additionally, if the baby does contract Hepatitis B, there is a significant risk that they could develop chronic Hepatitis B, which can lead to long-term health issues such as liver cirrhosis and liver cancer later in life. Therefore, the administration of HBIG, along with the Hepatitis B vaccine series, is crucial in protecting your newborn.

In summary, while your situation indicates a lower risk of transmission, the CDC guidelines strongly advocate for the administration of HBIG to all infants born to HBsAg-positive mothers. This is a preventive measure that can safeguard your baby's health. It is advisable to discuss this further with your obstetrician or pediatrician to ensure that your baby receives the best possible care immediately after birth. Additionally, following the vaccination schedule for Hepatitis B will further enhance your baby's protection against the virus.

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