8Newborn and young infant up to 2 months

Publication Details

Newborn assessment and resuscitation

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Immediate care of the newborn

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Early care of the newborn

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Assessment of the infant up to 2 months of age

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Assess the young infant with illness

In the young infant up to 2 months, assess for severe disease or local bacterial infection following the flow chart.

If the mother says that the young infant has diarrhoea, assess for and classify the diarrhoea.

  • The normally frequent or loose stools of a breastfed baby are not diarrhoea.
  • The mother of a breastfed baby should be able to recognize diarrhoea by the fact that the consistency or frequency of the stools will be different from normal.
  • The assessment is similar to the assessment of diarrhoea for an older infant or young child (Module 2, Chapter 3), but fewer signs are checked. Thirst is not assessed. This is because it is not possible to distinguish thirst from hunger in a young infant.
  • Diarrhoea in a young infant is classified in the same way as in an older infant or young child (see Module 2, Chapter 3).

Management of the young infant with possible severe bacterial infection

The young infant with possible severe bacterial infection needs urgent care and may have pneumonia, sepsis or meningitis. If possible, refer the infant to a hospital for urgent care after giving the first dose of an appropriate antibiotic.

  • Treat the young infant with antibiotics1
    • Give intramuscular (IM) benzylpenicillin AND intramuscular (IM) gentamicin and treat with antibiotics for at least a total of 10 days (up to 3 weeks).
    • If not improving in 2-3 days the antibiotic treatment may need to be changed, or the baby referred.
    • If meningitis is suspected (bulging fontanelle), give IM gentamicin AND IM ampicillin if available, OR treat with IM/IV ceftriaxone. Treat meningitis for 21 days.
  • Continue the IM/IV treatment until the infant has been well for at least 3 days.
  • Then substitute the IM/IV treatment with an appropriate oral antibiotic such as amoxicillin.
  • Continue to give IM gentamicin until a minimum treatment of 5 days has been given.
  • If there is no response to the treatment after 48 hours, or if the infant's condition deteriorates, then give IV/IM chloramphenicol (but not in premature/low weight neonates).
  • Treat convulsions/fits with phenobarbital (loading dose of 15 mg/kg). If convulsions persists, give further doses of 10 mg/kg phenobarbital up to a maximum of 40 mg/kg. Watch out for apnoea (infant stops breathing). If needed, continue with phenobarbital at a maintenance dose of 5 mg/kg/day.
  • Keep the young infant warm.
  • Manage fluids carefully.
  • Prevent low blood sugar
    • The mother should breastfeed the infant frequently
    • If the infant has difficulty breathing or is too sick to suckle, help the mother express breast milk. Feed the expressed breast milk to the infant by dropper (if able to swallow) or by NG tube 6 times per day. Give 20 ml of breast milk per kilogram of body weight at each feed. Give a total of 120 ml/kg/day.
    • If the mother is not able to express breast milk, prepare a breast milk substitute or give diluted cow's milk with added sugar.

Management of the young infant with local bacterial infection

Young infants with local bacterial infection often have an infected umbilicus or a skin infection.

  • Treatment includes giving an appropriate oral antibiotic, such as oral amoxicillin, for 5 days.
  • Teach the mother to administer the antibiotics.
  • If possible, the child should return for follow-up in 2 days to be sure the infection is improving.

Footnotes

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Antibiotic doses in young infants:

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Benzylpenicillin: 50 000units/kg/dose 12 hourly (1st week of life) or 6 hourly (weeks 2-4 and older). (Vial of 600 mg [1 000 000 units] dilute with 1.6 ml sterile water to give 500 000 units/ml).

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Gentamicin: 5mg/kg/dose once daily (1st week of life) or 7.5 mg/kg/dose once daily (aged weeks 2-4 and older), (vial of 80mg/2ml, dilute to 8ml with sterile water to give 10mg/ml).

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Ampicillin: 50 mg/kg/dose IM/IV every 12 hours (1st week of life), every 8 hours (weeks 2-4 of life), (vial of 250 mg mix with 1.3 ml sterile water to give 250 mg/1.5 ml).

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Ceftriaxone: 50 mg/kg/dose IV every 12 hours or 100mg/kg IV/IM once daily (vial of 1g mix with 9.6 ml sterile water to give 1g/10 ml).

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Chloramphenicol: 25 mg/kg/dose IV every 12 hours or 25 mg/kg/dose IM every 6 hours (vial of 1g mixed with 9.2 ml sterile saline to give 1g/10 ml).