Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
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• maternal infections, including urinary tract infection during the last months of pregnancy<br />
• premature rupture of the membranes (>18 hours)<br />
• unhygienic delivery practices, including poor cord care<br />
These risk factors are significant <strong>and</strong> have important practical implications:<br />
• Babies with these maternal risk factors may appear normal at birth.<br />
• The signs may appear after the baby has returned home.<br />
• Identification of the maternal risk factors can lead to prophylactic antibiotic treatment that<br />
may be life saving.<br />
• These babies need careful follow-up <strong>and</strong> should benefit from a longer stay at the health<br />
center.<br />
• Even in the absence of laboratory tests in peripheral health centers, just taking a good<br />
maternal history may help identify these risk factors <strong>and</strong> enable suitable actions.<br />
Late-onset infections (day 4-28) are usually acquired from the environment in the home or<br />
facility. They are caused by several factors including:<br />
• Unhygienic use of formulas, other milk, <strong>and</strong> fluids instead of exclusive breastfeeding.<br />
• Poor newborn care practices, such as lack of proper h<strong>and</strong> washing, contact with unclean<br />
clothes <strong>and</strong> other items, infected persons, use of improperly cleaned/sterilized<br />
supplies/equipment (the last mentioned is particularly common at the facility level).<br />
• Excessive, invasive hospital procedures with poor infection control practices.<br />
TYPES OF NEONATAL INFECTION<br />
Major Infections<br />
Specific entities such as pneumonia, diarrhea, septicemia, <strong>and</strong> meningitis are difficult to<br />
diagnose in the newborn, as the signs may be nonspecific <strong>and</strong> the disease spreads rapidly to<br />
involve several organs. Hence, the catch-all term “neonatal sepsis” is used in the public health<br />
area.<br />
Relevant to diarrheas in the newborn period, babies receiving breast milk pass loose stools<br />
with separate watery <strong>and</strong> “curdy” portions several times a day, being particularly frequent in<br />
days 3-5. These are termed “transitional stools” <strong>and</strong> may be wrongly diagnosed as diarrhea,<br />
<strong>and</strong> oral rehydration solution/therapy may be given. The latter is not only needless, but it may<br />
also carry a risk of causing real infection if given in an unhygienic manner.<br />
The risk of diarrheas <strong>and</strong> other major infections is particularly high if initiation of breastfeeding is<br />
delayed <strong>and</strong> the newborn <strong>and</strong> the infant under six months receive other milks <strong>and</strong> fluids. Thus,<br />
even when the mother is HIV-positive <strong>and</strong> opts to give formula feeds, the health workers should<br />
counsel <strong>and</strong> support the family adequately to ensure that the feeds are given in a clean manner.<br />
Otherwise there is a real risk of the baby developing diarrhea with spread of infection that can<br />
result in complications <strong>and</strong> even death. Where appropriate care is not taken, especially in<br />
illiterate, low socio-economic groups, there will actually be a greater chance of babies dying of<br />
such infections than from HIV/AIDS.<br />
150<br />
<strong>Integrated</strong> maternal <strong>and</strong> newborn care<br />
<strong>Basic</strong> skills course