Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
CHAPTER 13: Treatment of Infections
in the Newborn
Infections are the major cause of death during the neonatal period accounting for 35 percent of
deaths in the first four weeks of life. Newborn infants, especially low birth weight infants, are at a
particularly high risk for infection because of their underdeveloped immune processes and their
increased exposure to germs since, being totally dependent on the mother, family members and
other care providers, they come in frequent physical contact with a number of persons.
Newborn babies are also susceptible to germs that do not readily cause major infections in
normal older infants. Common organisms include E. coli, Klebsiella sps, Staphylococcus sps,
and group B streptococci. Organisms vary by region, over time, and due to long-term use of
antibiotics.
In the newborn, minor/localized infections may spread easily. Rapid progression of disease is
very common and it may become life threatening. This necessitates early identification and
prompt treatment with antibiotics. In the later stages babies not only stop sucking but are also
unable to accept and retain feeds, thereby necessitating intravenous fluids and antibiotics that
are feasible only at higher level health centers. Hence, early identification and prompt treatment
are essential.
Socio-cultural factors also influence the impact of infections. Mothers and babies are confined to
their homes, and even those who have facility births go home early and then continue to remain
there. Danger signs, even if identified, are often attributed to nonmedical reasons, and
appropriate care is not sought early so that when babies reach facilities, the disease has
advanced considerably. Many families, moreover, do not have adequate faith in the care
provided at facilities. Women are frequently not empowered, and major decisions in the family
are made by the men. While paternal grandmothers may have some influence, mothers often
have very little influence when medical decisions are being made. Some families are also
handicapped by little or no access to services, either because of distance or due to lack of
finances.
Pre-service education of doctors, nurses, and midwives related to newborn care is often
inadequate and inappropriate, so that basic health workers do not have the competence to
manage newborn infants, especially sick babies. They also do not have the support of the
necessary equipment, supplies, and drugs of appropriate sizes and strengths. Their interaction
with families also presents challenges in some cases due to lack of courtesy. They often do not
have the time nor the skills to establish rapport and to counsel mothers and families effectively.
THE TIMING OF INFECTIONS
Some infections are early onset and some are late onset. Early onset infections (from delivery
through day 3) are usually acquired from maternal risk factors and during delivery. These
factors include:
Integrated maternal and newborn care
Basic skills course
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