Explaining the hepatitis B exposed-neonate pathway — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the postnatal ward. A mother who is known to be hepatitis B surface-antigen positive (found on her routine antenatal screening) has just delivered a healthy term baby boy by normal vaginal delivery. The baby is well, feeding, and afebrile. The midwife has asked you to come and talk to the parents because the baby is due to receive the hepatitis B vaccine and the hepatitis B immunoglobulin injection, and the parents — who were told during the pregnancy that the mother carries hepatitis B — are anxious and have questions. They do not understand why the baby needs "two injections for an infection he doesn't have", whether the baby is already infected, whether they can breastfeed, and whether this will affect a future pregnancy. ^[4]

Your tasks are: ^[6]

1. Explain in plain language what hepatitis B is, how it is passed from mother to baby at birth, and why the birth-dose vaccine and immunoglobulin within the first day are so important to the baby. ^{[4] [6]}
2. Explain what chronic hepatitis B means — that it is usually silent in childhood but can cause liver problems decades later — and why preventing it now changes the baby's whole future. ^[6]
3. Address the parents' questions about breastfeeding, whether the baby is already infected, and what the follow-up blood test at nine to twelve months will tell them. ^[4]
4. Explain how a future pregnancy would be protected — maternal antiviral tablets (tenofovir) in the third trimester for a mother with a high viral load, alongside the same birth-dose bundle. ^[4]

You are not expected to give exact doses to the parents; explain the plan in plain language and confirm that any decision is made by the neonatal team with the parents' consent. ^[6]