By ULY CLINIC staff

 

SEVERE ILLNESS IN NEWBORN AND YOUNG INFANTS:

Newborns and young infants with severe illness present with signs and symptoms which are not disease specific

Diagnostic Criteria

Sick new born or young infant with one or more of the following:

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• Unable to breastfeed, convulsions, drowsy or unconsciousness, central cyanosis and movements only when stimulated or no movement at all

• Respiratory rate less than 20b/min or apnoea (cessation of breathing for >15 seconds)

• Tachypnoea ( Respiratory rate ≥ 60b/min), grunting, and/or severe chest in drawing

• Fever (temp ≥ 37.5°C or hypothermia (temp ≤ 35.0°C)

• Localizing signs of infection like; skin pustules and umbilical redness or umbilicus draining pus.

 

Investigations

 

• FBC

• CRP

• Serum electrolytes, calcium and magnesium

• CSF for biochemistry, microbiology

• Swabs for gram stain and culture

• Chest x ray

• Renal and Liver function tests

• Blood for culture and sensitivity

• Urinalysis and urine culture
   

Treatment

Non pharmacological treatment of newborn and young infants with
severe illness:

 

• Ensure the airway is patent by suctioning and removing any blockage

• If apnoeic ventilate with bag and mask with oxygen (or room air if oxygen not available)

• If High fever, Control the environment and undress the child

• Give oxygen 1.5-2L/min
   

Note:

Do not use antipyretic agents such as Paracetamol for controlling fever in neonates up to the age of 21 days.

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Pharmacological treatment of newborn and young in fants with severe illness:

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1. If RBG, <2.2 mmol/l (<40 mg/dL)

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Give

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2mls/kg of 10% dextrose IV. Then give IV infusion according to maintenance fluid while oral feeds are built up

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2. If Hypocalcaemic Total calcium <2.2 mmol/L OR ionized calcium <1.2 mmol/L

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Give

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Calcium gluconate 10% 2mls/kg IV slowly

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3. If convulsing

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Give

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Phenobarbitone (IV/IM) 20 mg/kg, if convulsions persist after 30 minutes: Give further doses of Phenobarbitone 10mg/kg to the maximum of 40mg/kg. Maintenance Phenobarbitone 5mg/kg PO once daily

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4. For infections

 

• Give Ampicillin IV 50mg/kg 12 hourly (1st week of life), 8 hourly (2-4weeks of life) AND

• Gentamicin IV 3 mg/kg/dose (low birth weight babies), 5 mg/kg/ dose (normal birth weight babies), 7.5 mg/kg/dose (weeks 2-4 of life) once daily for 10 days.

• Give Cloxacillin IV 50mg/kg 12 hourly (first week of life), 8 hourly (2 to 4 weeks of life) with skin pustules or abscesses as these might be signs of Staphylococcus infection

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If not improving in 72 hours give Ceftriaxone IV 50mg/kg once daily for 10 days

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In case of meningitis If not responding to number 4

 

• Give Ceftriaxone IV 100mg/kg once daily for 2 weeks OR

• Cefotaxime IV 50 mg/kg 8 hourly (full term babies first week of life), 6 hourly (full term babies 2 to 4 weeks of life) and 12 hourly (premature babies) for 2 weeks

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Give Vitamin K1 IMg single dose to all neonates after the first hour of birth (1mg for birth weight ≥1.5 kg and 0.5 mg for birth weight <1.5kg )